Pharyngitis, cough, cold Flashcards Preview

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Flashcards in Pharyngitis, cough, cold Deck (52):
1

What is pharyngitis usually caused by?

Group A streptococcus (GAS)
(Strep pyogenes)

2

What might GAS cause

Poststreptococcal glomerulonephritis
Acute rheumatic fever (rare in US)

3

What are the characteristics of GAS pharyngitis throat pain?

Usually severe
Worse on 1 side

4

What is the recommended initial tx of of GAS pharyngitis?

Amoxicillin

5

What is the dosing of amoxicillin for GAS pharyngitis?

20 mg/kg/dose (max 500 mg/dose) BID x 10 days

6

What medication do you avoid as first line for GAS pharyngitis and why? What is an exception?

Azithromycin
Strep rapidly develops resistance to macrolides
Consider if PCN allergic

7

What is a newly recognized cause of pharyngitis?

Fusobacterium necophorum pharyngitis (FNP)

8

What age groups is FNP endemic to?

Adolescents
Young adults

9

What % of pharyngitis does FNP cause in the specified age groups?

10%

10

What could FNP develop and what is the risk with it?

Lemierre syndrome
Life threatening -> mortality rates of 5%

11

Sign that it is FNP

Lack of cough

12

What do you treat FNP with?

Clindamycin
Penicillin + metronidazole

13

What is the rule with cough suppression?

Don't suppress indiscriminately

14

Do you suppress a productive cough?

No

15

When do you suppress a cough?

If tiring or sleep limiting

16

What do you prescribe for non-productive coughs?

Antitussives = cough suppressants

17

What do you prescribe for a productive cough?

Expectorants
Mucolytics

18

How should your pt ingest the antitussive benzonatate?

Caps and softgels should be swallowed w/o chewing

19

What is a common antitussive?

Dextromethorphan (robutussin)

20

What is dextromethorphan?

D isomer of codeine analog of levorphanol

21

Does dextromethorphan have analgesic and addictive properties?

No

22

What does dextromethorphan do to reduce cough?

Inhibits central (medullary) cough center

23

What is a common expectorant (you use it all the time)?

Guaifenesin (glyceryl guaicolate) aka Mucinex

24

What does guaifenesin do to respiratory tract secretions?

Increases them

25

What is n-acetylcysteine?

A mucolytic

26

What does n-acetylcysteine do?

The sulfhydryl group opens disulfide bonds in mucoproteins thereby reducing viscosity

27

How do you administer acetylcysteine?

Aerosolization or nebulization

28

What is pertussis and what is it caused by?

Chronic cough
Bordatella pertussis

29

What do the Chinese call pertussis?

Cough of 100 days

30

Are atypical presentations of pertussis common? Give some examples

Yes
Completely/partially immunized pts
Adolescents/adults

31

What population do we see the most pertussis?

Infants < 6 months

32

Whats a frequent sign of pertussis?

Post-tussive emesis

33

Is the incidence of pertussis increasing or decreasing?

Increasing

34

What are some causes of rising incidence of pertussis?

Waning immunity
Acellular vaccines
Severe complications w/ whole cell vaccines

35

When do you consider a diagnosis of pertussis?

All children w/ cough > 14 days

36

What is the tx of choice for pertussis? How long do you dose it?

Erythromycin
14 days to prevent relapse

37

What are some alternative agents for pertussis tx?

Clarithromycin
Azithromycin
Trimethoprim/sulfamethoxazole (bactrim)

38

What do decongestants act as?

Sympathomimetics (alpha agonists)
Vasoconstrictors

39

What is an issue with decongestants and how do we deal with that?

Prolonged use can cause rebound congestion (>3-5 days)
Limit dose frequency

40

What are two long-acting topical decongestants?

Oxymetazoline HCl
Xylometazoline HCl

41

What are some benefits of systemic decongestants?

Lower incidence of rebound congestion
Results typically last longer than topicals

42

What is a legal issue with systemic decongestants and why?

Sales are limited on pseudoephedrine by law
Have been used in the illegal making of methamphetamine

43

What are systemic decongestants? What is their systemic effect?

Alpha 1 agonist
Vasoconstrictors

44

What do systemic decongestants activate at higher concentrations?

Beta receptors

45

What are the CVS AEs of phenylephrine?

HTN
Arrhythmia (rare)
Stroke (rare)

46

What are the CNS AEs of phenylephrine?

Headache
Anxiety
Tremor
Restlessness

47

What are the CVS AEs of pseudoephedrine?

HTN
Palpitations
Tachycardia
Stroke (rare)

48

What are the CNS AEs of pseudoephedrine?

Headache
Insomnia
Nervousness
Excitability

49

In what chronic disease should you avoid pseudoephedrine and phenylephrine?

HTN

50

What does guaifenesin do to phlegm and bronchial secretions?

Helps loosen phlegm and bronchial secretions

51

What does guaifenesin do to secretion viscosity?

Reduces secretion viscosity

52

What does guaifenesin do to the mucocilliary mechanism?

Increases efficiency of mucociliary mechanism