Pharmaceutical Management of Cough Flashcards
What is a cough?
Protective reflex action caused when airway is irritated or obstructed
What is an acute cough?
<3 weeks
What is a subacute cough?
3-8 weeks
What is a chronic cough?
> 8 weeks
Where is an acute cough from?
Viral upper respiratory tract
How does a chronic cough present?
Dry/minimally productive cough
What are common causes of chronic cough?
GORD
Asthma syndromes
Rhinitis
Drugs
Environment - eg. dust
What do you consider when assessing a cough?
Age, sex
Cough characteristics
Exacerbating features
Where?
Acute/chronic?
Worse morning, midday or night?
What are the specific cough syndromes?
Cough variant asthma
GORD
Upper airway disease
Treatment of cough due to other respiratory diseases
Describe cough variant asthma
Isolated cough in patient without objective evidence of asthma
What are the clinical indicators of cough variant asthma?
Nocturnal
Started when young
After exercise
Allergen exposure
How do you treat cough variant asthma?
Eliminate allergen
Bet-2-agontists
Antihistamines
Steroids
TAKE MEDICATION IN EVENING
Describe GORD
Patients with GORD have increased cough reflex sensitivity which improves anti-reflux therapy
How do you treat GORD?
PPI or H2 antagonist
Eliminate causative medications
Lifestyle advice
What is the problem with long term use of PPIs?
Increase pH of stomach = more likely to get an infection
Osteoporosis
Describe upper airways disease + cough?
Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx
Describe upper airways disease + cough?
Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx
Describe upper airways disease + cough?
Accompanied by nasal stuffiness, sinusitis
= secretions drain into posterior pharynx
What is the treatment for upper airways disease + cough?
Antihistamines - limited efficacy
Trial of corticosteroid = ONLY IF PROMINENT
When do you refer someone?
> 3 weeks
Sign of infection
Shortness of breath
Whooping cough in children
Recurrent nocturnal cough in kids
Adverse drug reaction
Failed medication
What are CO2 retainers?
People with COPD have lower O2 saturation = giving them too much O2 dangerous
What are things you can get OTC?
Expectorants
Suppressants
Demulcents
What are examples of suppressants?
Codeine, pholcodine + dextromethorphan
What are examples of expectorants?
Guaifenesin
Ipecacuanha
What are suppressants?
Where no underlying cause
May be useful if sleep disturbed
What are expectorants?
Apparent promotion of expulsion of bronchial secretions
What are demulcents?
Soothing actions
Harmless + inexpensive
Describe use of antihistamines
Allergy type cough
Avoid patients who are taking phenothiazines + tricyclic antidepressants
Avoid alcohol
Can make drowsy
Describe use of sympathomimetics
Bronchodilator + decongestant
Care in high BP, diabetics, coronary artery disease
Interactions with beta blockers, tricyclic antidepressants
Describe use of theophylline
Bronchodilation
GI irritation, palpitations, insomnia + headaches
Side effects = toxicity
Describe use of mucolytics
Break mucus apart
Inhaled, oral
Relief after 60 seconds after inspiration
What is CRP?
Measure of inflammation
Increased = bacterial infection
Should be less than 5
What are some non-pharmacological actions?
Fluids
Paracetamol/ibuprofen = associated fever + pain
Lemon + honey
Steam
Simple linctus cough mixture
Who are the medications for?
ONLY children over 6
