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Pharm > Pharyngitis, cough, cold > Flashcards

Pharyngitis, cough, cold Flashcards

1
Q

What is pharyngitis usually caused by?

A

Group A streptococcus (GAS)

Strep pyogenes

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2
Q

What might GAS cause

A

Poststreptococcal glomerulonephritis

Acute rheumatic fever (rare in US)

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3
Q

What are the characteristics of GAS pharyngitis throat pain?

A

Usually severe

Worse on 1 side

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4
Q

What is the recommended initial tx of of GAS pharyngitis?

A

Amoxicillin

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5
Q

What is the dosing of amoxicillin for GAS pharyngitis?

A

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

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6
Q

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

A

Azithromycin
Strep rapidly develops resistance to macrolides
Consider if PCN allergic

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7
Q

What is a newly recognized cause of pharyngitis?

A

Fusobacterium necophorum pharyngitis (FNP)

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8
Q

What age groups is FNP endemic to?

A

Adolescents

Young adults

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9
Q

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

A

10%

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10
Q

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

A

Lemierre syndrome

Life threatening -> mortality rates of 5%

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11
Q

Sign that it is FNP

A

Lack of cough

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12
Q

What do you treat FNP with?

A

Clindamycin

Penicillin + metronidazole

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13
Q

What is the rule with cough suppression?

A

Don’t suppress indiscriminately

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14
Q

Do you suppress a productive cough?

A

No

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15
Q

When do you suppress a cough?

A

If tiring or sleep limiting

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16
Q

What do you prescribe for non-productive coughs?

A

Antitussives = cough suppressants

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17
Q

What do you prescribe for a productive cough?

A

Expectorants

Mucolytics

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18
Q

How should your pt ingest the antitussive benzonatate?

A

Caps and softgels should be swallowed w/o chewing

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19
Q

What is a common antitussive?

A

Dextromethorphan (robutussin)

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20
Q

What is dextromethorphan?

A

D isomer of codeine analog of levorphanol

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21
Q

Does dextromethorphan have analgesic and addictive properties?

A

No

22
Q

What does dextromethorphan do to reduce cough?

A

Inhibits central (medullary) cough center

23
Q

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

A

Guaifenesin (glyceryl guaicolate) aka Mucinex

24
Q

What does guaifenesin do to respiratory tract secretions?

A

Increases them

25
Q

What is n-acetylcysteine?

A

A mucolytic

26
Q

What does n-acetylcysteine do?

A

The sulfhydryl group opens disulfide bonds in mucoproteins thereby reducing viscosity

27
Q

How do you administer acetylcysteine?

A

Aerosolization or nebulization

28
Q

What is pertussis and what is it caused by?

A

Chronic cough

Bordatella pertussis

29
Q

What do the Chinese call pertussis?

A

Cough of 100 days

30
Q

Are atypical presentations of pertussis common? Give some examples

A

Yes
Completely/partially immunized pts
Adolescents/adults

31
Q

What population do we see the most pertussis?

A

Infants < 6 months

32
Q

Whats a frequent sign of pertussis?

A

Post-tussive emesis

33
Q

Is the incidence of pertussis increasing or decreasing?

A

Increasing

34
Q

What are some causes of rising incidence of pertussis?

A

Waning immunity
Acellular vaccines
Severe complications w/ whole cell vaccines

35
Q

When do you consider a diagnosis of pertussis?

A

All children w/ cough > 14 days

36
Q

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

A

Erythromycin

14 days to prevent relapse

37
Q

What are some alternative agents for pertussis tx?

A

Clarithromycin
Azithromycin
Trimethoprim/sulfamethoxazole (bactrim)

38
Q

What do decongestants act as?

A

Sympathomimetics (alpha agonists)

Vasoconstrictors

39
Q

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

A

Prolonged use can cause rebound congestion (>3-5 days)

Limit dose frequency

40
Q

What are two long-acting topical decongestants?

A

Oxymetazoline HCl

Xylometazoline HCl

41
Q

What are some benefits of systemic decongestants?

A

Lower incidence of rebound congestion

Results typically last longer than topicals

42
Q

What is a legal issue with systemic decongestants and why?

A

Sales are limited on pseudoephedrine by law

Have been used in the illegal making of methamphetamine

43
Q

What are systemic decongestants? What is their systemic effect?

A

Alpha 1 agonist

Vasoconstrictors

44
Q

What do systemic decongestants activate at higher concentrations?

A

Beta receptors

45
Q

What are the CVS AEs of phenylephrine?

A

HTN
Arrhythmia (rare)
Stroke (rare)

46
Q

What are the CNS AEs of phenylephrine?

A

Headache
Anxiety
Tremor
Restlessness

47
Q

What are the CVS AEs of pseudoephedrine?

A

HTN
Palpitations
Tachycardia
Stroke (rare)

48
Q

What are the CNS AEs of pseudoephedrine?

A

Headache
Insomnia
Nervousness
Excitability

49
Q

In what chronic disease should you avoid pseudoephedrine and phenylephrine?

A

HTN

50
Q

What does guaifenesin do to phlegm and bronchial secretions?

A

Helps loosen phlegm and bronchial secretions

51
Q

What does guaifenesin do to secretion viscosity?

A

Reduces secretion viscosity

52
Q

What does guaifenesin do to the mucocilliary mechanism?

A

Increases efficiency of mucociliary mechanism

Pharm (32 decks)

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