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Flashcards in Cough Deck (43):
1

What will the majority of coughs presenting in the pharmacy be caused by?

A viral upper respiratory tract infection

2

What will coughs often be associated with?

Other symptoms of a cold

3

Is the evidence of using cough suppressants and expectorants strong?

No

But some people report finding them helpful

4

Are most cold self limiting?

Yes and they will be often be better within a few days without treatment

5

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

6

What are the types (natures) of cough?

Productive

Unproductive

7

What is an unproductive cough?

No sputum produced

Dry, tickley, tight

Usually caused by viral infection and are self limiting

8

What is a productive cough?

Chesty or loose

Sputum is normally produced

An over secretion of sputum which leads to coughing

9

What does a coloured sputum indicate?

Yellow, green or rust coloured

A bacterial chest infection such as pneumonia or bronchitis. require referral

10

What can repeated episodes of bronchitis indicate?

COPD

11

What are the classic symptoms of TB?

Haemoptysis

chronic fever

night sweats

More likely to present in disadvantaged communities

12

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)

13

Is referral necessary for croup?

Yes

14

What are the associated symptoms with cough?

Cold, sore throat and catarrh

15

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

16

What can coughing be a symptom of with regards to cardiovascular?

Heart failure

If there is a history of heart disease, especially with persisting cough, then referral is advisable

17

What can gastro oesophageal reflux cause?

A cough

Sometimes such refux can be asymptomatic apart from coughing

18

What is a key risk factor of coughing?

Smoking

In RTS scenarios presenting with cough, always ask whether the patient is a smoker

1/3 longterm smokers develop a cough

19

what is current medication important?

May interact with OTC cough medicine

20

Which class of drug in particular is associated with a dry cough?

ACE inhibitors

Ramipril, enalapril, lisinopril, captopril

May develop within days, weeks or months

More common in women

typically irritating, nonproductive and persistent cough

21

What is the referral criteria for cough?

- Cough lasting 2 weeks or more

- Sputum (yellow, green, rust coloured or blood stained)

- Chest pain

- SOB

- Wheezing

- Whooping cough or croup

- Failed medication

- Suspected ADR

- Recurrent nocturnal cough

22

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

23

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

24

What are expectorants claimed to do?

Promote expulsion of bronchial secretions

25

When are suppressants useful?

Where there is no identifiable cause

26

Give some examples of cough suppressants

Codeine/pholcodine

Dextromethrophan

Demulcents

27

What are the advantages of using phlocodine over codeine for cough?

Fewer side effects

Less liable to be abused

28

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

Drowsiness

29

Is Dexthromethorphan more or less potent that codeine and pholcodine?

Less potent

Can be given to children over 6

30

Give some examples of demulcents

glycerine

lemon and honey

simple linctus

useful for their soothing effects

31

What is the dose required in adults to produce expectoration with Gauifenesin?

100-200mg

For any product to have an effect, must have a sufficiently high dose

32

What other constituents can be used in cough remedies?

Antihistamines

Sympathomimetics

Theophylline

33

Give some examples of antihistamines used in OTC cough products?

Diphenhydramine (benylin original)

Promethazine

(Anticholinergic actions help)

34

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

35

What are the interactions with antihistamines for cough?

Alcohol

TCA's

Phenothiazines

36

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

37

Can be sympathomimetics be useful in combination?

Yes with expectorants

as part of an expectorant/decongestant combination

38

Who should sympathomimetics be used in caution in?

Hypertension

Diabetes

Hyperthyroidism

CHD

39

What interactions are associated with sympathomimetics?

Monamine oxidase inhibitors

Beta blockers

TCA's

Reversible inhibitors of monamine oxidase A

40

Why is theophylline sometimes included in cough remedies?

For its bronchodilator effect]

Not recommended in children

41

What diabetics prefer to use for their cough?

Sugar free preparations

42

When can steam inhalations be useful in coughs?

Particularly in productive coughs

43

What general advice is there for patients who have coughs and colds?

Increase fluid intake

Can help hydrate the lungs and hot drinks can soothe the throat