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Flashcards in Cough Meds Deck (24)
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How do you define acute cough? What treatment is required?

Acute cough: < 3wk duration

Generally does not require pharm tx, especially in children

Suppression of cough may be harmful

Eliminate underlying causes and any precipitating factors


Tell me about Honey, Honey

Single nocturnal dose to relieve airway irritation and decrease cough

As effective in suppressing cough as dextromethorphan (DM)


What's the origin of DM?

OTC derivative of morphine w/no analgesic or addictive properties at recommended doses

May reduce cough severity

Has NOT been shown to be effective or safe in young children


What are DM ADRs?

Normal dose:
- CNS (confusion, excitement, irritability, nervousness)

High dose: NV, HA

Extreme high dose: euphoria and robo tripping


Codeine Pk

Codeine --> 2D6 --> Morphine

Effective in suppressive cough

May produce analgesic and antitussive effects


Who should you avoid using codeine in?

Do NOT use in pt < 18yo

Concerns of respiratory depression and death in children


What is a prescription alternative to opioids for suppression of SEVERE cough?

- liquid-filled capsule
- C.I. in kids < 10yo


Benzonatate ADRs

Risks associated w/benzonatate clearly outweigh its benefits**

- Nausea
- CNS (dizzy, HA, sedation, confusion, hallucination)
- chest numbness

** FDA warning - single capsule can be fatal for young children **


What is Guaifenesin MOA?

Increase volume of secretions in respiratory tract --> facilitate removal of viscous mucus by coughing

ER tab C.I. < 12yo
Rec dose = generally considered safe


When would you use antihistamines for cough?


Reduce cough by reducing postnasal drip

ADRs: classic anticholinergic effects


When would you use decongestants for cough?


May help reduce coughing by reducing PND

Not rec for children < 4yo

C.I. w/in 14d of MAOI


What is the main OTC decongestant?


Pseudoephedrine (METH HEAD) products are more difficult to obtain


Decongestants ADRs

(Act as sympathomimetics)

1. increase HR/BP
2. transient CNS effects (excitability, insomnia, HA, nervousness, confusion, dizziness)
3. dry nose/throat, rebound nasal congestion


When would you use SABAs or SAMAs to treat cough?

If the cough has a bronchospastic component


When would you use corticosteroids for a cough?

Inhaled & PO corticosteroids have been used for tx of cough in pt w/out asthma


Cough General Recommendations


1. Saline nasal sprays & fluids
2. Mist inhaler (e.g. humidifier)
3. Sialagogues
4. Honey (up to 2tbs) qhs (if > 12mo)
5. Menthol or camphor rubs are okay for adults (Vicks VapoRub)


Adults: Cough Secondary to Common Cold/PND

Step 1. Antihistamine-decongestant combos
- combo w/1st gen antihistamine have more drying effects
- pseudoephedrine > phenylephrine

Step 2. Naproxen** (reduce inflammation)

Step 3. Inhaled ipratropium - cough persisting 3-8wk)

Step 4. ICS, if ipratropium does not work

Step 5. DM or codeine NOT rec for acute cold cough


Kids: Cough Secondary to Common Cold/PND (stepwise)

Step 1. Saline nasal spray/fluid to relieve nasal congestion/dryness

Step 2. Topical antitussives (Vicks, VapoRub) - inhaling camphor/menthol/eucalyptus helps w/cough and congestion
- local anesthetic sensation and improved airflow

Step 3. Honey can relieve cough by increasing saliva --> coats larynx and relieves irritation
- NO Honey in < 1yo (botulism)

Do NOT rec Codeine or DM containing products


Adults: Acute bronchitis & Cough

Acute bronchitis - cough lasts up to 3wk, only sometimes productive

- DON'T routinely prescribe Abx
- Short-term Codeine or DM MIGHT help
- Save bronchodilator for pt who wheezes


Adults: Chronic bronchitis & Cough

Chronic bronchitis: productive cough occurring most days for 3 or more months/yr for at least 2 years

- eliminate irritants
- treat per COPD


Describe when you would use guaifenesin with bronchitis?

Don't give expectorants (guaifenesin)

Not enough evidence they are effective


Who should you avoid cough & cold meds in?

These meds withdrawn d/t concerns about efficacy and safety (e.g. seizures, OD)

NOT recommended in kids < 4yo


How can you use saline nasal sprays/fluids in children?

Infants: saline drops to loosen mucus, then suction w/bulb syringe

Humidifiers/vaporizers add moisture to air to help ease cough/congestion


What is the warning regarding topical antitussives (Vicks VapoRub)?

Do NOT use topicals w/camphor for children <2y d/t absorption concerns and LIVER damage