Exam 3: Cough Flashcards
(47 cards)
Cough: Mechanical stimulus
Mucus or nasal drippings down throat
Cough: Chemical stimulus
Breathing in chemicals in the air (teargas, cigarette smoke, etc.)
Cough: Physiology
Vagus and superior laryngeal nerves to cough center in brainstem, leads to complex series of involuntary muscular actions (cough reflex)
Cough: Causes
Common cold, viral infxn, pulmonary embolism, pneumonia, post nasal drip/upper airway cough syndrome (UACS), asthma, bronchitis, GERD, CHF, Meds (ACEI/BB)
Cough categories: Duration: Acute
≤3 weeks
Usually attributed to upper respiratory tract infection or cold
Only type of cough that should be self-treated OTC
Cough categories: Duration: Sub-acute
3-8 weeks
Cough categories: Duration: Chronic
≥8 weeks
Usually attributed to many things: meds, asthma, COPD, GERD
Cough categories: productivity: productive vs non-productive
Productive: produces phlegm/mucus/sputum
Non-productive: dry cough
Cough categories: Effectiveness: Effective vs Ineffective cough
Effective: successfully clears airway of phlegm/mucus/sputum
Ineffective: does not successfully clear airway
Upper Airway Cough Syndrome (UACS) formerly known as ___
Post-nasal drip syndrome
Upper Airway Cough Syndrome (UACS) def
Situation where a productive or nonproductive cough is associated with other upper respiratory symptoms such as nasal congestion, runny nose, tickle in throat, throat clearing
Nasal secretions drip and irritate throat and produce cough
Pt may not make association bt cough/nasal sx
**Often more at night when pt is laying down
Complications of untreated cough
Exhaustion Insomnia Musculoskeletal pain Hoarseness Excessive perspiration Urinary incontinence
Cough Treatment Goals
Reduce freq and severity of cough episodes
Prevent complications
Cough Self-care Exclusions
Cough with any of: chest pain, chills, cyanosis, fever, hemoptysis, lower extremity edema, night sweats, persistent headache, rash, SOB, throat tightness, unintended weight loss
Duration >7 days Foreign object inhalation/aspiration H/o cough associated with asthma/COPD Drug associated cough worsens/develops new symptoms during self-treatment
Cough Non-Pharm Treatment
Adequate hydration/fluids
Vaporizers and humidifiers
Non-medicated cough drops, lozenges, hard candies
Honey (1/2-1tsp prn, increases saliva prod and reduces irritation, caution for DM pts)
There is evidence honey is just as good as ____
Dextromethorphan
Cough Treatment Options: Step 1
Identify type of cough: non-productive/productive, UACS
Cough Treatment Options: Step 2
Select approrpaite agent based on type of cough and pt-specific factors
Cough Treatment Options: Step 3
Select appropriate dosage form
- Infants/young children: liquid suspensions (shake before use)
- Children >4yo: chewable/meltaway tabs
- adults: regular or ER tabs
Nonproductive Cough Treatment: 3 Options
OTC Oral antitussives, OTC topical antitussives, Rx Oral antitussives
OTC Oral antitussives examples
Codeine
Dextromethorphan (Delsym, Robitussin)
OTC oral antitussives: Codeine: MOA
Opioid agonist, centrally acting (increases threshold for cough reflex in cough center
OTC oral antitussives: Dextromethorphan: MOA
NMDA antagonist, centrally acting (increases threshold for cough reflex in cough center)
OTC oral antitussives: ADE/DDI
ADE: may cause CNS depression, N/V, drowsiness
DDI: MOAis
