Cough

Question 1

Acute cough is a common symptom of ?

Answer 1

Viral upper respiratory tract infection
URTI

Question 2

How many episodes kits have cough early?

Answer 2

7 to 10 episodes / yearly.

Question 3

True or false

90% a URTI is caused by viruses ( syncytial / rhinovirus / influenza)

10% of URTI caused by bacteria
(staphylococcus pneumoniae, Haemophilus influenza, staphylococcus aureus,klebsiella pneumoniae).

Answer 3

True

Question 4

What part of the brain is responsible for cough?

Answer 4

Cough flex center
Which get triggered by receptors located in Pharynx larynx trachea and bronchi . The neural impulses will carried to the cough center in medulla.

Question 5

What is the most common cause of persistent, cough and children?

Answer 5

Recurrent viral bronchitis

Question 6

What are the clinical feature of acute viral cough?

Answer 6

sudden onset
fever
Minimal sputum production
Symptoms worse at evening

Question 7

What are the symptoms of acute viral cough?

Answer 7

Cold symptoms
1. Runny nose.
2. Sore throat.
3. Congestion (often )

Question 8

Viral cough usually last? (it’s duration.)

Answer 8

Between 7 to 10 days
More than 14 days may suggest post, viral cough or secondary bacterial infection

Question 9

What is the misconception about cough with mucopurulent sputum?

Answer 9

People think that it will be bacterial cause, and referral to the GP is must.

Question 10

What diseases cause increase in mucus production?

Answer 10

Smoking
Environmental irritant
Allergy
Infection
Genetic predisposition
Foreign bodies
Chronic bronchitis
Asthma and COPD
Cystic fibrosis
Acute bronchitis
Pneumonia

Question 11

Give me examples of condition to eliminate likely to cause
(cough causes)

Answer 11

1. Upper airways cough syndrome:
   - post nasal drip or rhinosinusitis
   - Acute bronchitis.

Question 12

UACS characterized by?

Answer 12

Sinus or nasal discharge
It’s flows behind the throat, causing abnormal sensation there that need to be clear frequently .

Question 13

Other causing of UACS?

Answer 13

Allergies and post infection UACS after URTI.

Question 14

Cough caused by allergies are

Answer 14

Nonproductive
Worsen at night
Associated sneezing , nasal discharge a blockage, conjunctivitis and itchy, oral cavity.

Question 15

What medication we can use for UACS?

Answer 15

Antihistamine and decongestants

Question 16

Acute bronchitis, some commonly seen in ————————— and what are its symptoms?

Answer 16

1. Autumn and winter.
2. Similar symptoms to URTI :
   - Fever
   - sputum production
   - Runny nose
   - Sore throat
   - Congestion
   +
   - dyspnoea
   - Wheezing

Question 17

Acute bronchitis cough last for?

Answer 17

7 to 10 days
can be processed for three weeks

Question 18

What are the origins of acute bronchitis?

Answer 18

• Usually virus but it can be also bacteria.

The symptoms were resolved without antibiotic
If the patient is unwell, referral to a physician

Question 19

Give examples of condition to eliminate unlikely causes

Answer 19

COPD
Asthma
pneumonia(community acquired)
Medicine induced cough or wheeze

Question 20

1. COPD characterized by?
2. Sign and symptoms?
3. It’s common more to whom ?
4. What is the important factor to cause chronic bronchitis?
5. Example of diseases undergo COPD?

Answer 20

1. Destruction of lung tissues.
2. Cough / sputum production/ increase breathlessness
3. Older adults (men).
   - Symptoms: chronic cough-breathlessness-wheezing-recurrent chest infection.
4. Smoking.
5. Chronic bronchitis , emphysema and chronic obstructive airways disease.

Question 21

1. Define asthma
2. Characterized by.?
3. Symptoms.?
4. Possible risk factors associated with development of asthma include?
5. What type of cough asthma patient have ?

Answer 21

1. Chronic inflammatory condition.
2. Coughing, wheezing, chest tightness, shortness of breath(recurrent at night time cough).
3. Variable symptoms, intermittent, worsen at night.
   - Symptoms get provoked by triggers, such allergens, infection, and irritant exposure.
4. Family are personal history of atopy.
5. Nonproductive, but mainly productive.
   - especially in children (what’s on at night and recurrent).

Question 22

1. What causes pneumonia?
2. Type of cough.
3. Sign and symptom.
4. Most cases occurred during which season?
5. Do we need a doctor referral or watt?

Answer 22

1. Bacteria infection.(S.pneumoniae) 80%
2. First 24–48 hours productive painful after that rapidly become productive with this sputum being stained red.
3. High fever>38 , malaise, headache, and breathlessness( worsen inspiration).
4. Autumn and winter.
5. Urgent referral to a doctor so antibiotic can be started as soon as possible.

Question 23

Give example of drugs, that induce, cough or wheeze

Answer 23

1. ACE inhibitor (pril)
2. Beta blocker.
3. NSAID

Question 24

Cough from ace inhibitor reserve how many days after withdrawal?

Answer 24

3 to 4 weeks to resolve completely

Question 25

What alternative of drugs you have instead of using ACRI to prevent cough

Answer 25

Angiotensin 2 receptor blocker Have lower incidence of cough

Question 26

Example of condition to eliminate very unlikely causes

Answer 26

1. heart failure. 2. Bronchiectasis 3. Tuberculosis (TB) 4. Carcinoma of the lung. 5. Gastro oseophageal reflux disease (GORD)

Question 27

Why is hard to diagnose heart failure in early mild cases

Answer 27

Because it has an insidious progression

Question 28

What are the early symptoms of heart failure?

Answer 28

1. Fatigue 2. Shortness of breath. 3. Orthopnea. 4 dyspnoea at night

Question 29

When the heart failure condition progress, the patient may experience?

Answer 29

1. Ankle swelling. 2. Reductive frothy رغوي cough with pink sputum (worsen at night).

Question 30

1. Bronchiectasis caused by? 2 . Characterized by.?

Answer 30

1. Caused by irreversible dilation of the bronchi that result from previous lower respiratory tract infection. 2. Cough of long duration. 75% of patient coughing daily with sputum production .

Question 31

1. Tuberculosis is caused by? 2. Symptoms of TB? 3. Does the patient need to be a referral?

Answer 31

1. Bacterial infection - Mycobacterium tuberculosis, transmitted by inhalation. 2. Fever, weight, loss, night sweats, anorexia, malaise, and chronic, productive, cough with haemoptysis. 3. Yes for further investigation, which include: - chest x-ray - Sputum smear test 

Question 32

1. Carcinoma strongly related to? 2. Symptoms.?

Answer 32

1. Related to age.(increasing.) 40 to 45. 2. Cough, fatigue, shortness of breath, just pain, weight loss, and appetite loss. -The cuff last more than three weeks .

Question 33

1. GORD type of cough ? 2. Symptoms.?

Answer 33

1. Does not usually present with cough, but patient may cough when lying down. 2. Reflux or heartburn. - Increase in cup for flexibility. - Respond well to proton pump inhibitor. - GORD considered in all cases of unexplained cough.

Question 34

What are the cough treatment goals?

Answer 34

1. Reduce the number and severity of tough episodes. 2. Brent complication. - Cough treatment is symptomatic.

Question 35

Mention cough complication:

Answer 35

1. Common. - Exhaustion - Insomnia ارق - Musculoskeletal pain - Hoarseness - Urinary incontinence سلس البول 2. Less common. - Dysrhythmias خلل فالنظم - Syncope اغماء - Stroke - Rip fracture

Question 36

How to differentiate between serious and nonserious condition of cough in adults?

Answer 36

1. Cough lasting longer than three weeks consider serious. - UACS campers is four weeks and pharmacist can manage it. 2. Certain symptoms. 3. Sputum color are in. 4. Symptoms associated with infection. - Fever, rhinorrhea سيلان الانف , sore throat. 4. Presence of blood (Haemoptysis). 5. Trigger factor. - Certain atmospheric factors, such as air temperature changes, pollution, dry atmosphere.

Question 37

What hinders the differentiation between clinical efficacy and normal symptoms resolution?

Answer 37

The self limiting nature of acute cough.

Question 38

Differentiate between cough, suppressant and expectorant?

Answer 38

1. Cough suppressant: - treat dry and productive cough. - example : Pholcodine 2. Expectorant: - Treat wet , productive cough. - example : Guanifenesin/guaiphenesin

Question 39

What is the mechanism of action of guaifenesin expectorant?

Answer 39

- stimulates secretion of respiratory tract fluid. - Increase sputum volume. - Decrease viscosity. - Which assist in the removal of sputum.

Question 40

Write the name of the only active ingredient that have evidence of effectiveness as expectorant?

Answer 40

Guaifenesin

Question 41

What do you mean by mycolytics?

Answer 41

Breakdown of mucus

Question 42

1. Why mucolytic is important? 2. Mention diseases that we use mucolytic: 3. Give example of OTC medication.

Answer 42

1. Is needed in diseases in which there is increase in mucus production. 2. Cystic fibrosis, COPD,Bronchiectasis , respiratory infection, and Turberculosis. 3. - N-acetylcysteine (ACC) - bromhexine hydrochloride (Bisolvon) - ambroxol hydrochloride (Mucpsolvan) - herbal prep(Prospan syp)

Question 43

1. What are the cough suppressant? 2 . Give another name to it

Answer 43

1. - they directly act on the cough center to depress cough reflux . - Codeine - Standard or benchmark antitussive - effective at reducing cough - Less effect on acute cough - ex : pholcodeine - few side effects less liable to be misused. 2. Antitussive.

Question 44

Give me example of cough, suppressant medication

Answer 44

Pholcodeine - Antitussive activity+ sedated\ Drowsiness

Question 45

Why cough suppressant medication have less affect on acute cough

Answer 45

Patient have a greater voluntary control of the cough reflects on acute cough .

Question 46

Give two example of cough, suppressant medication (antitussive)

Answer 46

1.Pholcodeine - 2nd line therapy 2. Dextromethrophan (less potent) - Limited abuse potential - Fewer side effects - 1st line therapy

Question 47

Give me example of antihistamine medication

Answer 47

Anticholinergic - Drying action of mucus membrane - ex: Diphenhydramine & promethazine - reduce frequency of cough

Question 48

Can we take a combination of antihistamine and cough, suppressant?

Answer 48

Yes - antihistamine can help to dry up secretion through their anticholinergic side-effects. - If the cough is disturbing the sleep, it’s better to take the dose at night.

Question 49

What is demulcents ? ملطف

Answer 49

- pharmacologically inert - Reduce irritation by coating the pharynx and prevent cough. - ex : glycerin, lemon, honey, Linctus

Question 50

True or false Demulcent that soothe the throat are useful for children and pregnant women b/c they don’t have active ingredient .

Answer 50

True

Question 51

Give me examples of combination mixtures

Answer 51

1. Preparations contain multiple active ingredient to target different symptoms of URTI. 2. Combination products may contain subtherapeutic doses of active ingredient. 3. illogical combination of ingredient. - Cough suppressant with expectorant - Antihistamine with expectorant 4. Whether to avoid the illogical combination. 5. Should advise the patient to drink more fluid instead of taking antitussive medication. told them that the symptoms will resolve on their own.

Question 52

Antihistamine is used to treat what type of cough

Answer 52

Productive cough

Question 53

Side effect and symptoms of antihistamine medication

Answer 53

- they can interact with other sedating medication result in increased sedation. - Cause dry mouth and constipation Because of their antimuscarinic properties - Avoided if the patient have glaucoma and prostate enlargement Because they increased intraocular pressure and urinary retention

Question 54

Why demulcents are more commonly to use?

Answer 54

Because of the restriction placed on antitussive.

Question 55

Tips for a patient education

Answer 55

1. Suck cough drops or hard candies. - not less than 6 2. Consider taking honey. -not less than one year 3. Moisturize the air.(humidifier/shower) 4. Drink fluids 5. Avoid tobacco smoke. 6. Gargling, warm salt, water.