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OTC > Respiratory Systems > Flashcards

Respiratory Systems Flashcards

1
Q

What kind of medication is Guaiphenesin?

A

Cough EXPECTORANT

These claim to make the coughing easier while enhancing production of mucus and phlegm.

Other example: Acetylcysteine, ammonium chloride

Not effective in children

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2
Q

What kind of medicine is Dextromethorphan?

A

Cough suppressant (antitussive)

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3
Q

What antihistamine do we usually give to children?

A

Chlorphenamine maleate (piriton)

Suitable for 1 year and over

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4
Q

What age are steroid nasal sprays e.g. beconase, flixonase, not suitable in?

A

Under 18’s

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5
Q

Is it pharmacologically rational for a cough/cold remedy to contain dextromethorphan and guanefenesin? What about dextromethorphan and ammonium chloride?

A

No:
Dextromethorphan is a cough suppressant so person coughing less

Guanefenesin and ammonium chloride both cough expectorants which means they make it easier to cough things up: work against each other

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6
Q

What is the medication causing drowsiness usually included in cough/ cough remedies to help people sleep?

A

Diphenhydramine

A sedating antihistamine, found in things like Night nurse.

Also found in sleep aids such as sominex

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7
Q

Can pseudoephidrine cause drowsniess?

Can guaifenesin cause drowsiness?

Can dextromethorphan?

A

No

Remember pseudoephidrine (SUDAFED) can be abused- stimulating- side effects include restlessness and insomnia, and hallucinations!

Guaifenesin does not cause drowsiness

Dextromethorphan can cause a little bit of drowsiness

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8
Q

Children under __ should not be given cough and cold medication OTC containing PSEUDOEPHEDRINE
PHENYLEPHRINE
DEXTROMETHORPHAN
PHOLCODINE
GUAIFENESIN
Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

A

Children under 6 years old

Medicines containing:

ANTITUSSIVES (suppressants) (DEXTROMETHORPHAN
PHOLCODINE)

Expectorants (GUAIFENESIN, ipecacuanha)

Nasal decongestants (pseudo, phenylephrine, ephedrine, oxymetazoline, xylometazoline)

Antihistamines: Chlorphenamine, brompheniramine, diphenhydramine, doxylamine, promethazine and triprolidine.

For use in 6-12 years they should be SECOND LINE and be used for no more than 5 DAYS

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9
Q

A patient with a productive cough for the last week requests a product containing dextromethorphan because they have heard good things. What do you do?

A

They may have requested Benylin Dry Cough

Similar product: Benadril Tickly Cough containing Pholcodine

These are cough SUPPRESSANTS

Should NOT suppress a productive cough- need to get the mucous out- so recommend an expectorant (Guaiphenesin)

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10
Q

Why has the safety of using medicines containing codeine to treat coughs and colds in children younger than 18 been reviewed?

A

Because of the potential for serious problems like slowed or difficult breathing.

Children, especially those who already have breathing problems, may be more prone to these effects

Differences in metabolism of codeine: codeine is converted to Morphine in the body, this cause cause respiratory difficulties.

This use in under 18’s only applies to codeine linctus for colds/ cough; codeine containing products for pain relief can still be used in > 12 years, sold to > 16 years.

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11
Q

Pseudoephidrine is contra-indicated in which condition?

What about phenylephrine?

A

Pseudoephedrine: Hypertension, coronary artery disease, MAOI’s in the last two weeks

Phenylephrine: diabetes (as may increase glucose) and CV disease

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12
Q

Due to the damage influenza virus can do the airways - what complication can it lead to and in which patient groups need to be caution?

A

Pneumonia / pneumonitis

Very young
Elderly
Impaired immunological responses
Long term condition - heart, resp, kidney disease, diabetes

Warning signs of pneumonia complications - severe/productive cough
pleuritic pain
persisting high temp

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13
Q

When to refer for those with cold/flu? (7)

A
  1. Earache not improving with analgesic
  2. Very young
  3. Very old
  4. Long term conditions - Asthma, COPD, kidney, diabetes
  5. Persisting fever & productive cough
  6. Delirium
  7. Pleuritic type chest pain
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14
Q

OTC cough and cold medicines containing ….(4) should not be sold for under 6 years?

What about for 6- 12 year olds?

A
  1. Antitussives - dextromethorphan & pholcodine
  2. Expectorants - Guaifenesin & Ipecacuanha
  3. Nasal decongestants - Ephedrine, oxymetazoline etc
  4. Antihistamines - Brompheniramine, Chlorphenamine, promethazine etc

6- 12 years old can still use but for no longer than 5 days

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15
Q

How do nasal decongestants work and what advice should be given with their use?

A

Constrict blood vessels in nasal mucosa

No longer than 7 days use - rebound congestion can occur with topical but not oral decongestants

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16
Q

Can topical decongestants be used in 6- 12 years old?

Under 6?

A

6 -12 Yes

Under 6 No

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17
Q

Which of the topical decongestants have longer lasting effects

A

Oxymetazoline
Xylometazoline

upto 6 hours

compared to others such as ephedrine

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18
Q

In which patient groups should Ephedrine and pseudoephedrine be used with caution? & why?
(4)

A
  1. Hypertensive patients -raise BP
  2. Heart patients & Hyperthyroidism - stimulant effects on heart as they more vulnerable to irregularity
  3. Diabetics - increase blood glucose
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19
Q

What interactions can occur with ephedrine/pseudoephedrine?

A
  1. Monoamine oxidase inhibitors (MAOIs) - hypertensive crisis. Risk still there 2 weeks after MAOIs stopped.

Applicable to both oral and topical sympathomimetics

  1. Beta blockers - contradictory effect
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20
Q

Antihistamines can be used to reduce cold symptoms e.g. runny nose and sneezing

What are the interactions that can make side effects worse?

A

Cause drowsiness

  1. Alcohol will increase this effect
  2. Benzodiazepines or phenothiazines

Anticholinergic side effects (dry mouth, urinary retention, blurred vision, constipation) enhanced with other anticholinergic drugs

  1. Hyoscine
  2. Tricyclic antidepressants
  3. Inhaled ipratropium / tiotropium
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21
Q

Antihistamines should be avoided in which patient groups? (3)

A
  1. Closed angle glaucoma - increase ocular pressure
  2. Prostatic hypertrophy - acute urinary retention
  3. Epilepsy - seizures as stimulate the CNS but usually at high doses
22
Q

Annual flu vaccine is available to which patient groups? (9)

A
  1. Over 65
  2. Chronic respiratory
  3. Chronic heart disease
  4. Chronic renal failure
  5. Chronic neurological disease
  6. Diabetes mellitus
  7. Immunosuppression due to treatment/disease
  8. Pregnant
  9. People living in long stay residence
23
Q

Flu nasal spray available to who?

A
  1. Age 2, 3 and 4 and those in year 1, 2 and 3

2. 2-17 years at a risk due to condition e.g. diabetes

24
Q

Antivirals (3) are available for seasonal flu to at risk groups under which conditions?

A

Neuraminidase inhibitors
Oseltamivir
Zanamivir
Amantadine

Can be used in flu outbreaks if treatment is started within
36 h for zanamivir
48 h for oseltamivir

Amantadine not usually used - lower efficacy

25
Q

What is acute sinusitis ?

Treated with what?

A

When secretions in sinuses become stagnant with nasal secretions during/after cold.

Infected with Staphylococcus or haemophilis

Abx - amoxicillin or cefaclor if penicillin allergy

26
Q

Pt’s child has persistent night time chough. What would you advise?

A

Referral - as could be asthma

27
Q

When is a cough classed as acute or chronic?

A

acute - less than 3 weeks

chronic - more than 8 weeks

28
Q

What is a demulcents?

Example and how they work?

A

Simple linctus - soothing ingredients such as glycerol or syrup

Help to supress voluntary cough mechanism - reducing frequency of cough

Honey and lemon tea

29
Q

What are some ingredients (4) that are expectorants?

A
  1. Ipecacuanha
  2. Ammonium chloride
  3. Squill
  4. Guaifenesin

BNF - more likely placebo effect

30
Q

Anti-tussives such as codeine or opioid are not recommended … why?

What can be recommended for adults instead? Why?

A

under 6 years - NO - risk of respiratory side effects
12 -18 with breathing problems or breastfeeding mothers

Not ideal in general - due to high incidence of side effects - constipation and dependence

Pholcodine - fewer side effects than codeine

Dextromethorphan (Benylin/Robitussin dry cough) (non-sedating opiate) and menthol shown to supress cough reflex without adverse effects of opiates.

31
Q

What is croup and caused by the….?

Any treatment?

A

Croup - characteristic barking cough starts as a cold

causes trachea to become inflamed and swollen, thick mucus produced too

Worst in first 3 days

caused by the parainfluenza virus

No treatment as it is viral - antipyretic treatment if fever is present

No cough treatments especially those that can cause drowsiness

Parents should calm the child, sit them upright and maintain adequate fluids

32
Q

Emergency/ Referral cough symptoms? (13)

A

999

  1. Stridor (abnormal high pitched musical breathing) /airway obstruction
  2. Difficulty breathing
  3. Pale/cold/clammy
  4. Unable to swallow saliva/fluids
  5. Coughing - pink (left ventricular failure) /rust (pneumonia) / dark red (carcinoma)

if bright red and one off - no need to refer - might just be forceful coughing

GP

  1. Cough lasting 3 weeks
  2. Bacterial infection - coloured sputum
  3. Chest pain
  4. Recurrent night time coughing (asthma?)
  5. Medicine induced - ACE inhibitors (Captopril, Ramipril, Enalapril, Lisinopril)?
  6. Barking cough - croup
  7. Fever and night sweats - TB?
  8. Whooping cough (pertussis)
33
Q

How do ACE inhibitors cause cough?

A

They control break down of bradykinin and other kinins in lungs

34
Q

Theophylline can be used in OTC cough remedies.

What things/drugs can increase and decrease theophylline levels?

A

Increase:
Enzyme inhibitors such as:
Erythromycin
Cimetidine

Decrease:
Smoking
Enzyme inducers: 
Carbamazepine 
Phenytoin
Rifampicin
35
Q

What are some side effects of theophylline? (5)

A 
GI disturbance
Nausea
Palpitations
Insomnia
Headache
36
Q

90% of sore throats are viral. 10% are bacterial - what bacteria is the cause and which age group is most likely in?

A

Streptococcal - children of school age

37
Q

When to refer for a sore throat? (6)

A
  1. Lasting longer than 7-10 days
  2. Very painful with no other symptoms and no improvement in 24-48 hrs
  3. Difficulty swallowing
  4. Medication - steroid inhalers / CARBIMAZOLE (agranulocytosis - suppression of wbc in bone marrow), METHOTREXATE, AZATHIOPRINE
  5. White plaques on throat/mouth - indicated oral thrush)
  6. Red & swollen tonsils / swollen lymph glands
    (usually in strep throat or glandular fever - Epstein -Barr virus a.k.a kissing disease - paracetamol/ibuprofen
38
Q

How do steroid inhalers cause sore throat?

What to advise pts?

A

Beclometasone or budesonide - can cause hoarseness and candidal infections of mouth and throat

usually at high doses

Rinse mouth with water after using inhaler
use a spacer

39
Q

Management options for sore throat?

A

Analgesics - paracetamol/ibuprofen / flurbiprofen lozenges (12+) / benzydamine (anti-inflammatory) spray 6+ and mouthwash 12+

Local anaesthetic -lidocaine, benzocaine sprays or lozenges

Antibiotic lozenges - Cetylpyridium

40
Q

Advice on who can take and how to take flurbiprofen lozenges?

A

12+
Each lozenge 8.75mg - One lozenges sucked in mouth every 3-6 hrs
MAX 5 a day
Can be used for up to 3 days at a time

41
Q

What are the treatment option for strep throat (once u’ve referred to GP)?

A

1st line - Phenoxymethylpenicillin

if allergic

Clarithromycin

42
Q

Treatment for candidal pharyngitis ?

A
  1. Nystatin

if more widespread /long term: fluconazole

43
Q

Drugs that cause agranulocytosis? (7)

A
  1. Captopril
  2. Carbimazole
  3. Cytotoxics - methotrexate, azathioprine
  4. Neuroleptics - clozapine
  5. Penicillamine
  6. Sulfasalazine
  7. Sulfur containing ABX - sulfonamides
44
Q

What are the normal symptoms of hayfever? (4)

referral signs? (4)

A
  1. Rhinorrhorea - runny nose
  2. Itchy eyes & nose
  3. Congested nose
  4. Sneezing
  5. Wheezing
  6. Earache / facial pain
  7. Purulent conjunctivitis
  8. No improvement in 7 days
45
Q

Treatment options for hayfever?

A

Antihistamines:
New - acrivastine, cetirizine, loratadine
Old - chlorphenamine, promethazine, diphenhydramine

Nasal corticosteroids 18+

Sodium cromoglicate eye drops (discard after 28 days of opening)

Oral or topical decongestants

46
Q

How should the non-sedating antihistamines be taken and what age suitable?

A

Once a day:
Loratadine 2+
Cetirizine 6+

Three times a day
Acrivastine 12+

47
Q

Sedative effects of older antihistamines can be increased by … ? (4)

A
  1. Alcohol
  2. Sedatives
  3. Hypnotics
  4. Anxiolytics
48
Q

When should sodium cromoglicate eye drops be started to be most effective?

A

1 week before hay fever season likely to start

QDS

49
Q

Sodium cromoglicate eye drops contain the preservative ….. and should not be used by …

A

Benzalkonium chloride

soft contact lens wearers - can deposit in them

50
Q

What topical antihistamine is available and from what age?

A

Azelastine nasal spray
Begin 2-3 weeks before season
5+

51
Q

What type of hypersensitivity is hay fever?

A

IgE mediated type 1 reaction

52
Q

What are the symptoms of meningitis in infants/children?

A
  1. Excess sleepiness /irratbility
  2. Vomiting / feeding poorly
  3. Crying alot
  4. Soft bulging spot on head
  5. Being stiff/ jerky
  6. Purpuric rash (does NOT blanch white on pressure)
  7. Trouble looking at bright lights

OTC (11 decks)

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