OTC Cough and Cold Flashcards
Special symptoms of a FLU?
Fever and Myalgia
Cause of Common Cold?
Viral Infection: Rhinovirus most common (~50-60)
Pathogens: respiratory syncytial virus (RSV)
Predictable symptoms of Common Cold?
- Sore throat 1st symptom to appear
- Nasal symptoms dominate days 2- 3
- Cough (~20%) appears by days 4- 5
Rhinovirus cold symptoms can persist for 7- 10 days
Complication of common cold?
Sinusitis, middle ear infections, bronchitis, bacterial pneumonia, and acute exacerbations of asthma/COPD
Immunocompromised patients, smokers, and patients with underlying respiratory conditions are more prone to complications
Goal of therapy
Prevent transmission of cold viruses
Reduce bothersome symptoms
What can prevent colds the best?
*Lysol – kills 99%
When to have Physician Referral for Common Cold?
Fever > 101.5 °F (38.6 °C)
Worsening of symptoms or development of additional symptoms during self-treatment
Nonpharmacologic Therapy for the Common Cold and Cough
Soothing warm food products
(i.e. tea + lemon/honey, hot broths (i.e. chicken soup)
Humidification
Steamy showers, humidifiers, or vaporizers—Babies** Steam
Medical Devices
Camphor
Menthol
Moisture Devices
Vaporizers and Humidifiers:
Increased humidity, may soothe airways and decrease cough
Humidifiers and Vaporizers
Must be cleaned DAILY and disinfected weekly
Vaporizers superheat water to produce steam (warm mist)
Humidifiers use fans or ultrasonic technology to produce a cool mist
Which moisture device is good for children?
Cool mist is preferred in children because:
(decrease) Risk of scalding/burning if tipped over
Vaporizers vs. Humidifiers
Vaporizers***
Main job is to put vapors into the air and contains a medication well or cup for inhalants
Must be cleaned daily and disinfected weekly
Vaporizers vs. Humidifiers
Humidifiers***
This moisture device is better for a larger space
Should be recommended for a child’s room
Must be cleaned daily and disinfected weekly
Both humidifiers and vaporizers put humidity into the air but this particular moisture device puts more moisture into the air
OTC Pharmacotherapy for the Common Cold
Antitussives
Expectorants
Local Anesthetics
Cough (description)
Important defensive respiratory reflex
Most common symptom for which patients seek medical care
Goal of therapy
Reduce the number and severity of cough episodes
Cough Classification: Acute
Duration: < 3 weeks
Etiology :
Viral respiratory infections, asthma
Cough Classification: Sub-Acute
Duration: 3- 8 weeks
Etiology:
Bacterial sinusitis, asthma
Cough Classification: Chronic
Duration: > 8 weeks
Etiology:
Causes in NON-smoker: postnasal drip, GERD, HF, lung disorders (chronic bronchitis, asthma, COPD)
Which medications can cause a cough?
ACE Inhibitor (bradykinin)
B-Blockers (patient Selective)
Types of Cough
Productive:
Wet of “chesty” cough
Nonproductive:
Dry or “hacking” cough
Questions to Ask Your Patients for the Treatment of Cough
What are your symptoms? Severity of symptoms?
Duration of symptoms?
What else have you tried?
Dry or wet cough?
PMH? Medication? Social history (i.e. SMOKER)
Physician Referral for Cough
Thick yellow, tan, or green mucus or pus-like secretions
Fever > 101.5°F
Cough > 7 days, or comes and goes or keeps coming back
Treatment Goals
Cough treatment is SYMPTOMATIC, the underlying disorder must be treated to stop the cause of the cough
Halls
Vapor Action Menthol
Antitussives (Cough Suppressants)
DOC for nonproductive cough**
Control or eliminate cough
2 Different classes; Centrally Acting Antitussives- suppress cough center in the medulla of the brain -Codeine -Dextromethorphan -Diphenhydramine
Peripheral or Local Acting Antitussives
- Camphor
- Menthol
Expectorants (Protussives)
DOC for productive cough
Changes consistency of mucous and increases expectorated sputum volume
- Guaifenesin
- The BEST Expectorant is WATER
- -
What about Antitussive + Expectorant?
Never recommend Robutissum DM, or Guaifenesin DM
*UNLESS they cannot Sleep
Antitussives:
Delsym
Dextromethorphan 30 mg/ 5 mL
Most Potent**
Antitussives:
PediaCare ® Children’s
Dextromethorphan 7.5 mg/ 5 mL
Centrally Acting Antitussives
Codeine
Codeine
Gold standard antitussive*** – Cough suppessant BTC
Products: Guaituss AC ®, Cheratussin AC ®, Robitussin AC
AC means -> with CODIENED –Schedule C or III
Chlorpheniramine stops post nasal drip***
Patients do not use in wet cough***
Centrally Acting Antitussives:
Caution: Codeine
Caution in patients:
Impaired respiratory reserve (i.e. asthma, COPD), preexisting respiratory depression, drug abusers, and patients who take other respiratory depressants or sedatives
Centrally Acting Antitussives:
Dextromethorphan (DM)
Adverse Effects:
Overdose:
Usual dose: drowsiness, dizziness, nausea, vomiting, stomach discomfort, or constipation
Overdose:
respiratory depression and restlessness.
Centrally Acting Antitussives:
Dextromethorphan (DM)
DDI?
Warning?
Abuse?
Additive with CNS depressants (ETOH, antihistamines, psychotropic medications)
MAOIs (DM blocks serotonin reuptake) can cause serotonin syndrome (hypertension, hyperpyrexia, arrhythmias, seizures.
Warning:
Do NOT use if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric or emotional conditions, or Parkinson’s disease)
DM should not be administered for at least 14 days until MAOI has been stopped.
Abuse??? (DXM)
Phencyclidine-like euphoric effect
Centrally Acting Antitussives:
Diphenhydramine
Second line
Antitussive effect is most likely related to its anticholinergic effect.
May act indirectly by reducing postnasal drip
Remember should not be used/ caution in disease states with anticholinergic activity
i.e. Glaucoma,BPH and Acute Ashtma
Diphenhydramine–containing antitussives should not be used with any other diphenhydramine–containing products
Peripherally Acting Antitussives:
NAME THEM?
LETHAL DOSE?
Camphor and Menthol
nose and mouth creating a local anesthetic sensation and improved airflow
Used systemically as lozenges, topically as an ointment rub, liquid added to vaporizer
- 4 Tsp is a LETHAL DOSE
- -Toxic if ingested
- -Lacking efficacy data
Expectorants: Mucinex
Guaifenesin
Expectorants: Robitussin
Guaifenesin
Expectorants: MUCINEX D
DON’T DO THAT!!!
DO NOT USE
What is best Expectorants?
(WET COUGH) WATER IS THE BEST EXPECTORANT
when is Guaifenesin used?
Counseling point?
Indicated for ACUTE ineffective productive cough
Counseling point: Take with a full glass of water
what to take for Sore Throat Pain?
Benzocaine and dyclonine
Limit 2 days (For common cold)
If longer something else is going on.
Local systemic anesthetics
Patients with a history of allergic reaction to anesthetics should avoid products with benzocaine
Clinical efficacy not well documented
Whats the generic name Sucrets?
Dyclonine 3 mg + Menthol 6 mg
Combination Products: Rationale to use combos
Combination products may be convenient but avoid recommending if other active ingredients are unnecessary
Should recommend specific individualized therapy because symptoms appear, peak, and resolve at different times
Combination Products:
Advil Cold and Sinus
Ibuprofen
Pseudoephedrine
Combination Products:
Nyquil Cold and Flu
APAP
Dextromethrophan
Doxylamine
Combination Products:
Coricidin HBP
what’s the special function?
Chlorpheniramine
Dextromethrophan
HBP products
High Blood Pressure- there is no cough suppressant, they can used ocean nasal spray For decongestant
Combination Products:
Benadryl Allergy and Sinus Headache
APAP
Diphenhydramine
Phenylepherine
Pregnancy
Avoid to minimize possible adverse effects “Extra strength” “Maximum strength” “Long-acting” --combination products
Decongestants Normal saline (i.e. Ocean ® NS)
Oxymetazoline preferred topical decongestant
Antihistamines
Intranasal cromolyn DOC***
—>Chlorpheniramine (short-acting) first-generation antihistamine of choice
—>-If chlorpheniramine is not tolerated then loratidine and cetirizine are preferred alternatives
Alternative OTC Therapy
High dose Vitamin C (ascorbic acid) > 2 grams/ day
Airborne ® effervescent tablets, Emergen- C ®
Adverse Effects: Doses ≥ 4 grams/ day not recommended due to diarrhea and other GI symptoms*****
Zinc:
-Adverse Effects: Metallic taste and gastric upset
-Zinc Lozenge- Cold-Eeze
® Zinc Gluconate –around the clock** (only benifit used in this manner)
Echinacea
-Allergy to chrysanthemums
Oscillococcinum
-Contains extracts from duck heart and liver
Be-careful for sodium restricted patients!!!??
Alternative OTC Therapy:
Airbone: has sodium content
Homeopathic: no FDA protection
OTC Asthma Products:
Bronkaid and Primatene
what’s the generic name of Bronkaid?
Ephedrine 25 mg + Guaifenesin 400 mg
what’s the generic name of Primatene ?
Ephedrine 12.5 mg + Guaifenesin 200 mg
Physician Referral for Asthma ?
History of asthma episodes severe enough to require systemic corticosteroids or urgent medical care
Symptoms of moderate or greater severity or more frequent than twice weekly
Symptoms that have lasted more than 24 hours
Symptoms of different quality or severity than previous episodes
Symptoms:
- Moderate or greater severity or more frequent than twice weekly
- Lasted more than 24 hours
- Unresponsive to OTC asthma medications within 24 hours
- Different quality or severity than previous episodes.
Bronchodilators: Sorry Marcus
Short-acting nonselective beta-agonists
Epinephrine (DEAD) Primatene Mist Inhaler discontinued 12/31/2011 Contained chlorofluorocarbon (CFC)
Ephedrine
Oral: 12.5- 25mg
Products: (+ Guaifenesin)
Bronkaid ® Dual Action Formula and Primatene ® Tablets
Adverse Effects: palpitations, tachycardia, arrhythmias, nervousness, seizures
Combat of Methamphetamine Epidemic Act of 2005- purchase restrictions
What is the generic name Asthmanefrin?
2.25% Racepinephrine** HCl (1.125 % of epinephrine base)
Bronchodilator New Inhaler:
Racepinephrine
1-3 inhalations every 3 hours prn (max 12 inhalations/ 24 hours)
–Without a doctor
Counseling Points for OTC : Resiratory products
Remember, not all patients are OTC “self-care” candidates and in some cases should be referred to their PCP, if patient is an OTC “self-care” candidate:
