Pharyngitis, cough, cold

Question 1

What is pharyngitis usually caused by?

Answer 1

Group A streptococcus (GAS)

Strep pyogenes

Question 2

What might GAS cause

Answer 2

Poststreptococcal glomerulonephritis

Acute rheumatic fever (rare in US)

Question 3

What are the characteristics of GAS pharyngitis throat pain?

Answer 3

Usually severe

Worse on 1 side

Question 4

What is the recommended initial tx of of GAS pharyngitis?

Answer 4

Amoxicillin

Question 5

What is the dosing of amoxicillin for GAS pharyngitis?

Answer 5

20 mg/kg/dose (max 500 mg/dose) BID x 10 days

Question 6

What medication do you avoid as first line for GAS pharyngitis and why? What is an exception?

Answer 6

Azithromycin
Strep rapidly develops resistance to macrolides
Consider if PCN allergic

Question 7

What is a newly recognized cause of pharyngitis?

Answer 7

Fusobacterium necophorum pharyngitis (FNP)

Question 8

What age groups is FNP endemic to?

Answer 8

Adolescents

Young adults

Question 9

What % of pharyngitis does FNP cause in the specified age groups?

Answer 9

10%

Question 10

What could FNP develop and what is the risk with it?

Answer 10

Lemierre syndrome

Life threatening -> mortality rates of 5%

Question 11

Sign that it is FNP

Answer 11

Lack of cough

Question 12

What do you treat FNP with?

Answer 12

Clindamycin

Penicillin + metronidazole

Question 13

What is the rule with cough suppression?

Answer 13

Don’t suppress indiscriminately

Question 14

Do you suppress a productive cough?

Answer 14

No

Question 15

When do you suppress a cough?

Answer 15

If tiring or sleep limiting

Question 16

What do you prescribe for non-productive coughs?

Answer 16

Antitussives = cough suppressants

Question 17

What do you prescribe for a productive cough?

Answer 17

Expectorants

Mucolytics

Question 18

How should your pt ingest the antitussive benzonatate?

Answer 18

Caps and softgels should be swallowed w/o chewing

Question 19

What is a common antitussive?

Answer 19

Dextromethorphan (robutussin)

Question 20

What is dextromethorphan?

Answer 20

D isomer of codeine analog of levorphanol

Question 21

Does dextromethorphan have analgesic and addictive properties?

Answer 21

No

Question 22

What does dextromethorphan do to reduce cough?

Answer 22

Inhibits central (medullary) cough center

Question 23

What is a common expectorant (you use it all the time)?

Answer 23

Guaifenesin (glyceryl guaicolate) aka Mucinex

Question 24

What does guaifenesin do to respiratory tract secretions?

Answer 24

Increases them

Question 25

What is n-acetylcysteine?

Answer 25

A mucolytic

Question 26

What does n-acetylcysteine do?

Answer 26

The sulfhydryl group opens disulfide bonds in mucoproteins thereby reducing viscosity

Question 27

How do you administer acetylcysteine?

Answer 27

Aerosolization or nebulization

Question 28

What is pertussis and what is it caused by?

Answer 28

Chronic cough | Bordatella pertussis

Question 29

What do the Chinese call pertussis?

Answer 29

Cough of 100 days

Question 30

Are atypical presentations of pertussis common? Give some examples

Answer 30

Yes Completely/partially immunized pts Adolescents/adults

Question 31

What population do we see the most pertussis?

Answer 31

Infants < 6 months

Question 32

Whats a frequent sign of pertussis?

Answer 32

Post-tussive emesis

Question 33

Is the incidence of pertussis increasing or decreasing?

Answer 33

Increasing

Question 34

What are some causes of rising incidence of pertussis?

Answer 34

Waning immunity Acellular vaccines Severe complications w/ whole cell vaccines

Question 35

When do you consider a diagnosis of pertussis?

Answer 35

All children w/ cough > 14 days

Question 36

What is the tx of choice for pertussis? How long do you dose it?

Answer 36

Erythromycin | 14 days to prevent relapse

Question 37

What are some alternative agents for pertussis tx?

Answer 37

Clarithromycin Azithromycin Trimethoprim/sulfamethoxazole (bactrim)

Question 38

What do decongestants act as?

Answer 38

Sympathomimetics (alpha agonists) | Vasoconstrictors

Question 39

What is an issue with decongestants and how do we deal with that?

Answer 39

Prolonged use can cause rebound congestion (>3-5 days) | Limit dose frequency

Question 40

What are two long-acting topical decongestants?

Answer 40

Oxymetazoline HCl | Xylometazoline HCl

Question 41

What are some benefits of systemic decongestants?

Answer 41

Lower incidence of rebound congestion | Results typically last longer than topicals

Question 42

What is a legal issue with systemic decongestants and why?

Answer 42

Sales are limited on pseudoephedrine by law | Have been used in the illegal making of methamphetamine

Question 43

What are systemic decongestants? What is their systemic effect?

Answer 43

Alpha 1 agonist | Vasoconstrictors

Question 44

What do systemic decongestants activate at higher concentrations?

Answer 44

Beta receptors

Question 45

What are the CVS AEs of phenylephrine?

Answer 45

HTN Arrhythmia (rare) Stroke (rare)

Question 46

What are the CNS AEs of phenylephrine?

Answer 46

Headache Anxiety Tremor Restlessness

Question 47

What are the CVS AEs of pseudoephedrine?

Answer 47

HTN Palpitations Tachycardia Stroke (rare)

Question 48

What are the CNS AEs of pseudoephedrine?

Answer 48

Headache Insomnia Nervousness Excitability

Question 49

In what chronic disease should you avoid pseudoephedrine and phenylephrine?

Answer 49

HTN

Question 50

What does guaifenesin do to phlegm and bronchial secretions?

Answer 50

Helps loosen phlegm and bronchial secretions

Question 51

What does guaifenesin do to secretion viscosity?

Answer 51

Reduces secretion viscosity

Question 52

What does guaifenesin do to the mucocilliary mechanism?

Answer 52

Increases efficiency of mucociliary mechanism