Cough – Flashcard
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--- is an important defense mechanism playing a major role in maintaining airway integrity.
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- cough
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Cough can be --- or ---.
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- voluntary - involuntary
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True/ False. Cough is the most common reason people see medical attention
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True
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Cough is elicited by stimulation of sensory receptors in the --- and ---.
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- larynx - trachea
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--- cough is a cough that has lasted less than three weeks
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- acute
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--- cough is a cough that lasts between 3 and 8 weeks.
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- subacute
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--- cough is a cough that lasts more than 8 weeks.
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- chronic
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What is a productive cough?
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- "wet" or "chesty" cough - expels secretion from lower respiratory tract
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What is a nonproductive cough?
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- "Dry" or "hacking" cough - Usually associated with viral respiratory tract infections, atypical bacterial infections, GERD, cardiac disease, and some medications (ACE-I)
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What is ACE-I?
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- ACE inhibitor medication - Causes dry cough
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What are some symptoms of a viral URTI?
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- sneezing, rhinorrhea, sore throat, low- grade temp.
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What are symptoms of a lower respiratory tract infection?
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- temperature > 101.5, thick, discolored sputum, night sweats
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What are symptoms of post nasal drip?
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- Mucus drainage from nose; frequent clearing of the throat
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What are symptoms of GERD?
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- heartburn (symptoms worsening laying down)
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What are symptoms of asthma?
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- wheezing (coughing in response to certain irritants)
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What is a sign of COPD?
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- productive cough most days
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What are symptoms of CHF?
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- fatigue - edema - breathlessness
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What are common complications of a cough?
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- exhaustion - insomnia - musculoskeletal pain - hoarseness - executive perspiration - urinary incontinence
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What are nonpharmacologic options for a cough?
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- lozenges to decrease coughing and irritated airways - increasing room humidity with humidifiers or vaporizers to sooth irritated airways - hydration - promoting nasal drainage (nasal syringe with infant or raise head of bed)
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Are cool-mist humidifiers or warm-mist vaporizers preferred?
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- cool-mist, due to less risk of bacterial growth - however, vaporizers have a place you can add medication if necessary
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When you have a cough, water works as an --- by making mucus less viscous and easier to expel.
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- expectorant
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What are some precautions you need to take when recommending water as a nonpharm therapy for cough.
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- caution in over-hydrating patients with renal failure, heart failure, or LRTI
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What are the pharmacologic therapy options for cough?
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- systemic antitussives - topical antitussives - expectorants - antihistamines
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Systemic antitussives are known as cough suppressants and are the drug of choice for ---.
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- nonproductive cough - only recommend for productive cough that interferes with work or sleep
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What are the OTC FDA-approved oral antitussives?
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- dextromethorphan - diphenylhydramine - codeine (NOT in Missouri though)
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Delsym and Robitussin are both brand names for ---.
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- dextromethorphan
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What is dextromethorphan and what is it used for? What is it's mechanism?
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- antitussive - used for nonproductive cough caused by mechanical or chemical respiratory tract irritation - acts on medulla to increase cough threshold
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What is the adult dosage for dextromethorphan?
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- 10-20 mg every 4 hours or 30 mg every 6-8 hours - maximum 120 mg/24 hours
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Dextromethorphan has an initial onset of --- to --- minutes and last about 3-6 hours
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- 15 - 20
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What are the side effects of dextromethorphan?
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- drowsiness, stomach discomfort, constipation - however, side effects are very uncommon at normal dosage - this drug is under high abuse potential in teenagers - at high doses, this drug can cause confusion hallucination, severe nausea and vomiting...
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What are contraindications with dextromethorphan?
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- hypersensitivity - MAOIs (old antidepressents that aren't usually used anymore)
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What precautions must be taken when taking dextromethorphan?
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- alcohol - antihistamines - CNS depressants
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Benadryl is the brand name for ---, a common ---.
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- diphenylhydramine - antitussive
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Diphenylhydramine is a ---generation antihistamine
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- first
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What is diphenylhyramine used for?
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- suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation - MOST commonly used for post nasal drip
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True/False Diphenylhydramine is the first line therapy for cough?
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- FALSE - Dextromethorphan is
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What is the mechanism of action for diphenylhydramine?
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- acts on medulla to increase cough threshold.
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What is the adult dosage for diphenylhydramine? What is maximum?
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- 25 mg every 4 hours - Maximum of 150mg/24 hours - notice a lower dose is given when being used as antitussive rather than allergy
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Diphenylhydramine has a --- minute onset and lasts about --- to --- hours.
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- 15 - 4 - 6
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What are side effects of diphenylhydramine?
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- drowsiness, disturbed coordination, blurred vision, urinary retention, dry mouth, respiratory depression - these side effects commonly occur
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What are some contraindication with diphenylhydramine?
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- hypersensitivity, MAOIs (old antidepressants that aren't normally used anymore)
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What are some precautions to take with diphenylhydramine?
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- older adults and children may have paradoxical reactions ( may cause them to become excited when expected result would be drowsiness) - may enhance depression effects of medication - patients with narrow-angle glaucoma, cardiovascular disease, benign prostatic hyperplasia
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Codeine is an --- drug that is used for a --- cough.
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- antitussive - nonproductive
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What is the mechanism of action for codeine?
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- acts on the medulla to increase the cough threshold
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What are side effects of Codeine?
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- nausea/vomiting, sedation, dizziness, constipation
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What are precautions to take with Codeine?
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- use of CNS antidepressants - impaired respiratory function - addicts
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True/ False. Codeine is schedule V drug in Missouri, requiring a prescription.
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- TRUE
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--- and --- are the only two FDA-approved topical antitussives.
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- camphor - menthol
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How do topical antitussives work as an antitussive?
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- inhaled vapors stimulate sensory nerve endings within the nose and mucosa, creating a local anesthetic sensation and sense of improved airflow.
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What safety considerations should be taken with topical antitussives?
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- camphor and menthol may splatter and cause serious burns if used near an open flame - toxic if ingested; can cause burning of mouth, nausea & vomiting, and in some causes seizures or death
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Definition of antitussive.
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- cough suppressant
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Expectorants are also known as "protussives." What does this mean? What are the indications?
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- cough enhancer - expectorants would be suggested for someone with an ineffective productive cough (coughing up secretions, but not easy)
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What is the mechanism of action for expectorants?
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- thins and loosens respiratory secretions, making it easier for the body to expel the secretions
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--- is the only FDA-approved expectorant. What are the brand name drugs?
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- Guaifenesin - Robitussin syrup, Mucinex
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What is the adult dosing for Guaifenesin?
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- 200-400 mg every 4 hours - maximum of 2.4 grams/24 hours
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While Guaifenesin usually does not cause side effects, what are some that may occur when taking this medication?
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- nausea/vomiting, dizziness, headache, stomach pain, drowsiness
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There is little evidence showing Guaifenesin efficacy. What works just as good, if not better?
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- Water! - Men should drink 3 liters per day - Women should drink 2.2 liters per day
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Antihistamines are mainly used for cough after a cold due to ---.
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- post nasal drip
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What are the three first-generation antihistamines?
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- diphenylhydramine - chlorpheniramine, - brompheniramine
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Antihistamines have --- effects that help relieve rhinorrhea symptoms and sneezing.
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- anticholinergic
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What does an anticholinergic do?
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- blocks acetylcholine in the PNS and CNS - a product that has anticholinergic properties causes "drying up" in patients
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What is Rhinorrhea?
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- where the nasal cavity is filled with a lot of mucus
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Antihistamines have anticholinergic effects which cause anti---. What does this mean
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- Anti SLUD - Anti salvation, lacrimation, urination, and defacation
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What are the exclusions for self treatment of a cough?
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- coughing for longer than 7 days - fever greater than or equal to 103 degrees F - cough with thick mucus of green, yellow, tan, or puss-filled - drug-associated cough - symptoms of chronic disease associated with cough (COPD, asthma, emphysema) - cough that worsens as cold or flu resolves - cough that is associated with inhalation of dust, particles, objects - cough accompanied by night sweats, chest pain, cyanosis, hemoptysis, shortness of breath, unintentional weight loss
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What are the goals of therapy for cough?
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- primary: to reduce the number and severity of cough episodes - secondary: prevent complications - The UNDERLYING PROBLEM must be treated to stop the cough - treat the problem, not the ailments
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If a patient has a nonproductive cough, what will you recommend?
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- cough suppressive - antitussive
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If a patient has a productive cough what will you recommend?
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- expectorant aka "protussive" to think the mucus - may use suppressant only at bed time if the patient's cough is interfering with work or sleep
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What is post-nasal drip and what would you recommend for treatment?
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- coughing due to fluid thickening behind the throat - usually occurs after a cold - use first-generation antihistamine and add expectorant if phlegm in chest
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True/False. Combination products are typically referred over single products.
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- False
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What are the advantages and disadvantages of combination products?
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- advantages: convenient, compliance, placebo effect - disadvantages: increased chance of adverse drug reaction or side effects, use of unnecessary drugs, cost, masking other signs or symptoms
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True/False. Patients taking first-generation antihistamines should use sunscreen and protective clothing when going in the sun
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TRUE
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True/False. Topical antitussives may be applied under the nose.
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FALSE.
