Flashcards in Cough Deck (43):
What will the majority of coughs presenting in the pharmacy be caused by?
A viral upper respiratory tract infection
What will coughs often be associated with?
Other symptoms of a cold
Is the evidence of using cough suppressants and expectorants strong?
But some people report finding them helpful
Are most cold self limiting?
Yes and they will be often be better within a few days without treatment
In general, what duration of cough would be best referred to a doctor for further investigation?
Longer than 2 weeks where there is no improvement seen
What are the types (natures) of cough?
What is an unproductive cough?
No sputum produced
Dry, tickley, tight
Usually caused by viral infection and are self limiting
What is a productive cough?
Chesty or loose
Sputum is normally produced
An over secretion of sputum which leads to coughing
What does a coloured sputum indicate?
Yellow, green or rust coloured
A bacterial chest infection such as pneumonia or bronchitis. require referral
What can repeated episodes of bronchitis indicate?
What are the classic symptoms of TB?
More likely to present in disadvantaged communities
What is croup?
A harsh barking quality cough which often develops in infants
it develops 1 day or so after the onset of cold symptoms
Associated with difficulty breathing and an inspiratory stridor (noise when breathing in)
Is referral necessary for croup?
What are the associated symptoms with cough?
Cold, sore throat and catarrh
What can indicate asthma?
A recurrent night time cough, especially in children
They should be referred
Asthma may also sometimes present as a chronic cough without wheezing
What can coughing be a symptom of with regards to cardiovascular?
If there is a history of heart disease, especially with persisting cough, then referral is advisable
What can gastro oesophageal reflux cause?
Sometimes such refux can be asymptomatic apart from coughing
What is a key risk factor of coughing?
In RTS scenarios presenting with cough, always ask whether the patient is a smoker
1/3 longterm smokers develop a cough
what is current medication important?
May interact with OTC cough medicine
Which class of drug in particular is associated with a dry cough?
Ramipril, enalapril, lisinopril, captopril
May develop within days, weeks or months
More common in women
typically irritating, nonproductive and persistent cough
What is the referral criteria for cough?
- Cough lasting 2 weeks or more
- Sputum (yellow, green, rust coloured or blood stained)
- Chest pain
- Whooping cough or croup
- Failed medication
- Suspected ADR
- Recurrent nocturnal cough
What does the choice of treatment depend on?
The type of cough (productive or non productive)
Suppressants - unproductive e.g pholcodine
Expectorants - productive e.g guaifenesin
When are demulcents like simple linctus useful to treat coughs?
In pregnant women and children
they only soothe the throat and have no active ingredients
They are inexpensive
What are expectorants claimed to do?
Promote expulsion of bronchial secretions
When are suppressants useful?
Where there is no identifiable cause
Give some examples of cough suppressants
What are the advantages of using phlocodine over codeine for cough?
Fewer side effects
Less liable to be abused
What is the adult dose of pholcodine?
What is a common side effect of pholcodine?
Up to 15mg 3-4 times daily
Can be given to children over 6 at a dose of 5mg (5mg/5ml of pholcodine linctus BP)
more appropriately given as twice daily dose
Is Dexthromethorphan more or less potent that codeine and pholcodine?
Can be given to children over 6
Give some examples of demulcents
lemon and honey
useful for their soothing effects
What is the dose required in adults to produce expectoration with Gauifenesin?
For any product to have an effect, must have a sufficiently high dose
What other constituents can be used in cough remedies?
Give some examples of antihistamines used in OTC cough products?
Diphenhydramine (benylin original)
(Anticholinergic actions help)
Why might a combination of an antihistamine and cough suppressant be useful?
Antihistamines can help dry up secretions
Combination can be given as a night times dose if the cough is disturbing sleeping
What are the interactions with antihistamines for cough?
Why is pseudoephedrine (a sympathomimetic) used in cough and cold remedies?
For its bronchodilatory and decongestant actions
Can be useful if they have a blocked nose as well as cough
Can be sympathomimetics be useful in combination?
Yes with expectorants
as part of an expectorant/decongestant combination
Who should sympathomimetics be used in caution in?
What interactions are associated with sympathomimetics?
Monamine oxidase inhibitors
Reversible inhibitors of monamine oxidase A
Why is theophylline sometimes included in cough remedies?
For its bronchodilator effect]
Not recommended in children
What diabetics prefer to use for their cough?
Sugar free preparations
When can steam inhalations be useful in coughs?
Particularly in productive coughs