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OTC > Cough and Cold > Flashcards

Cough and Cold Flashcards

1
Q

How many colds do children have yearly?

A

6-10

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2
Q

How many colds do adults < 60 have yearly?

A

about 2-3

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3
Q

How many colds do adults > 60 have yearly?

A

about 1

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4
Q

Etiology of common cold

A

> 200 viruses (majority are rhinoviruses)

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5
Q

Cold season in US

A

August - April

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6
Q

Risk factors for common cold

A

smoking, allergic disorders affecting the nose or pharynx, increased population density in classrooms or daycare, sedentary lifestyle, less diverse social networks, chronic stress, sleep deprivation

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7
Q

Transmission of cold

A

usually self-inoculation; aerosol transmission can occur

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8
Q

signs and symptoms of cold caused by

A

direct tissue damage by virus and inflammation

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9
Q

first day of cold

A

sore throat, sneezing (virus first colonizes nasopharynx)

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10
Q

day 2-3 of cold

A

nasal symptoms; clear nasal secretions initially, turning thick and yellow later

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11
Q

days 4-5 of cold

A

cough may develop (about 30%)

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12
Q

T/F: low grade fever can be symptom of cold

A

true (< 100.4 degrees)

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13
Q

duration of common cold

A

can take 7-14 days to resolve

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14
Q

cold treatment goals

A
  • reduce bothersome symptoms

- prevent transmission to others

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15
Q

cold prevention strategies

A
  • CDC recommends frequent handwashing with soap and water or hand sanitizers
  • avoid touching nose, eyes, and mouth
  • use viral disinfectants and antiviral tissues to help prevent transmission
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16
Q

Exclusions for self treatment of common cold

A
  1. fever > 100.4
  2. chest pain
  3. shortness of breath
  4. worsening of symptoms or additional symptoms while self treating
  5. concurrent underlying chronic cardiopulmonary disease
  6. AIDS or chronic immunosuppressant therapy
  7. frail patients of advanced age
  8. infants younger than or equal to 3 months
    9, hypersensitivity to OTC recommendations
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17
Q

Non pharmacologic treatment of common cold

A

rest, fluid intake, warm fluids, vaporizers/humidifiers, saline nasal spray, nasal strips, aromatic oils, removal of nasal secretions in children < 4 w nasal aspirator

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18
Q

treatment if congestion and rhinorrhea most problematic

A

saline nasal spray or decongestant +/- humidifier/vaporizer

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19
Q

treatment if aches and pains are most problematic

A

systemic analgesics

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20
Q

treatment if fever is most problematic

A

systemic antipyretics

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21
Q

treatment if pharyngitis is most problematic

A

saline gargles or local anesthetic sprays/lozenges

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22
Q

treatment if sleeplessness is problematic

A

switch to nasal decongestant or use antihistamines and alcohol containing products only at night

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23
Q

indications for decongestants

A

nasal and eustachian tube congestion, cough associated w/ post nasal drip

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24
Q

MOA for direct acting decongestants

A

alpha-adrenergic agonists; constrict blood vessels which decreases vessel engorgement and mucosal edema; relieves congestion, not rhinorrhea

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25
Q

direct acting decongestants

A

phenylephrine, oxymetazoline, and tetrahydrozoline, and pseudoephedrine

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26
Q

MOA for indirect acting decongestants

A

displace NE from storage vesicles in pre-junctional nerve terminals

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27
Q

indirect acting decongestants

A

ephedrine and pseudoephedrine

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28
Q

adverse effects of decongestants (especially with oral)

A
  1. more common in systemic than topical
  2. children/older adults more susceptible
  3. DO NOT OVERDOSE
  4. CV - hypertension, tachycardia, arrhythmias
  5. CNS - restlessness, insomnia, anxiety, tremors
  6. Diseases sensitive to stimulation: hyperthyroidism, HTN, diabetes, CHD, IHD, glaucoma, BPH
  7. DDI - MAOIs, TCAs, methyldopa, antacids
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29
Q

pseudoephedrine

A
  • direct and indirect
  • well absorbed orally
  • not subject to first pass liver metabolism
  • half life greater than 6 hours
  • adult dose: 60mg q4-6h (240mg/day max)
  • behind the counter
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30
Q

phenylephrine

A
  • direct acting
  • oral bioavailability around 38%
  • 1st pass liver metabolism
  • half life 2.5 hours
  • adult dose: 10mg q4h (60mg/day max)
  • OTC
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31
Q

short acting topical decongestants

A

phenylephrine and naphazoline

dose q4-6h

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32
Q

intermediate acting topical decongestants

A

xylometazoline

dose q8-10h

33
Q

long acting topical decongestants

A

oxymetazoline; less like to cause rebound congestion than short acting
dose q10-12h

34
Q

dosage forms of topical decongestants

A

sprays, drops, inhalers

35
Q

rhinitis medicamentosa (RM)

A

rebound congestion

associated with long duration of topical decongestants, preservatives

36
Q

duration of use of topical decongestants

A

3-7 days max

37
Q

treatment of RM

A

slow withdrawal (2-6 weeks); wean off one nostril at a time, switch to saline spray, nasal steroids in severe cases. symptoms subside after 1-2 weeks decongestant free

38
Q

administration of nasal sprays

A
  • insert into one nostril

- keep head upright and sniff deeply while squeezing bottle

39
Q

administration of nasal inhalers

A
  • warm inhaler in hand
  • insert inhaler tip into nostril, sniff deeply
  • wipe inhaler after each use
40
Q

administration of pump nasal sprays

A
  • prime for first use
  • hold bottle between first two fingers and thumb on bottom of bottle
  • tilt head forward
  • insert nozzle tip and sniff deeply
41
Q

administration of nasal drops

A
  • lie on bed with head tilted back
  • squeeze bulb to withdraw medication
  • place drops into one nostril and tilt head side to side
  • do not rinse dropper
42
Q

local anesthetics

A

benzocaine, phenol, menthol, dyclonine HCl

43
Q

antihistamines have use in treating cold?

A

may provide some relief in adults if started early in course of a cold

44
Q

local anesthetics are used every

A

2-4 hours

for temporary relief only

45
Q

Systemic analgesics effective for

A

aches or fevers sometimes associated with colds

46
Q

NSAIDs or APAP more effective in cold?

A

NSAIDs, because of anti-inflammatory activity

47
Q

pregnancy/lactation and cold

A
  • consider r v. b assessment before any drug therapy
  • non drug therapy preferred
  • avoid any long acting, max strength, or combination
48
Q

topical decongestant preferred in pregnancy

A

oxymetazoline - however decongestants in general are not preferred

49
Q

decongestants compatible in breast feeding

A

pseudoephedrine

50
Q

older patients and decongestants

A

use with caution due to increased AE and prevalence of concomitant disease states

51
Q

Children and decongestants

A
  • nothing for < 2 years
  • discouraged in < 4 years
  • avoid combo products
52
Q

Complementary therapies for cold

A
  • zinc
  • vitamin C
  • vitamin D
  • probiotic products
  • airborne
53
Q

pathophysiology of cough

A

chemical or mechanical stimuli typically responsible for triggering our involuntary cough center in the medulla oblongata

54
Q

productive cough

A

wet or chesty cough

55
Q

non productive cough

A

dry or hacking cough

56
Q

acute cough
subacute
chronic

A

< 3 weeks
3-8 weeks
> 8 weeks

57
Q

goals of treating cough

A
  • reduce number and severity of cough episodes

- prevent complications

58
Q

exclusions of self treatment of cough

A
  1. dyspnea, SOB
  2. cyanosis
  3. hemoptysis
  4. weight loss
  5. night sweats
  6. cough worsens after 3-5 days
  7. cough doesn’t improve 2-3 weeks
  8. temp > 100.4 or temp > 100 for more than 3 days
  9. barking cough, whooping sound, cough begins suddenly w/o fever or URI symptoms
  10. immunocompromised status
  11. history of exposure to TB
  12. risk factors for HIV
  13. chronic illness
59
Q

nonpharmacologic treatment of cough

A

lozenges, hydration, humidification

60
Q

dry cough treatment

A

cough suppressant

61
Q

wet/productive cough treatment

A

expectorant

62
Q

ACCP cough guidelines

central cough suppressants

A

ineffective in cough associated with common cold

63
Q 
ACCP cough guidelines
pediatric patients (<14)
A

no Otc medications recommended

64
Q

cough suppressants

A

codeine, dextromethorphan, diphenhydramine HCl, Clophedianol

65
Q

codeine MOA

A

act centrally in medulla to increase cough threshold

66
Q

Codeine

A
  • might be useful for cough from bronchitis
  • schedule V drug; abuse potential
  • adult dose: 10-20 mg q4-6h (max 120mg/day)
67
Q

dextromethorphan MOA

A

act centrally in medulla to increase cough threshold

68
Q

dextromethorphan

A
  • codeine analogue

- adult dose: 10-20mg q4h or 30mg q6-8h (max 120 mg/day)

69
Q

diphenhydramine HCl

A
  • not first line
  • also acts in medulla to increase cough threshold
  • adult dose: 25mg q24h (max 150/day)
70
Q

clophedianol

A
  • only available in combo
  • centrally acting
  • side effects: excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria
71
Q

guaifenesin MOA

A

loosens and thins lower RT secretions making minimally productive coughs more productive

72
Q

guaifenesin

A
  • adult dose 200-400mg q6h (max 2.4g/day)

- drink pent of water

73
Q

topical antitussives

A

camphor and menthol (VICKX VAPORUB)

only in ages two and older

74
Q

MOA of topical antitussives

A

stimulate nerve endings in nose, pt feels like they have improved airflow

75
Q

dosage forms of topical antitussives

A

ointment, cream, patch, steam, lozenge

76
Q

ingredients in baby rub

A

eucalyptus, lavender, aloe, rosemary

77
Q

cough medications and pregnancy/lactation

A
  • diphenhydramine considered sage

- codeine only used if risks outweigh benefits

78
Q

cough medications and older patients

A
  • may be more susceptible to sedating effects of codeine
  • diphenhydramine may cause paradoxical excitation, restlessness, irritability, dizziness, sedation, syncope, confusion, or hypotension

OTC (22 decks)

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