1
Q
T/F: coughs are not important defensive respiratory tract reflex
A
F
2
Q
Coughs are the most common…
A
symptom for pt seeking healthcare
3
Q
Coughs are often one of the most…
A
irritating and longest lasting symptom
4
Q
More than _____ spent annually on OTC cough products
A
$4 billion
5
Q
Coughs are a symptom of…
A
diverse infectious and noninfectious disorders
6
Q
Coughs are initiated by…
A
stimulation of chemically and mechanically sensitive, vagally mediated sensory pathways in layngeal, esophageal, and tracheobronchial airway epi
7
Q
What processes sensory input and stimulate motor efferents for coughs?
A
complex medullary brainstem network “cough control center”
8
Q
Pathophysiology of coughs:
A
- deep inspiration followed by closure of glottis and forceful contraction of chest wall, abdominal wall, nad diaphragmatic muscles
- glottis opens, air is expelled and propels mucus, cellular debris, and foreign material out of respiratory system
9
Q
Causes of coughs:
A
- airway inflammation
- excess mucus production
- post nasal drip
10
Q
Classifications of coughs:
A
- acute
- subacute
- chronic
11
Q
Duration of acute coughs:
A
< 3 weeks
12
Q
Etiology of acute coughs:
A
- viral URTI
- pneumonia
- acute left ventricular failure
- asthma
- foreign body aspiration
13
Q
Duration of subacute coughs:
A
3-8 weeks
14
Q
Etiology of subacute coughs:
A
- post-infectious cough
- bacterial sinusitis
- asthma
15
Q
Duration of chronic coughs:
A
> 8 weeks
16
Q
Etiology of chronic coughs:
A
- upper airway cough syndrome (UACS)
- asthma
- GERD
- COPD
- ACE inhibitors
17
Q
Symptoms of productive cough:
A
- wet/chesty cough
- expels secretions from lower respiratory tract
- secretions are typically clear w/ bronchitis and purulent w/ bacterial infections
18
Q
Symptoms of nonproductive cough:
A
- dry/hacking cough
19
Q
Nonproductive coughs are associated w/…
A
- viral infections
- bacterial infections
- GERD
- cardiac disease
- meds (ACE inhibitor)
20
Q
Complications of coughs:
A
- exhaustion
- insomnia
- musculoskeletal pain
- hoarseness
- sore throat
- excessive perspiration
- urinary incontinence
21
Q
Exclusions for self-treatment:
A
- w/ fever
- chest pain
- shortness of breath
- suspected drug associated cough
- children < 4 YO
- lasts > 7 days
- cough that produces thick yellow, tan, or green mucus
22
Q
Duration of therapy for cough from viral URTIs:
A
2 weeks
23
Q
Duration of therapy for post-viral coughs:
A
> 3 weeks
24
Q
Duration of therapy for coughs from other respiratory infection:
A
3-4 weeks
25
Treatment goals of coughs:
- reduce bothersome symptoms
- prevent transmission to others
- reduce # and severity of episodes
- prevent complications
26
Non-pharm of cold relief:
- non-medicated lozenges
- humidification
- promotion of nasal drainage (rubber bulb for < 2 YO)
- hydration: helps form less viscous secretions
27
Pharm therapy of cold relief:
- cough suppressants (antitussive)
- expectorant (protussive)
- combination products
28
Examples of cough suppressants:
- codeine
- dextromethorphan
- diphenhydramine
- chlophedianol
29
Example of expectorants:
guaifenesin
30
MOA of cough suppressants:
- decreases sensitivity of cough receptors
| - interrupts cough impulse transmission by depressing the medullary cough center
31
Cough suppressants treat...
nonproductive coughs
32
Types of antitussive agents:
- systemic
| - topical
33
Examples of systemic antitussive agents:
- codeine
- dextromethorphan
- chlophedianol
34
Examples of topical antitussive agents:
- camphor
| - menthol
35
MOA of codeine:
acts centrally on medulla to increase the cough threshold
36
Indication of codeine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract irritation
37
Dosage of codeine:
10-20 mg Q4-6H
38
Onset of therapy of codeine:
15-30 minutes
39
Action of codeine occurs...
4-6H
40
Adverse effects of codeine:
- GI: nausea, vomiting, constipation
- CNS: sedation, dizziness
- respiratory depression w/ overdose
41
Drug interactions of codeine:
- other CNS depressants (sedatives, alcohol)
| - other respiratory depressants (alcohol)
42
Pts that need to take caution w/ codeine:
- asthma/COPD
| - at risk for drug abuse/misuse
43
Codeine is available with/without prescription
without
44
Codeine is a schedule ____ drug:
5
45
T/F: abuse is uncommon w/ codeine
F, also known as "purple drank"/"lean"
46
Lethal dose of codeine is...
0. 5-1g
| - causes death from respiratory depression and cardiopulmonary collapse
47
Codeine OTC sales may contain no more than...
65 mg in 30 mL (10mg/5mL)
48
MOA of dextromethorphan:
acts centrally in medulla to increase cough threshold (NMDA receptor antagonist)
49
Indication for dextromethorphan:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract infection
50
Dosage of dextromethorphan:
- 10-20 mg Q4H
| - 30 mg Q6-8H
51
Onset of dextromethorphan:
15-30 minutes
52
Peak effect of dextromethorphan:
2-3 H
53
Adverse effects of dextromethorphan:
- GI: discomfort, nausea, vomiting constipation
- CNS: drowsiness
- respiratory depression w/ overdose
54
Drug interactions w/ dextromethorphan:
- other CNS depressants (alcohol, antihistamines)
| - MAO inhibitors can cause serotonergic symptoms
55
Examples of serotonergic symptoms:
- hypertension
- fever
- arrhythmias
- seizures
56
Dextromethorphan abuse has occurred in 1 in ___ american teenagers:
10
| - more than cocaine/ecstasy/LDS/meth in this age group
57
Dextromethorphan abuse occurs more commonly in:
male adolescents
58
Dextromethorphan abuse occurs b/c:
- cheap and easily obtained
| - hard for parents/guardians to detect DXM abuse
59
Dextromethorphan can cause...
hallucinatory and dissociative effects
60
Euphoric effects of dextromethorphan are called...
robo-tripping
61
MOA of diphenhydramine:
- nonselective 1st gen antihistamine
- acts centrally in medulla to increase cough threshold
- significant sedating and anticholinergic properties
62
Indication of diphenhydramine:
suppression of nonproductive cough caused by chemical/mechanical respiratory tract
63
Dosage of diphenhydramine:
25 mg Q4H
64
Onset of diphenhydramine:
30-60 minutes
65
Peak effect of diphenhydramine:
2H
66
Adverse effects of diphenhydramine:
- dizziness
- drowsiness
- sedation
- dryness of eyes and mucous membrane
- blurred vision
- constipation
67
Which topical cough suppressants are the only FDA approved ones?
- menthol
| - camphor
68
MOA of topical cough suppressants:
stimulates sensory nerve endings w/in nose and mucosa, which creates local anesthetic sensation and sense of improved airflow
69
Indication for topical cough suppressants:
cough
70
Onset of action for topical cough suppressants:
immediate
71
Adverse effects of topical cough suppressants:
burning sensation in the mouth
72
Ingestion of 4 tsp of 5% camphor product has been shown to be...
lethal in children
73
Administration of ointments:
- rub on throat and chest in thick layer
- repeat up to Q8H
- loosen clothing around throat and chest
- cover w/ warm, dry cloth
74
Administration of lozenges:
allow lozenge to dissolve slowly in mouth QH
75
Administration of inhalations:
- place water in vaporizer
- place solution in medication chamber
- breathe in vapors Q8H
76
MOA of guaifenesin:
loosens and thins lower respiratory tract secretions, making minimally productive coughs more productive
77
Indication of guaifenesin:
symptomatic relief of productive coughs
| - only FDA approved expectorant
78
Dosage of guaifenesin:
200-400 mg Q4H
79
Onset of action for guaifenesin:
15-30 minutes
80
Adverse effects of guaifenesin:
- dizziness
- headache
- rash
- drowsiness
- stomach pain
81
Cough combination medications:
- antitussive w/ expectorant
| - topical products
82
Examples of antitussive w/ expectorant:
- guaifenesin and codeine
| - guaifenesin and dextromethorphan
83
Examples of topical products:
- camphor
| - menthol
84
T/F: cough combination medications are inconvenient
F
85
Cough combination medications carry the risk of...
unnecessary drug therapy
86
According to ACCP 2006 cough guidelines, you should recommend...
- combination of 1st gen antihistamine and decongestant to treat virus induced post-nasal drip and resolve cough
- codeine/DXM for short term symptomatic relief of cough associated post infection
- doesn't say anything about guaifenesin
87
Pregnant women should be recommended _____ first
non-Rx products
88
Pregnant women can take...
codeine/DXM
89
Breastfeeding women should not take codeine and diphenhydramine b/c...
it's excreted in breast milk
| - can irritate and decrease milk flow
90
It's unknown if _____ is secreted in breast milk
DXM
91
Elderly pt are more susceptible to...
- codeine
- DXM
- diphenhydramine
92
January 2008 FDA public health advisory states that children < 2 should avoid use of...
OTC cough and cold medications
| - potential serious and life threatening adverse effects
OTC
flashcards
Decks in class (23)
# Cards
-
SCHOLARMAC and Labels20
-
Essential Nutrients83
-
Intro to Dietary Supplements31
-
Vaginal Infections Home Tests41
-
Allergies81
-
Family Planning Methods67
-
Colds100
-
Coughs92
-
Urinary Incontinence42
-
Pain124
-
Wellness102
-
OTC Wounds64
-
Opthalamic and Contact Lens Care54
-
Tobacco Cessation105
-
Sun Safety81
-
Heartburn64
-
Dermatitis49
-
Acne and Insect Bites57
-
Diarrhea57
-
GI Disorders34
-
Constipation58
-
Fungal Infections and Hair Loss45
-
Warts and Footcare55
