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DEENT Exam 2 > Lecture 6 > Flashcards

Lecture 6 Flashcards

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1
Q

What is the common cold?

A

A viral infection of the upper respiratory tract.

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2
Q

Colds are self-limiting with a standard duration of?

A

7-14 days

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3
Q

Who has an increased susceptibility of the cold?

A

Patients with higher exposure rates, allergic disorders, smokers, sedentary lifestyle, chronic psychological stress (> 1 month) and sleep deprivation (

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4
Q

What are the physical assessment findings for cold?

A

Slightly red throat with evidence of postnasal drainage.
Nasal congestion.
Mildly to moderately tender sinuses on palpation.

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5
Q

Describe a cough caused by a cold.

A

Acute(lasting less than 3 weeks). Not subacute or chronic. May be productive or nonproductive (these differences do not change treatment).

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6
Q

Color and thickness of sputum do not indicate presence or absence of bacteria. T/F

A

True

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7
Q

What are the exclusions for self-treatment of acute cough?

A 
Fever > 103
Chest pain
Shortness of breath
Cough > 7 days
Worsening symptoms or additional symptoms
Asthma, COPD, CHF (swollen legs and ankles)
Unintended weight loss
Drenching nighttime sweats
Hemoptysis
Foreign object aspiration
Suspected drug associated cough
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8
Q

What are the exclusions for self-treatment of upper respiratory viral illness?

A

Fever > 101.5
Chest pain
Shortness of breath
Worsening symptoms or additional symptoms
Concurrent underlying chronic cardiopulmonary disease (asthma, COPD, HF)
AIDS or immunosuppressant therapy
Frail patients of advanced age.
Hypersensitivity to recommended OTC medications
Infants less than 9 months of age

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9
Q

What is the treatment goal for a fever?

A

alleviate the discomfort

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10
Q

What type of prevention can you use to prevent the common cold?

A 
Hand hygiene
Soap or soap substitutes
Hand sanitizers  with ethyl alcohol or triclosan (high resistant rates)
Antiviral disinfectants (Lysol)
Antiviral tissues
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11
Q

What nonpharmacological treatment would you use for pharyngitis?

A 
Rest
Hydration
Non-medicated lozenges or hard candies
Honey
Chicken-soup, broths, tea
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12
Q

What nonpharmacological treatment would you use for cough?

A 
Rest
Hydration
Non-medicated lozenges or hard candies
Honey
Humidifiers
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13
Q

What nonpharmacological treatment would you use for congestion?

A 
Rest
Hydration
Nasal strips
Position for nasal drainage
Nasal irrigation with saline or bulb syringe removal
Humidifiers
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14
Q

What nonpharmacological treatment would you use for rhinorrhea?

A

Rest
Hydration
Position for nasal drainage
Nasal irrigation with saline or bulb syringe removal

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15
Q

What is the pharmacological treatment would you use for nasal congestion?

A

Oral and topical decongestants

TOPICAL Antitussives

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16
Q

What is the pharmacological treatment would you use for rhinorrhea/sneezing?

A

First generation oral antihistamines IN COMBINATION with decongestant

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17
Q

What is the pharmacological treatment would you use for pharyngitis?

A

Local anesthetics

Systemic analgesics

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18
Q

What is the pharmacological treatment would you use for cough due to common cold?

A

First generation oral antihistamines and long acting decongestant
or
Naproxen
(Do not use expectorants or antitussives)

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19
Q

What is the pharmacological treatment would you use for myalgia, arthralgia, and headache?

A

Systemic analgesics

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20
Q

What is the pharmacological treatment would you use for fever?

A

Systemic analgesics

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21
Q

What should the general approach to treatment of a URI be?

A

Treat cough according to cough guidelines if patient has cough.
Treat other symptoms based on the chart. Combination products should be avoided due to the variation in symptom presentation.

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22
Q

What should be the treatment of cough and cold in children?

A

The FDA guidelines shows that cough and cold products should not be used until children are over the age of 2.
Manufacturers extended their warnings to patients less than 4 years and some even 6 years old.

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23
Q

When recommending a cold medication to a pregnant or breastfeeding patient what should you remember?

Study These Flashcards
A

Avoid max or extra strength products. Drugs that have been used a long time are generally preferred to newer agents due to historical use. Topical or local dosage forms are usually a safer choice than oral dosage forms. Try to recommend non-drug therapy whenever possible.

24
Q

When recommending a cold medication to a elderly person what should you remember?

Study These Flashcards
A

> 65 years
Start Low and Go Slow
Beers criteria
Avoid 1st generation antihistamines

25
Why are 1st generation antihistamines preferred over 2nd generation antihistamines for treatment of cough?
Due to their anticholinergic effects
26
What is the onset of 1st generation AH?
15-30 minutes
27
Of the first generation AH which one is the drug of choice for pregnant woman?
chlorpheniramine 4mg every 6-8 hours- may decrease milk production
28
Which 1st generation AH is Rx?
Brompheniramine (the adult one)- in combination | Promethazine (OTC/Rx) - in combination with codeine
29
What are the first generation antihistmaines?
``` Diphenhydramine 25-50mg Q6-8h Chlorpheniramine 4mg Q6-8h Clemastine Brompheniramine (pediatric and adult) Promethazine ```
30
What do decongestants do?
Intranasal and oral decongestants target nasal congestion. They can also alleviate sinus pressure, sinus headaches, and ear congestion. Should be used in short course.
31
Oral decongestants should be used with caution in what type of patients?
``` Patients with Cardiovascular disease Hypertension Hyperthyroidism Benign prostatic hyperplasia (BPH) Glaucoma Contraindicated with or within 14 days of MAOI ```
32
What are the most common adverse events associated with decongestants?
insomnia agitation tachycardia anorexia
33
What is the new formulation of pseudoephedrine that prevents tampering?
phenylephrine (Nexafed)
34
What is important about pregnant/breastfeeding woman and oral decongestants?
Can cause gastrocschisis(baby born with intestines outside of their body ;( can reduce milk production
35
Intranasal decongestants are very effective, however, they are limited by...
rhinitis medicamentosa (rebound congestion) thus the length of duration should be limited to 3-5 days
36
What are the options you can recommend if someone has rebound congestion?
Quit cold turkey. Rebound congestion will start to be relieved in a few days. Alternate nostrils (1 spray in left nostril in morning and 1 spray in right nostril at night) for a few days (no more than 3) and then discontinue use. Switch from topical agent to oral decongestant or intranasal corticosteroid for several days.
37
Which intranasal decongestant is preferred in pregnancy and children?
oxymetazoline for pregnant woman | none should be used for children less than 12
38
What is the dose that should be used for intranasal decongestants?
Oxymetazoline 2-3 drops per nostril Q12h Phenylephrine 2-3 drops per nostril Q4H Both are OTC
39
What should you know about dextromethorphan?
The adult max is 120 mg per day with an onset of action of 15-30 minutes. Pregancy category of C and lactation risk is unknown. DDI: MAOIs, additive CNS affects with alcohol, 1st generation antihistamines, and benzodiazepines. Robotrippping - abuse of dextromethorphan There is a lack of evidence supporting the use of dextromethorphan or codeine for the treatment of acute cough due to common cold.
40
What are the oral antitussives?
``` Dextromethorphan (OTC) Chlophedianol (OTC) Codeine (OTC/Rx) Hydrocodone (Rx) Benzonatate (Rx) ```
41
What should you know about topical antitussives?
available in ointments, lozenges, and inhalation. Weak evidence to support the use of these products in cough. Generally recognized as safe in pregnancy. Works within minutes.
42
How often should local anesthetics be used?
every 2-4 hours with a max of 12 a day
43
What should you know about local anesthetics?
Available in lozenges, troches, mouthwashes, and sprays. Pregnancy category for class is C. Avoid benzocaine if patient is allergic to caines. Methemoglobinemia(abnormal amount of methemoglobin is produced making it unable to release oxygen effectively to body tissues) may occur. May cause numbing or taste perversion.
44
What are the topical antitussives/anesthetics?
``` Menthol Camphor and menthol benzocaine dyclonine phenol pectin ```
45
How should you administer a topical antitussive ointment?
Rub on the throat and chest as a thick layer; application may be repeated up to 3 times daily or as directed by primary care provider; loosen clothing around throat and chest so vapors reach the nose and mouth; cover with a warm, dry cloth (optional). Do not use in the nostrils, under the nose, by the mouth, on damaged skin, or with tight bandages.
46
How should you administer a topical antitussive lozenges?
Allow lozenge to dissolve slowly in mouth; repeat hourly or as needed or as directed by a primary care provider.
47
How should you administer a topical antitussive inhalation?
For product to be added directly to cold water for use in a steam vaporizer: Add measured solution to cold water; place the mixture in the vaporizer; breathe in the medicated vapors up to 3 times daily. For products to be placed in the medication chamber of a hot steam vaporizer; Place water in vaporizer; place solution in medication chamber; breathe in the medicated vapors up to 3 times daily.
48
What are expectorants?
They work to increase the volume of secretions and reduce the viscosity of secretions in the trachea and bronchi, allowing for increased cough to expel secretions. Pregnancy category C. Adverse effects are uncommon and drug interactions are unlikely. Do not used OTC combination products that combine guaifensin and dextromethorphan because of their opposing MOA. Lack of evidence supporting the use of this product.
49
What is influenza?
A highly contagious viral disease from the orthomyxoviridae family. Types A and B causes disease in humans. Incubation period is 1 to 4 days with an average of 2 days.
50
How are influenza A viruses subtyped?
Based on the change in 2 surface antigens: Hemagglutinin and neuraminidase. (H1N1)
51
How are influenza B viruses subtyped?
The are not subtyped.
52
What does Hemagglutinin do?
Allows for viral entry into the host cells and has 16 subtypes (H1-H16).
53
What does Neruaminidase do?
Allows for release of new viral particles from host cells and has 9 subtypes. (N1-N9)
54
What are the influenza symptoms?
Abrupt onset with a duration of 3 to 7 days and include fever, myalgias, arthralgias, fatigue (can continue for greater than 2 weeks), pharyngitis, nonproductive cough ( can continue for greater than 2 weeks), headache, and anorexia.
55
What are the treatment goals for the flu?
``` Control symptoms Prevent complications Decrease work or school absences Prevent transmission Minimize medication adverse effects ```
56
What is the pharmacological treatment for the flu?
Treatment is based upon symptoms present

DEENT Exam 2 (7 decks)

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