Coughs Flashcards

1
Q

T/F: coughs are not important defensive respiratory tract reflex

A

F

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2
Q

Coughs are the most common…

A

symptom for pt seeking healthcare

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3
Q

Coughs are often one of the most…

A

irritating and longest lasting symptom

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4
Q

More than _____ spent annually on OTC cough products

A

$4 billion

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5
Q

Coughs are a symptom of…

A

diverse infectious and noninfectious disorders

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6
Q

Coughs are initiated by…

A

stimulation of chemically and mechanically sensitive, vagally mediated sensory pathways in layngeal, esophageal, and tracheobronchial airway epi

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7
Q

What processes sensory input and stimulate motor efferents for coughs?

A

complex medullary brainstem network “cough control center”

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8
Q

Pathophysiology of coughs:

A
  1. deep inspiration followed by closure of glottis and forceful contraction of chest wall, abdominal wall, nad diaphragmatic muscles
  2. glottis opens, air is expelled and propels mucus, cellular debris, and foreign material out of respiratory system
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9
Q

Causes of coughs:

A
  • airway inflammation
  • excess mucus production
  • post nasal drip
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10
Q

Classifications of coughs:

A
  • acute
  • subacute
  • chronic
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11
Q

Duration of acute coughs:

A

< 3 weeks

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12
Q

Etiology of acute coughs:

A
  • viral URTI
  • pneumonia
  • acute left ventricular failure
  • asthma
  • foreign body aspiration
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13
Q

Duration of subacute coughs:

A

3-8 weeks

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14
Q

Etiology of subacute coughs:

A
  • post-infectious cough
  • bacterial sinusitis
  • asthma
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15
Q

Duration of chronic coughs:

A

> 8 weeks

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16
Q

Etiology of chronic coughs:

A
  • upper airway cough syndrome (UACS)
  • asthma
  • GERD
  • COPD
  • ACE inhibitors
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17
Q

Symptoms of productive cough:

A
  • wet/chesty cough
  • expels secretions from lower respiratory tract
  • secretions are typically clear w/ bronchitis and purulent w/ bacterial infections
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18
Q

Symptoms of nonproductive cough:

A
  • dry/hacking cough
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19
Q

Nonproductive coughs are associated w/…

A
  • viral infections
  • bacterial infections
  • GERD
  • cardiac disease
  • meds (ACE inhibitor)
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20
Q

Complications of coughs:

A
  • exhaustion
  • insomnia
  • musculoskeletal pain
  • hoarseness
  • sore throat
  • excessive perspiration
  • urinary incontinence
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21
Q

Exclusions for self-treatment:

A
  • w/ fever
  • chest pain
  • shortness of breath
  • suspected drug associated cough
  • children < 4 YO
  • lasts > 7 days
  • cough that produces thick yellow, tan, or green mucus
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22
Q

Duration of therapy for cough from viral URTIs:

A

2 weeks

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23
Q

Duration of therapy for post-viral coughs:

A

> 3 weeks

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24
Q

Duration of therapy for coughs from other respiratory infection:

A

3-4 weeks

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25
Treatment goals of coughs:
- reduce bothersome symptoms - prevent transmission to others - reduce # and severity of episodes - prevent complications
26
Non-pharm of cold relief:
- non-medicated lozenges - humidification - promotion of nasal drainage (rubber bulb for < 2 YO) - hydration: helps form less viscous secretions
27
Pharm therapy of cold relief:
- cough suppressants (antitussive) - expectorant (protussive) - combination products
28
Examples of cough suppressants:
- codeine - dextromethorphan - diphenhydramine - chlophedianol
29
Example of expectorants:
guaifenesin
30
MOA of cough suppressants:
- decreases sensitivity of cough receptors | - interrupts cough impulse transmission by depressing the medullary cough center
31
Cough suppressants treat...
nonproductive coughs
32
Types of antitussive agents:
- systemic | - topical
33
Examples of systemic antitussive agents:
- codeine - dextromethorphan - chlophedianol
34
Examples of topical antitussive agents:
- camphor | - menthol
35
MOA of codeine:
acts centrally on medulla to increase the cough threshold
36
Indication of codeine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract irritation
37
Dosage of codeine:
10-20 mg Q4-6H
38
Onset of therapy of codeine:
15-30 minutes
39
Action of codeine occurs...
4-6H
40
Adverse effects of codeine:
- GI: nausea, vomiting, constipation - CNS: sedation, dizziness - respiratory depression w/ overdose
41
Drug interactions of codeine:
- other CNS depressants (sedatives, alcohol) | - other respiratory depressants (alcohol)
42
Pts that need to take caution w/ codeine:
- asthma/COPD | - at risk for drug abuse/misuse
43
Codeine is available with/without prescription
without
44
Codeine is a schedule ____ drug:
5
45
T/F: abuse is uncommon w/ codeine
F, also known as "purple drank"/"lean"
46
Lethal dose of codeine is...
0. 5-1g | - causes death from respiratory depression and cardiopulmonary collapse
47
Codeine OTC sales may contain no more than...
65 mg in 30 mL (10mg/5mL)
48
MOA of dextromethorphan:
acts centrally in medulla to increase cough threshold (NMDA receptor antagonist)
49
Indication for dextromethorphan:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract infection
50
Dosage of dextromethorphan:
- 10-20 mg Q4H | - 30 mg Q6-8H
51
Onset of dextromethorphan:
15-30 minutes
52
Peak effect of dextromethorphan:
2-3 H
53
Adverse effects of dextromethorphan:
- GI: discomfort, nausea, vomiting constipation - CNS: drowsiness - respiratory depression w/ overdose
54
Drug interactions w/ dextromethorphan:
- other CNS depressants (alcohol, antihistamines) | - MAO inhibitors can cause serotonergic symptoms
55
Examples of serotonergic symptoms:
- hypertension - fever - arrhythmias - seizures
56
Dextromethorphan abuse has occurred in 1 in ___ american teenagers:
10 | - more than cocaine/ecstasy/LDS/meth in this age group
57
Dextromethorphan abuse occurs more commonly in:
male adolescents
58
Dextromethorphan abuse occurs b/c:
- cheap and easily obtained | - hard for parents/guardians to detect DXM abuse
59
Dextromethorphan can cause...
hallucinatory and dissociative effects
60
Euphoric effects of dextromethorphan are called...
robo-tripping
61
MOA of diphenhydramine:
- nonselective 1st gen antihistamine - acts centrally in medulla to increase cough threshold - significant sedating and anticholinergic properties
62
Indication of diphenhydramine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract
63
Dosage of diphenhydramine:
25 mg Q4H
64
Onset of diphenhydramine:
30-60 minutes
65
Peak effect of diphenhydramine:
2H
66
Adverse effects of diphenhydramine:
- dizziness - drowsiness - sedation - dryness of eyes and mucous membrane - blurred vision - constipation
67
Which topical cough suppressants are the only FDA approved ones?
- menthol | - camphor
68
MOA of topical cough suppressants:
stimulates sensory nerve endings w/in nose and mucosa, which creates local anesthetic sensation and sense of improved airflow
69
Indication for topical cough suppressants:
cough
70
Onset of action for topical cough suppressants:
immediate
71
Adverse effects of topical cough suppressants:
burning sensation in the mouth
72
Ingestion of 4 tsp of 5% camphor product has been shown to be...
lethal in children
73
Administration of ointments:
- rub on throat and chest in thick layer - repeat up to Q8H - loosen clothing around throat and chest - cover w/ warm, dry cloth
74
Administration of lozenges:
allow lozenge to dissolve slowly in mouth QH
75
Administration of inhalations:
- place water in vaporizer - place solution in medication chamber - breathe in vapors Q8H
76
MOA of guaifenesin:
loosens and thins lower respiratory tract secretions, making minimally productive coughs more productive
77
Indication of guaifenesin:
symptomatic relief of productive coughs | - only FDA approved expectorant
78
Dosage of guaifenesin:
200-400 mg Q4H
79
Onset of action for guaifenesin:
15-30 minutes
80
Adverse effects of guaifenesin:
- dizziness - headache - rash - drowsiness - stomach pain
81
Cough combination medications:
- antitussive w/ expectorant | - topical products
82
Examples of antitussive w/ expectorant:
- guaifenesin and codeine | - guaifenesin and dextromethorphan
83
Examples of topical products:
- camphor | - menthol
84
T/F: cough combination medications are inconvenient
F
85
Cough combination medications carry the risk of...
unnecessary drug therapy
86
According to ACCP 2006 cough guidelines, you should recommend...
- combination of 1st gen antihistamine and decongestant to treat virus induced post-nasal drip and resolve cough - codeine/DXM for short term symptomatic relief of cough associated post infection - doesn't say anything about guaifenesin
87
Pregnant women should be recommended _____ first
non-Rx products
88
Pregnant women can take...
codeine/DXM
89
Breastfeeding women should not take codeine and diphenhydramine b/c...
it's excreted in breast milk | - can irritate and decrease milk flow
90
It's unknown if _____ is secreted in breast milk
DXM
91
Elderly pt are more susceptible to...
- codeine - DXM - diphenhydramine
92
January 2008 FDA public health advisory states that children < 2 should avoid use of...
OTC cough and cold medications | - potential serious and life threatening adverse effects