Lecture 11: Cough/Cold and Cold Sores Flashcards
FDA Statement 2008
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
Cough Pathophysiology
Caused by mechanical and chemical stimulation
Acute cough
less than 3 weeks
Subacute cough
3 to 8 weeks
Chronic Cough
more than 8 weeks
Drug Induced cough
ace-inhibitors, beta-blockers (systemic and ophthalmic)
Opthalmic
resembling or relating to the eye
Cough Clinical Presentation
Productive vs. Nonproductive
Productive: Wet or chesty cough which expels secretions from lower respiratory tract
Nonproductive - dry or hacking cough. No useful physiologic purpose
Cough Complications
Exhaustion Insomnia Musculoskeletal pain Hoarseness Excessive perspiration Urinary incontinence (loss of bladder control)
Cough- Exclusions to self care
- 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
Cough Treatment Goals
- Primary: reduce number and severity of cough episodes
2. Prevent complication
Nonpharmacologic Therapy - cough
non-medicated lozenges, humidifiers
vaporizers
Pharmacologic therapy - cough
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
Oral Antitussive MOA
act centrally at medulla to increase cough threshold
Oral Antitussive Indication
suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
Oral Antitussive PK
onset: 15-30 minutes
Duration: 3-6 hours
Oral Antitussive Adverse effects
all of these are rare however may experience: drowsiness nausea/vomiting stomach discomfort constipation
Oral Antitussive Drug Interactions
MAOIs (serotonin syndrome)
Oral Antitussive Overdose effects
Confusion Excitation Nervousness Irritability Restlessness Drowsiness Severe nausea/vomiting Respiratory depression
Oral Antitussive Adult dosing
10-20mg every 4 hours or 30mg every 6-8 hours
MDD: 120mg
Oral Antitussive 6-11 yrs old dosing old dosing
For 6 -11 years old: 5-10mg every 4 hours or 15mg every 6-8 hours
MDD: 60mg
Oral Antitussive 4-5 yrs old dosing
For 4-5 years old: 2.5-5mg every 4 hours or 7.5mg every 6-8 hours MDD: 30mg
Topical Antitussives
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
Expectorant MOA
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
Expectorant Indication
Relief of acute, ineffective, productive coughs
Expectorant Adverse effects
All rare bc its generally well tolerated
Nausea/vomiting Dizziness Headache Rash Diarrhea Drowsiness Stomach pain
Expectorant Adult dosing
Guaifenesin
200-400mg every 4 hours
MDD: 2.4g or 2400mg
Expectorant 6-11 yrs old dosing
Guaifenesin
For 6-11 yrs old: 100-200mg every 4 hours MDD: 1.2 g or 1200mg
Expectorant 4-5 years old dosing
For 4-5 years: 50-100mg every 4 hours
MDD: 600mg
Cold infections are classified as
viral and cannot be treated with antibiotics
Cold Pathophysiology
- 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)
Cold Clinical Presentation
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
Cold Complications: What cold can lead to?
Sinusitis
middle ear infection
bronchitis
pnuemonia
Cold vs. Allergy
Cold: Sore throat, nasal congestion, Sneezing, Rhinorrhea
Allergy: Watery eyes, Itchy nose, eyes and throat, Nasal congestion. Red, irritated eyes
COVID course of illness
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
Quarantine
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
Isolation
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
Exclusions to self care - cold
- 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
Nonpharmacologic Therapy for Cough/Cold
- Maintain fluid intake
- rest
- increased humidification
- saline nasal sprays
- warm soothing foods
- nasal strips
- aromatherapy
- sleeping upright
- nasal syringe for kids
Pharmacologic Therapy - cold
Sore throat:
Nasal congestion:
Cough:
- treat symptoms
Sore throat - local anesthetic, systemic analgesic
Nasal Congestion - decongestant, first gen antihistamine
Cough - antitussive, expectorant
Pharmacologic options- Sore throat
Local anesthetics
- Benzocaine, dyclonine hydrochloride
- Use every 2-4 hours
- Lozenges, throat sprays, oral disintegrating stringents
Systemic analgesic
- Acetaminophen, Ibuprofen
Allergy- combo products?
Second generation antihistamine + decongestant common
- good option if congestion is an allergy symptom
Cough- combo product?
Combination antitussive + expectorant common
- may be counterproductive but could use intermittently for a productive cough
Cold- Combo product
Single entity preferred over multi-product because various peak at different times
Aphthous Stomatitis (canker sores) Pathophysiology
- 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
Aphthous Stomatitis (canker sores) Clinical Presentation
Epithelial ulceration
- vary in number size and days present
- May be difficult to distinguish from cold sores
- can be painful
- cannot be cured
Nonpharmacologic therapy - Aphthous Stomatitis (canker sores)
- Nutrition
- avoid stress
- ice
- saline oral rinse -> 1-3 tsp salt to 4-8 ounces of warm water
Pharmacologic therapy - Aphthous Stomatitis (canker sores
- Topical oral protectants
- topical oral anesthetics
- oral wound cleansing agents such as Carbamide peroxide: 10-15% or Hydrogen Peroxide 1.5%
- systemic analgesics
Canker sores Exclusions to self-care
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
Canker sores Follow up
Seek medical care if:
Symptoms do not improve 7 days of treatment
Lesions do not heal in 14 days
Symptoms worsen
Herpes Simplex Labialis (HSL)
Cold sores
- up to 67% or people infected
- Traditionally: Herpes Simplex Virus (HSV-1)
HSL Pathophysiology
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 lifeHSL Clinical Presentation
- 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
Prodrome
Medical term for early signs or symptoms of an illness or health problem that appear before the major signs or symptoms start
HSL Prodrome
Burning, itching, tingling in area prior to lesion appearance
HSL Exclusions to Self-Care
Lesions present 14 days or more
- Increased frequency of outbreaks
- Compromised immunity
- Symptoms of infection (fever, swollen glands)
- No previous diagnosis of cold sore
HSL Goals of treatment
- Relieve pain and irritation
- Prevent secondary infection
- Prevent spread of lesions
HSL Treatment approach
Differentiate recurrent aphthous stomatitis
- OTC skin protectant + Topical docasanol 10% + topical/systemic anesthetic(Lidocaine)
- Protect lesion from infection
HSL Non-pharmacologic Recommendations
Clean area with gentle soap and water
- Keep lesion moist to prevent cracking
- Avoid triggers: Local trauma, sun exposure
HSL Treatment- Info about treatment
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
Patient education-HSL
Lesions are contagious
Condition is self-limiting
There are Treatment options
Docosanol 10%
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
These relieve pain but do not reduce symptoms duration
- Topical skin protectants
- External application of topical analgesics
- Systemic analgesics
Systemic Antivirals:
Superior to topical therapy
Prescription only
