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PHRM 504 > Lecture 11: Cough/Cold and Cold Sores > Flashcards

Lecture 11: Cough/Cold and Cold Sores Flashcards

1
Q

FDA Statement 2008

A

no cough and cold medications in children under 4
- Labels may be more conservative than drug monographs
- Self-care guidelines list ages as exclusions for treatment
Rule of thumb: If there are dosing guidelines available, the product may be used

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2
Q

Cough Pathophysiology

A

Caused by mechanical and chemical stimulation

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3
Q

Acute cough

A

less than 3 weeks

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4
Q

Subacute cough

A

3 to 8 weeks

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5
Q

Chronic Cough

A

more than 8 weeks

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6
Q

Drug Induced cough

A

ace-inhibitors, beta-blockers (systemic and ophthalmic)

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7
Q

Opthalmic

A

resembling or relating to the eye

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8
Q

Cough Clinical Presentation

Productive vs. Nonproductive

A

Productive: Wet or chesty cough which expels secretions from lower respiratory tract

Nonproductive - dry or hacking cough. No useful physiologic purpose

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9
Q

Cough Complications

A 
Exhaustion
Insomnia
Musculoskeletal pain
Hoarseness
Excessive perspiration
Urinary incontinence (loss of bladder control)
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10
Q

Cough- Exclusions to self care

A
  • Lasting longer than 7 days
  • high fever (>103 F) or low fever that does not resolve with self-care
  • cough with more symptoms involving SOB, chest pain, chills, swollen ankles, cyanosis,
  • Cough producing thick green or yellow mucus
  • Cough that worsens as cold or flu resolves
  • Drug induced cough
  • History of symptoms of chronic disease such as COPD, asthma, CHF
  • Cough associated with inhalation of dust, particles or objects, if irritant or object stays in lungs
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11
Q

Cough Treatment Goals

A
  1. Primary: reduce number and severity of cough episodes

2. Prevent complication

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12
Q

Nonpharmacologic Therapy - cough

A

non-medicated lozenges, humidifiers

vaporizers

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13
Q

Pharmacologic therapy - cough

A

Antitussive
Expectorant

First generation antihistamines + decongestant

Antihistamine for cough-MOA: Increase cough threshold and prevent postnasal drip

Antihistamine for cough Indication: Suppression of nonproductive cough

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14
Q

Oral Antitussive MOA

A

act centrally at medulla to increase cough threshold

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15
Q

Oral Antitussive Indication

A

suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation

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16
Q

Oral Antitussive PK

A

onset: 15-30 minutes
Duration: 3-6 hours

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17
Q

Oral Antitussive Adverse effects

A 
all of these are rare however may experience:
drowsiness
nausea/vomiting
stomach discomfort
constipation
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18
Q

Oral Antitussive Drug Interactions

A

MAOIs (serotonin syndrome)

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19
Q

Oral Antitussive Overdose effects

A 
Confusion
Excitation
Nervousness
Irritability
Restlessness
Drowsiness
Severe nausea/vomiting
Respiratory depression
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20
Q

Oral Antitussive Adult dosing

A

10-20mg every 4 hours or 30mg every 6-8 hours

MDD: 120mg

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21
Q

Oral Antitussive 6-11 yrs old dosing old dosing

A

For 6 -11 years old: 5-10mg every 4 hours or 15mg every 6-8 hours
MDD: 60mg

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22
Q

Oral Antitussive 4-5 yrs old dosing

A

For 4-5 years old: 2.5-5mg every 4 hours or 7.5mg every 6-8 hours MDD: 30mg

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23
Q

Topical Antitussives

A

MOA is unknown, may create local anesthetic sensation

Menthol and Camphor are FDA approved options

Ointment - apply to chest and throat
Lozenges - cough drops, repeat hourly as needed
Inhalation - add to vaporizer to be inhaled up to 3 times/day

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24
Q

Expectorant MOA

A

Unknown: Loosens and thins secretions in the lower respiratory tract
- Makes it easier to cough things up but also think it makes it easier to get things out the nose

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25
Q

Expectorant Indication

A

Relief of acute, ineffective, productive coughs

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26
Q

Expectorant Adverse effects

A

All rare bc its generally well tolerated

Nausea/vomiting
Dizziness
Headache
Rash
Diarrhea
Drowsiness
Stomach pain
27
Q

Expectorant Adult dosing

A

Guaifenesin
200-400mg every 4 hours
MDD: 2.4g or 2400mg

28
Q

Expectorant 6-11 yrs old dosing

A

Guaifenesin

For 6-11 yrs old: 100-200mg every 4 hours MDD: 1.2 g or 1200mg

29
Q

Expectorant 4-5 years old dosing

A

For 4-5 years: 50-100mg every 4 hours

MDD: 600mg

30
Q

Cold infections are classified as

A

viral and cannot be treated with antibiotics

31
Q

Cold Pathophysiology

A
  • Viral Infection of upper respiratory tract
  • self-limiting with no cure,
  • transmission through aerosol and direct contact with virus
    •Most efficiently spread through direct inoculation of nasal mucosa or conjunctiva (mucous membrane that covers the front of the eye)
32
Q

Cold Clinical Presentation

A

Sore throat, nasal symptoms, cough

  • low grade fever
  • generally lasts 7-14 days
  • Mucus: thin, clear, watery for 1-2 days, becomes thicker and may change to yellow or green and then back to thin/clear/watery at the end of illness
33
Q

Cold Complications: What cold can lead to?

A

Sinusitis
middle ear infection
bronchitis
pnuemonia

34
Q

Cold vs. Allergy

A

Cold: Sore throat, nasal congestion, Sneezing, Rhinorrhea

Allergy: Watery eyes, Itchy nose, eyes and throat, Nasal congestion. Red, irritated eyes

35
Q

COVID course of illness

A

Exposure
Once it hits peak thats when you have symptoms
Then you recover

Its becomes infectious before the peak and when symptoms occur and is no longer infectious when symptoms subside

36
Q

Quarantine

A

Keeps someone who may have exposed to the virus away from other people if not vaccinated

  • Close contact: within 6 feet of someone who has COVID-19 for a total of 15 minutes or more
37
Q

Isolation

A

Keeps someone is infected with the virus away from others (even in their home)

  • At least 10 days since symptoms first appeared
  • At least 24 hours with no fever without fever-reducing medication
  • tested positive, no symptoms:
  • 10 days have passed since the date you had your positive test
38
Q

Exclusions to self care - cold

A
  • Fever above 101.5
  • chest pain
  • shortness of breath
  • worsening symptoms
  • underlying chronic lung issue ( COPD, CHF, Asthma)
  • AIDS
  • frail old patients
  • younger than 9 months
  • hypersensitivity to recommended OTC products
39
Q

Nonpharmacologic Therapy for Cough/Cold

A
  • Maintain fluid intake
  • rest
  • increased humidification
  • saline nasal sprays
  • warm soothing foods
  • nasal strips
  • aromatherapy
  • sleeping upright
  • nasal syringe for kids
40
Q

Pharmacologic Therapy - cold

Sore throat:
Nasal congestion:
Cough:

A
  • treat symptoms
    Sore throat - local anesthetic, systemic analgesic

Nasal Congestion - decongestant, first gen antihistamine

Cough - antitussive, expectorant

41
Q

Pharmacologic options- Sore throat

A

Local anesthetics

  • Benzocaine, dyclonine hydrochloride
  • Use every 2-4 hours
  • Lozenges, throat sprays, oral disintegrating stringents

Systemic analgesic
- Acetaminophen, Ibuprofen

42
Q

Allergy- combo products?

A

Second generation antihistamine + decongestant common

- good option if congestion is an allergy symptom

43
Q

Cough- combo product?

A

Combination antitussive + expectorant common

  • may be counterproductive but could use intermittently for a productive cough
44
Q

Cold- Combo product

A

Single entity preferred over multi-product because various peak at different times

45
Q

Aphthous Stomatitis (canker sores) Pathophysiology

A
  • commonly unknown: local trauma may impact
  • smoking, biting inside of cheek
  • poor nutrition
  • immune-modulating diseases states
  • only affect labial or buccal mucosa
  • heal in 10-14 days
46
Q

Aphthous Stomatitis (canker sores) Clinical Presentation

A

Epithelial ulceration

  • vary in number size and days present
  • May be difficult to distinguish from cold sores
  • can be painful
  • cannot be cured
47
Q

Nonpharmacologic therapy - Aphthous Stomatitis (canker sores)

A
  • Nutrition
  • avoid stress
  • ice
  • saline oral rinse -> 1-3 tsp salt to 4-8 ounces of warm water
48
Q

Pharmacologic therapy - Aphthous Stomatitis (canker sores

A
  • Topical oral protectants
  • topical oral anesthetics
  • oral wound cleansing agents such as Carbamide peroxide: 10-15% or Hydrogen Peroxide 1.5%
  • systemic analgesics
49
Q

Canker sores Exclusions to self-care

A

Lesions associated with underlying pathology

  • Lesions present for 14 days or more
  • Frequently occurring lesions
  • Symptoms of systemic illness
  • Failure of appropriate self-care treatment
50
Q

Canker sores Follow up

A

Seek medical care if:
Symptoms do not improve 7 days of treatment
Lesions do not heal in 14 days
Symptoms worsen

51
Q

Herpes Simplex Labialis (HSL)

A

Cold sores

  • up to 67% or people infected
  • Traditionally: Herpes Simplex Virus (HSV-1)
52
Q

HSL Pathophysiology

A 
Transmitted via direct contact (fluid)
- Viable on surfaces for several hours
Often through kissing or sharing drinks
- Enters host through break in skin or membrane
-Latent phase in trigeminal ganglia
- Reactivated upon exposure to a trigger
     • Fever, injury, stress, immunosupression, menstruation
- Infected for life
53
Q

HSL Clinical Presentation

A
  • Commonly occurs on lips or areas bordering lips
  • small red papules of fluid (1-3mm in diameter)
    Symptoms may be painful cosmetically objectionable, malaise, fever, pus
54
Q

Prodrome

A

Medical term for early signs or symptoms of an illness or health problem that appear before the major signs or symptoms start

55
Q

HSL Prodrome

A

Burning, itching, tingling in area prior to lesion appearance

56
Q

HSL Exclusions to Self-Care

A

Lesions present 14 days or more

  • Increased frequency of outbreaks
  • Compromised immunity
  • Symptoms of infection (fever, swollen glands)
  • No previous diagnosis of cold sore
57
Q

HSL Goals of treatment

A
  • Relieve pain and irritation
  • Prevent secondary infection
  • Prevent spread of lesions
58
Q

HSL Treatment approach

A

Differentiate recurrent aphthous stomatitis

  • OTC skin protectant + Topical docasanol 10% + topical/systemic anesthetic(Lidocaine)
  • Protect lesion from infection
59
Q

HSL Non-pharmacologic Recommendations

A

Clean area with gentle soap and water

  • Keep lesion moist to prevent cracking
  • Avoid triggers: Local trauma, sun exposure
60
Q

HSL Treatment- Info about treatment

A

Docosanol 10% (Abreva), systemic antivirals

  • Prevents viral replication
  • Only FDA approved product
  • Reduces duration and severity of the symptoms

•20% reduction in median times to cessation of symptoms compared to placebo

61
Q

Patient education-HSL

A

Lesions are contagious
Condition is self-limiting
There are Treatment options

62
Q

Docosanol 10%

A

Abreva
- Apply at first sign of an outbreak
• 5 times/day until lesion has healed up to 10 days
•Improved outcomes with earlier application

-Prevents viral applications

63
Q

These relieve pain but do not reduce symptoms duration

A
  • Topical skin protectants
  • External application of topical analgesics
  • Systemic analgesics
64
Q

Systemic Antivirals:

A

Superior to topical therapy

Prescription only

PHRM 504 (22 decks)

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