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Flashcards in 3 - Cough / Cold / Allergy Deck (91)
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1

Patients should not use INCS / TAC if:

Intranasal corticosteroids

  • First talk to your provider if:
    • recent nasal ulcers / surgery / unhealed nasal injuries
    • asthma meds
    • prescription steroid medications
    • currently have eye infection
      • ​glaucoma or cataracts

2

Types of Allergens

  • Outdoor = Seasonal
    • ​Tree pollen / Grass / Ragweed
    • Pollen.com to check pollen counts
  • Indoor = Perennial = HARDEST TO AVOID AND MANAGE
    • Dust mites / Animal Dander
    • Mold / Cockroach droppings
  • Airborn
    • ​Smoke / perfume / fues

3

Budesonide Nasal Spray

Rhinocort

  • LOWER VOLUME OF SPRAY
    • vs fluticasone / TAC
  • Scent / Alcohol free
  • No Drug interactions! (like nasacort)
  • Only indicated for Ages 6+
    • still potential for slow growth rate
    • see md if >2 mo use in a year
  • Dose:
    • 1-2 sprays en qd
  • May take Up to 2 weeks for full symptom relief

4

Dextromethophan Dose

Dayquil / Robitussin / Delsym

10-20mg q 4 hr

or

30mg q6-8

 

Max = 120mg/day

5

Allergy Drugs with NO SEDATION

Loratadiine

Fexofenadine

6

Guaifenesin Dose

only FDA approved expectorant

>12 years old

200-400mg Q4

take with a full glass of water

used for non-productive congested cough

Aka ineffective productive cough

 

7

FDA Public Health Advisory for

OTC cold/cough medications

  • Should NOT be used to treat infants & children <2 years old
    • mainly due to IMPROPER USAGE
  • For children 2-11 yrs old:
    • understand that OTC drugs do NOT shorten duration of cold
    • check drug facts, beware of overlap active ingredients
    • Only use measuring spoons / cups
    • do not use for sedation

8

Short Acting Topical Decongestants

4-6 hours

Phenylephrine

0.25-1% Neo-Synephrine

Levmetamfetamine

Vapor Inhalor

Propylhexedrine

Benzedrex inhaler

9

Intranasal Corticosteroids

INCS

Treatment for Allergic Rhinitis

Only for ALLERGIES

not for COLDS

even if symptoms are indicated, ONLY ALLERGIES

Triamcinalone (TAC) / Fluticasone Propionate

Budesonide / Fluticasone Furoate

10

Cold Symptoms

  • Limited to Upper Respiratory Tract
    • 1-3 days after infection
  • 1st symptom = Sore Throat
  • Days 2-3 = Nasal symptoms
  • Days 4-5 = Cough (only 20% of patients)
  • Typically does not cause soreness or fever

11

Triamcinolone Nasal Counseling

  • TAC use QD w/o missing a dose
    • may take up to 1 week to provide full relief/benefit
      • most will see improvement on FIRST DAY
  • Pregnancy: talk to PCP before use
  • Can be used in children 2+:
    • but potential for slowed growth rate
    • try not to use for >2 months in a year

12

When to see Doctor for SORE THROAT

  • If you have been in contact with someone w/ STREP THROAT
  • Sudden Onset
    • w/ fever and/or Swollen glands
      • ​or a RASH
  • ​​Trouble Swallowing liquids
  • Sore throat for >1 week
  • FRONT OF NECK = sore / stiff

13

Which allergy medications are okay for children

2y/o and older?

ALL 2ndgen Antihistamines

Cromylyn Sodium

TAC 

Fluticasone Furoate (sensimist

Fluticasone Propionate is 4+ y/o

 

14

Pregnancy & Nursing

for Cough Supressants

Diphenhydramine is generall PREFERRED

DM is not a teratogen, and is generally safe during pregnancy

 

DM products w/o ethanol are SAFE for nursing mothers

15

Sore Throat Treatment Options

  • Stay Hydrated / Warm Liquids = Tea/honey
    • painful swallowing can lead to DEHYDRATION
      • avoid citrus drinks
  • Salt Water Gargling  = 1-1.5ts of salt in 1 cup warm water
    • salt water pulls liquid OUT of swollen membranes
  • Popsicles / Ice Chips
    • cold has NUMBING EFFECT
  • Hard Candies
    • reduce dryness / soothe pain
  • Vaporizer / Humidifyer
  • OTC PAIN MEDICATIONS for pain = Tylenol

16

Avoiding Allergens

Treatment for Allergic Rhinitis

  • Highest pollen conditions occur on DRY & Windy days
    • Pollen.com
  • Stay indoors:
    • highest pollen count is between 5am - 10am
  • Keep windows closed / change filters

17

Fluticasone FUROATE

flonase SENSIMIST

  • LOW VOLUME SPRAY
    • vs fluticasone propionate / TAC
  • Alcohol & Scent Free
    • vs fluticasone propionate
  • Approved for Ages 2+
    • vs 4+ for fluticasone propionate
  • Same indicaitions & drug interactions as fluticasone propionate
    • ​still indicate for watery EYES
    • 1 week for full effect

18

Productive Cough

Wet Cough

Expels secretions from LOWER respiratory tract

 

Can Be Effective if secretions are EASILY EXPELLED

ineffective if secretions are DIFFICULT to expel

19

Cromylyn Sodium Dose

NasalCrom

Mast Cell Stabilizer, okay for 2+ & pregnancy & elderly

1 spray (5.2mg) EN 3TID/4-QID

USE BEFORE SYMPTOMS

max 6 times / day

takes up to 7days for effect

20

Pregnancy / Nursing Use

of Antihistamines

  • Nursing: AVOID
    • excreted in breast milk
    • can inhibit lactation
  • Pregnancy: AVOID
    • unless CLEARLY NEEDED
      • benefits > risks

21

Age Considerations

for Antihistamines

  • Diphenhydramine = 1st gen OTC histamine
    • on BEER's LIST
      • ​Do not use in patients 65> age
      • Risk of sedation & AC effects INCREASED
  • ​​Most antihistamines have NO DOSING for <6yrs old
    • except for Loratadine / Fexofenadine / Cetirizine/levocet
      • >2yrs old

22

Topical Decongestants for Pregnancy or Children?

DNU IN PREGNANCY

reduced uterine blood flow

All okay, including menthol for 2+ y/o

 

saline can be used for <2y/o

23

Cetirizine Dose

5-10mg QD

Drowsiness warning

 

24

Side Effects of

Topical Decongestants

 

Phenylephrine Spray / Vapor Inhalor / Benzedrex

oxymetazoline

  • Rebound Effect --> Vicious Cycle
    • overuse of the topical products
      • only use SHORT TERM
        • for COLDS not allergies
    • can cause nasal membranes to be MORE congestion
  • To treat Rebound effect:
    • D/C offending drug -> use oral Decongestants or saline
    • Takes 1-2 weeks for nasal membranes to return to normal.

25

Diphenhydramine Dose

as a Cough Supressant

25mg Q4 hours

okay for children 6+but FDA PH advisory 2-11 years

Acts centrallin in medulla to increase cough threshhold

Side effects:

Drowsiness / Blurred Vision

Dry Mouth

Urinary Retention

26

Difference between ALLERGY vs Cold/URI

  • Allergies:
    • sometimes cough, less often than cold
    • NEVER ACHES / PAINS / FEVER
      • sometimes fatigue / sore throat
    • ITCHY eyes
      • eyes can be watery in both cold and allergy
    • sneezing is more common
    • Duration of Symptoms very depending on TRIGGER
      • days-months

27

Counseling for Dextromethorphan

  • DM:
    • Do not use if currently taking or 2 weeks after stopping
      • MAO INHIBITOR
      • or SSRIs
  • Diphenhydramine products:
    • may cause drowsiness / avoid alcohol
  • Stop Use & see MD if:
    • cough >7 days or returns or w/ fever/rash/headache
    • cough w/ too much phlegm
    • cough that is chronic, or occurs w/ smoking / asthma

28

Considerations for

Guaifenesin (expectorant)

No association w/ developmental toxicity 

Pregnancy / Nursing SAFE

Drink w/ FULL GLASS OF WATER

  • Ask doctor if:
    • too much phlegm beforehand or chronic cough
    • cough > 7 days
      • or comes back / fever / rash / headache

29

Exclusions for Self-Treatment

for Allergic Rhinitis

  • SYMPTOMS OF INFECTION
    • otitis media  = ear inflammation
    • fever / wheezing / bronchitis / chest congestion
    • Thick respiratory secretions, NOT CLEAR
  • Symptoms of undiagnosed / uncontrolled ASTHMA:
    • wheezing / SOB / COPD
  • Pregnant:
    • common cause of nonallergic rhinitis
  • Patients who DO NOT respond or symptoms worsen
    • ​after taking OTC options

30

Topical Rub Products

Include Camphor / Menthol

VICKS VAPORUB

ONLY FOR EXTERNAL USE

Apply on Chest / Throat

may cover w/ loose dry cloth

allow vapors to hit nose / mouth

DO NOT APPLY TO IRRITATED SKIN