URI Case

Question 1

5 classes of meds used for URI

Answer 1

decongestants
pain/fever relievers
cough suppressants
cough expectorants
vitamins/supplements

Question 2

2 classes of meds used for allergic rhinitis

Answer 2

antihistamines
intranasal corticosteroids

Question 3

decongestants activate __ alpha and beta receptors

Answer 3

adrenergic

Question 4

effect of decongestants on alpha adrenergic receptors

Answer 4

stimulate respiratory mucosa -> vasoconstriction -> reduced mucosal swelling -> improved ventilation

Question 5

effect of decongestants on beta adrenergic receptors

Answer 5

bronchial relaxation

Question 6

2 major s.e of decongestants include __,
which can lead to __ (6)

Answer 6

vasoconstriction, tachycardia

-angina
-HTN
-worsening CVD
-increased glycogenolysis and gluconeogenesis -> labile blood sugars
-CNS stimulation -> nervous, insomnia, dizzy, drowsy
-urinary retention

Question 7

3 contraindications for decongestants

Answer 7

HTN
< 6 yo
first trimester pregnancy

Question 8

only FDA approved decongestant for pt’s w. HTN

Answer 8

coricidin

Question 9

1st line decongestant

Answer 9

pseudoephedrine (sudafed)

phenylephrine = garbage

Question 10

7 cough suppressants

Answer 10

dextromethorphan
opiates
benzonate (tessalon)
lozenges
viscous preparations
menthol
camphor

Question 11

where in the body do cough suppressants/antitussives work (2)

Answer 11

centrally -> medullary cough center
locally -> site of irritation

Question 12

what 4 cough suppressants/antitussives work centrally on the medullary cough center

Answer 12

codeine
dextromethorphan
opiates
benzonate (tessalon)

Question 13

what 2 cough suppressants/antitussives work locally at the site of irritation

Answer 13

lozenges
viscous preparations
menthol
camphor

Question 14

which cough suppressant is an isomer of codeine but has a lower addiction profile

Answer 14

dextromethorphan

Question 15

3 s.e of antitussives

Answer 15

nausea
dizzy
drowsy

Question 16

t/f: dextromethorphan is safe in pregnancy

Answer 16

t!

Question 17

contraindication for dextromethorphan

Answer 17

MAOIs
caution in w. SSRI

Question 18

which antitussive can cause serotonin syndrome

Answer 18

dextromethorphan

Question 19

sx of serotonin syndrome

Answer 19

confusion
agitation
tachycardia
HTN
twitching
muscle rigidity
diaphoresis
fever
sz

Question 20

which cough suppressant is a common allergen

Answer 20

codeine

Question 21

t/f: codeine is safe in pregnancy

Answer 21

f!

class C

Question 22

t/f: benzonate is safe in pregnancy

Answer 22

f!

Question 23

how do expectorants/antimucolytics work (3)

Answer 23

dissolve thick mucous
enhance airway clearing
promote cough

Question 24

s.e of expectorants

Answer 24

n/v
rash

Question 25

2 expectorants

Answer 25

mucinex
robitussin

Question 26

active ingredient in expectorants

Answer 26

guaifensin

Question 27

contraindication for expectorants

Answer 27

< 6 yo

Question 28

t/f: guaifensin is safe in pregnancy

Answer 28

t!

Question 29

what condition might guaifensin exacerbate

Answer 29

nephrolithiasis

Question 30

what is robitussin DM

Answer 30

dextromethorphan/guaifensin

Question 31

3 vitamins/supplements that might be supportive for URI

Answer 31

vitamin C
echinacea
zinc

Question 32

tx for mild-mod bacterial sinusitis

Answer 32

augmentin 875 mg PO bid x 7 days

alt: doxycycline

Question 33

tx for bacterial sinusitis if risk for resistance or abx failure

Answer 33

augmentin 2000 mg po bid x 10-14 days

alt: levofloxacin, moxifloxacin

Question 34

tx for severe (inpt) bacterial sinusitis

Answer 34

ampicillin/sulbactram 3 g IV qid

alt: levofloxacin OR ceftriaxone

Question 35

what abx are NOT recommended for bacterial sinusitis dt high rates of resistance to strep pneumo

Answer 35

macrolides
bactrim
2nd and 3rd gen cephalosporins