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OTC Cough and Cold Flashcards

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1
Q

Special symptoms of a FLU?

A

Fever and Myalgia

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2
Q

Cause of Common Cold?

A

Viral Infection: Rhinovirus most common (~50-60)

Pathogens: respiratory syncytial virus (RSV)

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3
Q

Predictable symptoms of Common Cold?

A
  1. Sore throat 1st symptom to appear
  2. Nasal symptoms dominate days 2- 3
  3. Cough (~20%) appears by days 4- 5

Rhinovirus cold symptoms can persist for 7- 10 days

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4
Q

Complication of common cold?

A

Sinusitis, middle ear infections, bronchitis, bacterial pneumonia, and acute exacerbations of asthma/COPD

Immunocompromised patients, smokers, and patients with underlying respiratory conditions are more prone to complications

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5
Q

Goal of therapy

A

Prevent transmission of cold viruses

Reduce bothersome symptoms

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6
Q

What can prevent colds the best?

A

*Lysol – kills 99%

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7
Q

When to have Physician Referral for Common Cold?

A

Fever > 101.5 °F (38.6 °C)

Worsening of symptoms or development of additional symptoms during self-treatment

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8
Q

Nonpharmacologic Therapy for the Common Cold and Cough

A

Soothing warm food products
(i.e. tea + lemon/honey, hot broths (i.e. chicken soup)

Humidification
Steamy showers, humidifiers, or vaporizers—Babies** Steam

Medical Devices
Camphor
Menthol

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9
Q

Moisture Devices

A

Vaporizers and Humidifiers:
Increased humidity, may soothe airways and decrease cough

Humidifiers and Vaporizers
Must be cleaned DAILY and disinfected weekly

Vaporizers superheat water to produce steam (warm mist)

Humidifiers use fans or ultrasonic technology to produce a cool mist

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10
Q

Which moisture device is good for children?

A

Cool mist is preferred in children because:

(decrease) Risk of scalding/burning if tipped over

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11
Q

Vaporizers vs. Humidifiers

Vaporizers***

A

Main job is to put vapors into the air and contains a medication well or cup for inhalants

Must be cleaned daily and disinfected weekly

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12
Q

Vaporizers vs. Humidifiers

Humidifiers***

A

This moisture device is better for a larger space

Should be recommended for a child’s room

Must be cleaned daily and disinfected weekly

Both humidifiers and vaporizers put humidity into the air but this particular moisture device puts more moisture into the air

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13
Q

OTC Pharmacotherapy for the Common Cold

A

Antitussives

Expectorants

Local Anesthetics

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14
Q

Cough (description)

A

Important defensive respiratory reflex

Most common symptom for which patients seek medical care

Goal of therapy
Reduce the number and severity of cough episodes

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15
Q

Cough Classification: Acute

A

Duration: < 3 weeks

Etiology :
Viral respiratory infections, asthma

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16
Q

Cough Classification: Sub-Acute

A

Duration: 3- 8 weeks

Etiology:
Bacterial sinusitis, asthma

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17
Q

Cough Classification: Chronic

A

Duration: > 8 weeks

Etiology:
Causes in NON-smoker: postnasal drip, GERD, HF, lung disorders (chronic bronchitis, asthma, COPD)

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18
Q

Which medications can cause a cough?

A

ACE Inhibitor (bradykinin)

B-Blockers (patient Selective)

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19
Q

Types of Cough

A

Productive:
Wet of “chesty” cough

Nonproductive:
Dry or “hacking” cough

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20
Q

Questions to Ask Your Patients for the Treatment of Cough

A

What are your symptoms? Severity of symptoms?
Duration of symptoms?

What else have you tried?

Dry or wet cough?

PMH? Medication? Social history (i.e. SMOKER)

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21
Q

Physician Referral for Cough

A

Thick yellow, tan, or green mucus or pus-like secretions

Fever > 101.5°F

Cough > 7 days, or comes and goes or keeps coming back

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22
Q

Treatment Goals

A

Cough treatment is SYMPTOMATIC, the underlying disorder must be treated to stop the cause of the cough

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23
Q

Halls

Study These Flashcards
A

Vapor Action Menthol

24
Q

Antitussives (Cough Suppressants)

Study These Flashcards
A

DOC for nonproductive cough**

Control or eliminate cough

2 Different classes;
Centrally Acting Antitussives- suppress cough center in the medulla of the brain
-Codeine
-Dextromethorphan
-Diphenhydramine

Peripheral or Local Acting Antitussives

  • Camphor
  • Menthol
25
Expectorants (Protussives)
**DOC for productive cough** Changes consistency of mucous and increases expectorated sputum volume - Guaifenesin - The BEST Expectorant is WATER - -
26
What about Antitussive + Expectorant?
Never recommend Robutissum DM, or Guaifenesin DM ***UNLESS they cannot Sleep**
27
Antitussives: | Delsym
Dextromethorphan 30 mg/ 5 mL Most Potent**
28
Antitussives: | PediaCare ® Children’s
Dextromethorphan 7.5 mg/ 5 mL
29
Centrally Acting Antitussives Codeine
***Codeine*** Gold standard antitussive*** -- Cough suppessant BTC Products: Guaituss AC ®, Cheratussin AC ®, Robitussin AC AC means -> with CODIENED --Schedule C or III Chlorpheniramine stops post nasal drip*** Patients do not use in wet cough***
30
Centrally Acting Antitussives: Caution: Codeine
Caution in patients: Impaired respiratory reserve (i.e. asthma, COPD), preexisting respiratory depression, drug abusers, and patients who take other respiratory depressants or sedatives
31
Centrally Acting Antitussives: Dextromethorphan (DM) Adverse Effects: Overdose:
Usual dose: drowsiness, dizziness, nausea, vomiting, stomach discomfort, or constipation Overdose: respiratory depression and restlessness.
32
Centrally Acting Antitussives: Dextromethorphan (DM) DDI? Warning? Abuse?
Additive with CNS depressants (ETOH, antihistamines, psychotropic medications) MAOIs (DM blocks serotonin reuptake) can cause serotonin syndrome (hypertension, hyperpyrexia, arrhythmias, seizures. Warning: Do NOT use if you are now taking a prescription monoamine oxidase inhibitor (MAOI) (certain drugs for depression, psychiatric or emotional conditions, or Parkinson's disease) DM should not be administered for at least 14 days until MAOI has been stopped. Abuse??? (DXM) Phencyclidine-like euphoric effect
33
Centrally Acting Antitussives: Diphenhydramine
Second line Antitussive effect is most likely related to its anticholinergic effect. May act indirectly by reducing postnasal drip Remember should not be used/ caution in disease states with anticholinergic activity i.e. Glaucoma,BPH and Acute Ashtma Diphenhydramine–containing antitussives should not be used with any other diphenhydramine–containing products
34
Peripherally Acting Antitussives: NAME THEM? LETHAL DOSE?
Camphor and Menthol nose and mouth creating a local anesthetic sensation and improved airflow Used systemically as lozenges, topically as an ointment rub, liquid added to vaporizer * ****4 Tsp is a LETHAL DOSE**** - -Toxic if ingested - -Lacking efficacy data
35
Expectorants: Mucinex
Guaifenesin
36
Expectorants: Robitussin
Guaifenesin
37
Expectorants: MUCINEX D
DON’T DO THAT!!! DO NOT USE
38
What is best Expectorants?
(WET COUGH) WATER IS THE BEST EXPECTORANT
39
when is Guaifenesin used? Counseling point?
Indicated for ACUTE ineffective productive cough Counseling point: Take with a full glass of water
40
what to take for Sore Throat Pain?
Benzocaine and dyclonine Limit 2 days (For common cold) If longer something else is going on. ----------------------------------------- Local systemic anesthetics Patients with a history of allergic reaction to anesthetics should avoid products with benzocaine Clinical efficacy not well documented
41
Whats the generic name Sucrets?
Dyclonine 3 mg + Menthol 6 mg
42
Combination Products: Rationale to use combos
Combination products may be convenient but avoid recommending if other active ingredients are unnecessary Should recommend specific individualized therapy because symptoms appear, peak, and resolve at different times
43
Combination Products: Advil Cold and Sinus
Ibuprofen | Pseudoephedrine
44
Combination Products: Nyquil Cold and Flu
APAP Dextromethrophan Doxylamine
45
Combination Products: Coricidin HBP what's the special function?
Chlorpheniramine Dextromethrophan HBP products High Blood Pressure- there is no cough suppressant, they can used ocean nasal spray For decongestant
46
Combination Products: Benadryl Allergy and Sinus Headache
APAP Diphenhydramine Phenylepherine
47
Pregnancy
``` Avoid to minimize possible adverse effects “Extra strength” “Maximum strength” “Long-acting” --combination products ``` ``` Decongestants Normal saline (i.e. Ocean ® NS) ``` Oxymetazoline preferred topical decongestant Antihistamines Intranasal cromolyn DOC*** --->Chlorpheniramine (short-acting) first-generation antihistamine of choice --->-If chlorpheniramine is not tolerated then loratidine and cetirizine are preferred alternatives
48
Alternative OTC Therapy
High dose Vitamin C (ascorbic acid) > 2 grams/ day Airborne ® effervescent tablets, Emergen- C ® Adverse Effects: Doses ≥ 4 grams/ day not recommended due to diarrhea and other GI symptoms***** Zinc: -Adverse Effects: Metallic taste and gastric upset -Zinc Lozenge- Cold-Eeze ® Zinc Gluconate –around the clock** (only benifit used in this manner) Echinacea -Allergy to chrysanthemums Oscillococcinum -Contains extracts from duck heart and liver
49
Be-careful for sodium restricted patients!!!??
Alternative OTC Therapy: Airbone: has sodium content Homeopathic: no FDA protection
50
OTC Asthma Products:
Bronkaid and Primatene
51
what's the generic name of Bronkaid?
Ephedrine 25 mg + Guaifenesin 400 mg
52
what's the generic name of Primatene ?
Ephedrine 12.5 mg + Guaifenesin 200 mg
53
Physician Referral for Asthma ?
History of asthma episodes severe enough to require systemic corticosteroids or urgent medical care Symptoms of moderate or greater severity or more frequent than twice weekly Symptoms that have lasted more than 24 hours Symptoms of different quality or severity than previous episodes Symptoms: - Moderate or greater severity or more frequent than twice weekly - Lasted more than 24 hours - Unresponsive to OTC asthma medications within 24 hours - Different quality or severity than previous episodes.
54
Bronchodilators: Sorry Marcus
Short-acting nonselective beta-agonists ``` Epinephrine (DEAD) Primatene Mist Inhaler discontinued 12/31/2011 Contained chlorofluorocarbon (CFC) ``` Ephedrine Oral: 12.5- 25mg Products: (+ Guaifenesin) Bronkaid ® Dual Action Formula and Primatene ® Tablets Adverse Effects: palpitations, tachycardia, arrhythmias, nervousness, seizures Combat of Methamphetamine Epidemic Act of 2005- purchase restrictions
55
What is the generic name Asthmanefrin?
2.25% Racepinephrine** HCl (1.125 % of epinephrine base)
56
Bronchodilator New Inhaler:
Racepinephrine 1-3 inhalations every 3 hours prn (max 12 inhalations/ 24 hours) --Without a doctor
57
Counseling Points for OTC : Resiratory products
Remember, not all patients are OTC “self-care” candidates and in some cases should be referred to their PCP, if patient is an OTC “self-care” candidate:

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