Respiratory Conditions Flashcards
If a patient presents to the pharmacy complaining of upper respiratory tract symptoms such as cough, and you decide to assess her, what red flags would require you to refer the patient to MD?
- high fever > 40.5C or fever > 38.5 for more than 3 days
- infants < 6 months with fever and rectal temp > 38.5
- severe headache
- neck pain or stiffness
- photophobia
- difficulty breathing
- wheezing
- stridor
- COPD/ Asthma
- cough that lasts > 3 weeks
- signs of dehydration in infants (sunken eyes, no tears, decreased urination)
What are the distinct symptoms of allergic rhinitis?
-watery eyes and runny nose
-no fever
-itchy throat
-sneezing
-earache in children
-only occurs for as long as there is exposure to allergen
When to refer to a Dr in common cold
fever > 40.5 or >38.5 for > 72 hrs, cough > 3 weeks, severe headache, severe sudden throat pain
What kinds of respiratory conditions is a fever most common in?
influenza
sinusitis (possible, but if it occurs, must refer)
pharyngitis
how long does the common cold last?
5-7 days, sometimes upto 14 days (25%)
how long does influenza virus last?
10 days
how long pharyngitis last?
3 days
how long does sinusitis last?
days to weeks
what is the first symptom that occurs in the collom cold?
sore throat (dry, scatchy)
A fever of 38-40 degrees C with a sudden onset is most common in what kind of respiratory condition?
influenza virus
What sets sinusitis apart from others in terms of symptoms?
-facial tenderness
-pain btwn eyes, jaw and tooth pain
-headache
Treatment for allergic rhinitis
- oral antihistamines
- intranasal ICS for runny nose (fluticasone spray)
- oral or topical decongestants for congestion
- cromoglycate/olopatadine for watery eyes
how would you rule out OTITIS MEDIA?
ask about ear pain or fever duration
how would you rule out influenza?
ask about any muscle pain, rapid fever, chills, cough, clear nasal discharge
how would you rule out a common cold?
nasal discharge, sore throat/dry and cough, typically no fever
what questions will you ask a patient to rule in/out rhinosinusitis?
any facial pain, persistent yellow/green discharge, jaw pain
Major symptoms to help differentiate between the different types of colds?
influenza = sudden fever
common cold = mainly nasal congestion
pharyngitis = sore throat
A 20 year old woman with mild fever 38 ºC, sore throat, runny nose, congestion from the last 3 days. An assessing pharmacist consider her condition as minor ailment because she does not any other underlying condition or medication. What is her condition?
common cold
*no sudden fever or muscle pain, so R/O influenza
*no facial pain, so R/O sinusitis
*no watery eyes, so R/O allergic rhinitis
* no severe/rapid onset of sore throat, so R/O pharyngitis (which usually lasts only 3 days)
1 year old child presents to pharmacy with fever for the past 4 days. no meds taken. what would you recommend?
refer to Dr
OTC Treatment for allergies - snezing/rhinorrhea
antihistamines
OTC Treatment for allergies - nasal congestion
oral or topical decongestants
What are the common causes of cough?
asthma, chronic bronchitis, COPD, hart failure.
Drugs - ACEi
Emphysema, foreign body, GERD, post-nasal drip, upper/lower resp infection
If a patient complains of a cough, when would you refer them?
age < 3 months
comorbid conditions: COPD, asthma, GERD, heart failure, DVT, recent trauma
-fever > 72 hrs
-high fever
-blood in cough
-covid positive
-meds: ACEi, NSAIDs, immunosuppressants.
Patient is 5 years old looking for cough and cold products. What would you recommend?
non pharms. no OTC available.
If no improvement in cough symptoms in > 3 weeks, then what should be done?
refer the patient to see Dr
Treatment for cough due to COPD
dextromethorphan or codeine
Treatment for cough due to non-allergic rhinitis
intranasal corticosteroid or ipratropium
Treatment for cough due to allergic rhinitis
1st and 2nd gen antihistamines to suppress cough
Treatment for cough due to pertussis
macrolide + isolation for 5 days.
booster pertussis vaccine dose in adults.
Treatment for cough due to cough with no clear cause
decongestant + 1st gen antihistamine for 2 weeks
Treatment for cough due to chronic bronchitis or URTI
ipratropium or salbutamol
Examples of antitussives
dextromethorphan, codeine and expectorants
What age group is codeine indicated for?
18+
What type of cough does dextromethorphan suppress?
dry, non-productive cough (no congestion)
Dextromethorphan onset, duration, age group
onset: 15-30 min
duration: 3-6 hrs
age: > 6 years old
How is dextromethorphan related to opioid?
chemically related to opioids, but no analgesic effect, only anti-tussive effect
Contraindications of dextromethorphan
lung disease, pregnant/breastfeeding women, chronic/persistent cough
Dextromethorphan concurrent use with MAOi, SSRIs, TCAs can cause?
serotonin syndrome
(Cat. X with MAOi phenelzine)
all antihistamines are taken once daily, except?
1st gen antihistamine ex. benadryl q 4-6 hours prn
Drug interactions with codeine
AVOID MAOi,
okay to use with antidepressants like SSRI, TCA, dual-acting antidepressants
Codeine: cyp2d6 substrate
Expectorant
Guafenesin - expels mucous and phlegm
Indicated in 12+ y/o
200-400 mg q4hrs
which opioids should be avoided with MAOi
codeine
fentanyl
meperidine
tramadol
MoA of guaifenesin
-extract of tar
-reduces sputum viscosity, allows more effective removal of secretions from the respiratory tract
-increases ciliary action to make the fluid from resp tract less viscous = helps with removal of mucous
Side effects of guaifenesin
rare- drowsy, N/V
overdose can cause N/V
Contraindications of guaifenesin
chronic, persistent cough
lung disease
women who are pregnant/breastfeeding
Examples of oral decongenstants
pseduoephedrine
phenylephrine
ephedrine
When should oral decongestants be avoided?
1st trimester of pregnancy
in HTN, hyperthyroidism, glaucoma, BPH
avoid with MAOi
MoA of decongestants
alpha1 agonist
-vasoconstriction in nasal mucous membrane
What is the cautionary measure to take for topical decongestants?
prolonged use can cause rebound congestion (nose sprays), limit to no more than 3-5 days.
Indication for topical decongestants
Sinus and red eye, colds, flu, hay fever, sinusitis
oral vs topical decongestants related to HTN
avoid in HTN (oral)
avoid in UNCONTROLLED HTN (topical = ok to use for 3 days if bp is controlled)
Examples of topical decongestants
oxymetazoline 0.05%
xylometazoline
oxymetazoline interactions with maoi based on dosage forms
ophthalmic = non
nasal = cat X
topical = cat B
no interactions with SSRI/SNRI
TCA + oxy nasal = cat C
What method of thermometer temperature gives an accurate reading in children age 15 month?
rectal
What is the cause of Reye’s syndrome?
Administering ASA to infants, children, or teens.
Why should systemic decongestants be avoided in patients with HTN?
-at normal doses, it increases the BP of the patient with high BP.
-whereas in pts with no HTN, systemic decongestants will only increase BP at HIGH doses.
topical eye decongestants, if used for > 3-5 days can cause?
HYPEREMIA
Gold standard to measure temperature in children less than or = 5 years old?
rectal
Gold standard for children > 5 and adults for temperature reading?
oral thermometer
fever temperature in rectal reading
> 38C
fever temperature in oral reading
> 37.5 C
fever temperature in tympanic (ear) reading
> 37.5C
Normal body temperature
37.2 to 37.8 C
what age group can use a tympanic thermometer
OVER 6 months (avoid if < 6 months)
What is the preferred method for temperature measurements in patients up to 3 months of age?
rectal
when children present with fever, when should you refer to Dr?
< 6 months = refer always
other age groups: if fever continues/worsens after 3 days of self-treatment, or any signs of infection
childrens’ dose of acetaminophen
10-15 mg/kg q 4-6 hrs prn/po/pr - max 75 mg/kg/day
