OTC: Cough, Cold, & Allergy – Flashcards
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Name the two (2) types of cough characteristics
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1. productive 2. non-productive
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Why do we cough?
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A cough is an important defense mechanism to rid the airways of mucus and foreign bodies. 1. acute ( 3 weeks)
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What do we use for the tx of cough?
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1. antitussives (cough suppressants) 2. expectorant
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What is the GOLD standard treatment for cough?
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codeine
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Name the three (3) antitussives (cough suppressants) used for cough tx
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1. codeine 2. dextromethorphan 3. diphenhydramine (Benadryl)
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MOA of antitussives
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centrally mediated suppression of cough
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Which agent is the only narcotic agent used for cough as antitussive?
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codeine
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Which agent often comes with a Rx for severe cough or night cough?
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codeine
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MAX dose of codein
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10-20 mg q4-6 hr (120mg/d)
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What are the three (3) SE of codeine?
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1. sedation 2. nausea 3. constipation
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MAX dose for dextromethorphan
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10-30 mg q 4-8hr (120mg/d)
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Which agent is best to use for hacking, nonproductive cough?
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antitussive dextromethorphan
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Name the two (2) SE of dextromethorphan
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1. drowsiness 2. GI distress (N/V, bloating, etc.)
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DI with dextromethorphan
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MAOI
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The only antitussive that has both centrally mediated suppression of cough center AND anticholinergic
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diphenhydramine (Benadryl)
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MAX dose of diphenhydramine (Benadryl)
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25mg q 4hr (75mg/d MAX)
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Trade/Brand names (2) for dextromethorphan
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1. IR Benylin - for liquid 2. ER Delsym - for suspension
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What is the MOA of expectorant guaifenesin?
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thinning of mucus to enhance clearance
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What is the MAX dose of guaifenesin (Robitussin, Mucinex, Humibid)?
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2,400 mg/d (2.4 g/d) (regardless if immediate or extended release)
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Name the immediately release & extended release guaifenesin products
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1. IR: Robitussin syrup 2. ER: Mucinex & Humibid sprinkle
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Which agent is used for productive cough?
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expectorant guaifenesin (Robutussin, Mucinex, Humibid)
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What is the most common SE of the expectorant guaifenesin?
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GI discomfort
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What should pts be counseled on when using expectorant guaifenesin to increase it effectiveness?
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increase fluid intake
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What are the two (2) FDA approved topical antitussives?
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1. camphor 2. menthol
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What is the MOA for topical antitussives?
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local anesthetic effect in nasal mucosa
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What are the three (3) products availavility for topical antitussives?
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1. lozenges 2. ointment 3. steam inhalation
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Something to counsel patient on topical antitussives?
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ointment & solution are TOXIC if ingested
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Five (5) sore throat remedies
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1. saline gargle 2. benzocaine 3. dyclonine 4. phenol 5. menthol
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What are the primary ingredients in Robitussin DM?
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(expectorant & cough suppressant) guaifenesin + dextromethorphan
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What are the primary ingredients in Robitussin PE?
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(expectorant & decongestant) guaifenesin + pseudoephedrine
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What is one disadvantage for using benzocaine as local anesthetic to help soar throat pain?
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decreases sense of taste
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What is the common cause of cold?
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Usually viral, most commonly rhinoviruses
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How does a cold normally transmitted?
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transmitted through hand-to-hand contact followed by touching eyes or nasal mucosa
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What is a common pathophysiology of a cold?
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a cold results in the release of numerous inflammatory mediators, primarily CYTOKINES
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Clinical presentation of a COLD
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~ Gradual onset with slow progression (1-2 weeks duration) ~ sore throat ~ nasal symptoms ~ watery eyes ~ sneezing ~ cough ~ malaise ~ low-grade fever
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Name the three (3) non-pharmacologic therapy of cold
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1. humidifiers (helps liquify secretions) 2. increased fluid intake (ten 8 oz. glasses in 24 hours) 3. rest
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What are the four (4) OTC remedies for symptomatic COLD?
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1. Decongestants - for nasal congestion 2. Antihistamines - for excess nasal discharge 3. Analgesics - for related pain or HA 4. Loca anesthestic sprays/lozenges - for sore throat (pharyngitis)
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What is the etiology of Allergic Rhinitis?
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Allergic rhinitis results from exposure to perennial or seasonal allergens, which lead to the development of nasal symptoms.
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What is the pathophysiology of Allergic Rhinitis?
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The pathophysiology of allergic rhinitis is complex, involving numerous mediators (primarily histamine) and cell types (mast cells).
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Give some clinical presentation of allergic rhinitis
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◦ Nasal: congestion, rhinorrhea, nasal pruritis, sneezing, & postnasal drip ◦ Ocular: itching, lacrimation, redness, & irritation ◦ General: HA, malaise, mood swings, and irritability
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What are some non-pharmacological treatments for allergic rhinitis?
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1. Limit outside exposure during periods of high pollen 2. Avoid indoor & outdoor mold 3. Avoid dust, especially in the bedroom 4. Avoid pet dander, especially cats
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Name the three (3) 1st-Generation antihistamines used for allergic rhinitis
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1. chlorpheniramine (Chlor-Trimeton) 2. brompheniramine (Lodrane) 3. diphenhydramine (Benadryl)
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What are the five (5) 2nd-Generation antihistamines?
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1. clemastine (Tavist) 2. cetirizine (Zyrtec) 3. loratidine (Claritin) 4. desloratidine (Clarinex) 5. fexofenadine (Allegra)
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Which Gen of Antihistamines are peripherally selective?
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2nd-Gen (d/t peripherally selective, it doesn't cause sedation)
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Which Gen of Antihistamines are sedative?
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1st-Gen: sedative 2nd-Gen: non-sedative
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Which Gen of Antihistamines have anticholinergic effects?
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1st-Gen
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What are the key SEs of antihistamines?
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1. sedation 2. anticholinergic effect (only for 1st-gen) Drying up your body: ◦ dry mouth ◦ dry eyes ◦ urinary retention ◦ constipation
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What are the three (3) major concern about using antihistamine in children & elderly patients?
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1. paradoxical stimulation 2. decrease performance in school 3. death in children <2 y/o
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What do "paradoxical stimulation" means?
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Paradoxical stimulation means that the drug works in the opposite fashion it was intended. If it is intended to cause sedation, if might cause hypervigilance, hyperactivity, heart racing etc.
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What are some CI of antihistamines?
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1. Do not drive or operate heavy machinery 2. Avoid use with alcohol 3. Prostatic hyperplasia can occur 4. Narrow-angle glaucoma is possible
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What are the two (2) OTC oral decongestants?
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1. phenylephrine 2. pseudoephedrine (Sudafed)
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What is the MOA for oral decongestants?
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1. αlpha-agonist & vasoconstriction 2. constriction of blood vessels to decrease blood supply to nasal mucosa & decrease mucosal edema
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Why are oral decongestants not effective in allergic rhinitis?
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b/c it has no effect on histamine or allergy-mediated reaction
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What are the four (4) requirements of the 2005 Combat Methamphetamine Epidemic Act?
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1. Pseudoephedrine must be kept either behind the counter or in a locked cabinet 2. Quantity is limited to 3.6g/d & 9g/month per patient 3. Pharmacist must maintain a logbook with the following information - product name, quantity sold, patient's name & address, & time and date sale 4. Patients must show valid identification and sign a logbook
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Are oral decongestants safety to use for long-term?
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These products are relatively safe with no dependence. They can be used long term.
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What are the two (2) main SE of oral decongestants?
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1. nervousness 2. insomnia
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What are the two (2) topical decongestant sprays?
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1. Short-acting: phenylephrine (Neo-Synephrine) 2. Longest-acting: oxymetazoline (Afrin)
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The use of topical decongestants > 3-5 days can cause what?
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Rhinitis medicamentosa (rebound congestion)
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This solution is very safe & effective to use in infants & children for nasal decongestion.
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Nasal saline solution
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What is the MOA for cromolyn sodium (Nasalcrom)?
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mast cell stabilizer; prevention of the mast cells from releasing inflammatory mediators
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Patient education on cromolyn sodium (Nasalcrom)
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Not efficacious if taken prn; must be taken on a scheduled basis (4-6 times a day)
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What are the three (3) analgesics used for the treatment of pain, fever, & headaches associated with cold, flu, or allergies?
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1. APAP 2. Aspirin 3. NSAIDs (ibuprofen, naproxen, ketoprofen)
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Cough & cold products are not to be used in children less than what age?
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< 4 y/o
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What are the four (4) non-prescription treatment of allergies?
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1. antihistamines (sedating or non-sedating) 2. ocular antihistamines 3. decongestants (for nasal congestion) 4. cromolyn (scheduled, not PRN)
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What is the primary advantage of recommending dextromethorphan over codeine?
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it has less dependence potential
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Which agent is the only OTC expectorant approved by the FDA?
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guaifenesin (Robutussin, Mucinex, Humibid)
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Which agent is the active ingredient in some OTC products for insomnia?
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diphenhydramine (Benadryl)
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Oral decongestants are CI in pts taken this type of drug
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MAO inhibitor antidepressant
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Which oral decongestant is the weakest of the two?
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phenylephrine
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Which oral decongestant causes more SE?
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pseudoephedrine (Sudafed)
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Which oral decongestant causes less nervous system stimulation?
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pseudoephedrine (Sudafed)
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What is a common herbal remedy for cold Tx?
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echinacea (may support the immune system)
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Name a mineral for cold Tx
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zinc (b/c zinc is healthy for the immune system)
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People with a cold should increase the intake of which vitamin?
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vitamin C
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What are the temperature ranges for fever vs. high fever?
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fever: 101-103 degrees high: 103-105 degrees
