Respiratory Conditions

Question 1

Allergic Rhinitis

Answer 1

• Signs and Symptoms
  
  • Watery eyes; itchy nose, eyes or throat, sneezing, nasal congestion, runny nose
• Best is avoidance
• Nasal saline irrigation, HEPA filter
• Recommended OTC
  
  • Antihistamines
    
    • 1st generation: benadryl (diphenhydramine)
      
      • sedative,
    • 2nd generation, claratin (loratidine), allegra (fexofenadine), zyrtec (cetirizine)
      
      • non-sedative
      • weak, good for mild allgery
  • ​Inhaled corticosteroids
    
    • Flonase (fluticasone) and triamcinaclone
    • when taking this, don’t need antihistamine
• ​Exclusions:
  
  • Signs of otitis media, sinusitis, lower respiratory problems
  • history of non-allergic rhinitis
  • narrow-angle glaucoma
  • • pregnant or lactating
• Other Info:
  
  • Only treat most prevalent
  • itch: require sedating antihistamine, can use zyrtec due to minial sedation

Question 2

Cold

Answer 2

• Signs and Symptoms:
  
  • Sore throat, nasal congestion, runny nose, sneezing, low fever, chills, headache, possble cough
• Exclusions
  
  • Fever >101.5
  • Chest pain
  • Sign of bacterial infection
  • COPD
  • Not improve in 7 days
  • AID/Immunosuppresed
  • Infant
  • Frail/elderly
• Nonpharmacologic:
  
  • fluid, rest, toilet
  • Echinacea at the 1st signs/symptoms
• Recommended OTC:
  
  • Jolly ranchers
    
    • instead of local anesthic like benzocaine
  • Decongestant:
    
    • pseudophedrine, (systemic) oxymetazoline (LA), ephedrine, pheylephrine (topical)
      
      • AVOID selling phenylephrine (systemic), degraded in liver and not reach nose (ex: sudafed-PE)
  • Antitussive:
    
    • dextromethorphan: 6-8 hrs, not constipative, not sedative
    • codeine: 4-6 hour, constipative, sedative, use for sleep
    • (benzonatate (Tessalon perle))
  • Expectorants:
    
    • Guanisefen: witchcraft
  • Analgesics
    
    • Not aspirin
• ​​Other Notes
  
  • No cold preps for kids under 4
  • Honey works such as well to soothe throats
  • Treat symptoms as they come instead of using combo products
  • Echinacea not for those on immunosuppressants

Question 3

Influenza

Answer 3

• Signs and Symptoms
  
  • Aches and Pains, myalgia
  • Fever
  • Sore Throat, cough, fatigue
• Use same method as cold

Question 4

Rhinitis Medicamentosa (Rebound Congestion)

Answer 4

• Signs and Symptoms:
  
  • Stuffy nose due to overuse of decongestants
• Treatments
  
  • Quit cold turkey
  • Leversee method
    
    • one nostril at a time
  • Long-Term: use steroidal nasal spray for allergies

Question 5

Asthma

Answer 5

• Signs and Symptoms
  
  • Wheezy, cough, shortness of breath
  • cough could be only symptom
• Don’t sell primatene mist or tablets
• Refer for MDI

Question 6

Cough

Answer 6

• Exclusions
  
  • Fever>101.5
  • history of underlying disease associated with cough
    
    • COPD, chronic bronchitis, CHF​
  • Suspected drug associated cough
  • cough>7 days
  • uninteded weight loss
  • drenching nighttime sweats
• OTC
  
  • codeine 10-20 mg q4h
    
    • constipative, sedative
  • dextromethorphan 10-20 mg q4h

Question 7

Strep Throat Considerations

Answer 7

• Must have at least two of the three:
  
  1. ​Sore Throat
  2. Tender Lymph Node
  3. Pus on tonsils
• If there is a cough, then NOT strep
• 1 to 2 year olds don’t get strep
• May be associated with fever