C/C/F Matrix

Pseuodoephedrine/ Phenylephrine dosing

FDA 2+, manufacturer 4+

Pseuodoephedrine/ Phenylephrine MOA

Class: systemic decongestatant; stimulates alpha-adrenergic receptors in nose/sinuses and constricts blood vessels decreasing sinusoid vessel enlargement and mucosal edema (phenylephrine is less effective than pseudo)

Pseuodoephedrine/ Phenylephrine is used to treat

Nasal/sinus congestion, can also help a little with cough with post-nasal drip but NOT best choice for cough treatment, can also help with eustachian tube congestion (clogged ears)

Pseuodoephedrine/ Phenylephrine Side Effects

Raised BP, HR, arrhythmias (beta stimulation/norepinephrine),

Insomnia, anxiety, nervousness, restlessness, tremor, anorexia (crosses BBB),

Urinary retention (stimulation of urethra/prostate smooth muscle, alpha agonism),

Dry nose, bleeding due to dryness

Pseuodoephedrine/ Phenylephrine Pros/Cons

P: onset within 30min-2hr, available as long acting as well (12/24hrs)

C: concern for abuse (meth)

pts who should avoid Pseuodoephedrine/ Phenylephrine

Pts with hyperthyroidism, CV issues, insomnia, anxiety, BPH/prostate enlargement, diabetes, older adults, rarely can cause closed angle glaucoma, pregnancy/bf

pts contraindicated for Pseuodoephedrine/ Phenylephrine

pts taking MAOIs

Oxymetazoline, phenylephrine, naphazoline dosing

Naphazoline and Phenylephrine= 2+

Oxymetazoline (Afrin) = 6+

Physiologically addictive

Oxymetazoline, phenylephrine, naphazoline MOA

Class: topical decongestant

MOA: stimulates alpha-adrenergic receptors in nose/sinuses and constricts blood vessels decreasing sinusoid vessel engorgement and mucosal edema, doesn’t absorb systemically

Oxymetazoline, phenylephrine, naphazoline treats

nasal/sinus congestion, good option for people who cannot take sudafed

Oxymetazoline, phenylephrine, naphazoline side effects

dry nose, bleeding, rhinitis medicamentosa (rebound congestion) if taken longer than 3-7 days

Oxymetazoline, phenylephrine, naphazoline Pros/cons

P: rapid acting, lacks systemic effects, better for pts with pregnancy/bf, heart problems, BPH, Oxymetazoline is absorbed the least and is the most preferred here- also long acting since dosed twice a day and the others are every 4-6hr

C: additional side effects→ local irritation, trauma from improper use

Pt Counseling: viral contamination possible

Nasal Saline Dosing

any age, Max irrigation: twice daily

Nasal Saline MOA

Class: moisturizer

MOA: relieves nasal irritation and dryness, aid in removal of thick/dried mucus from nose

Nasal Saline treats

Nasal congestion and dryness; withdrawal from nasal decongestants

Nasal Saline Side effects

runny nose, mild stinging/burning

Nasal Saline Pros and Cons

P: immediate onset of action, well tolerated, can be used in any age, pregnancy/bf, more effective than saline nasal spray/drops

C: don’t recommend to kids who can’t do it, can be uncomfortable, needed boiled/distilled water

Menthol/Camphor Dosing

Ointment: 2+ (still not great to put on kids that young, risk of eating)

Lozenge: 6+ , (might be choking hazard still)

Menthol/Camphor MOA- general

Menthol stimulates TRPM8 receptors → anesthetic

(pain on skin or sore throat)

Menthol/Camphor MOA: cough

lozenges decrease throat irritation and increase saliva causing a reduction in cough, Suppresses cough reflux sensitivity

Menthol/Camphor MOA: Nasal/chest congestion

Chest rub containing Menthol/Camphor vapors stimulate sensory nerve endings within the nose/chest and mucosa creating a local anesthetic sensation and sense of improved airflow (no actual effect on lungs, just a sensation)

Menthol/Camphor treats

Nasal/chest congestion (rub), Dry cough (rub), Sore throat (menthol lozenges)

Menthol/Camphor Pros and Cons

P: safe in most pt populations, menthol lozenges safe in pregnancy/bf

C: do not recommend in pregnancy/bf, lacks evidence of effectiveness

Caution: children can overdose if eaten, apply to feet of young children and cover with sock, choking risk with lozenges in children and sometimes older adults

Dextromethorphan/Codeine dosing

Dex: 2+ per FDA, 4+ per Manufacturer

Dex Dose: 4-6: max 30mg/day, 6-12: max 60mg/day, >12 max: 120mg/day

Codeine: >18

Dextromethorphan/Codeine MOA

Class: antitussive (cough suppressant)

MOA Dex: nonopioid that acts centrally in the medulla to increase the cough threshold

MOA Cod: opiod that acts centrally in the medulla to increase the cough threshold

Dextromethorphan/Codeine treats

Dry cough

Dextromethorphan/Codeine side effects

Dex: stomach discomfort, drowsiness/CNS depression, abuse (euphoria, hallucinations)

Cod: euphoria, risk of addiction, N/V, sedation, dizziness, constipation, respiratory distress (overdose)

Dextromethorphan/Codeine Pros and Cons

Dex: P: safe in kids and older adults, safe in pregnancy/bf

Dex: C: not for productive coughs unless pts cannot sleep or interfering with daily activities

Dex CON: DDI with MAOIs

Cod Avoid: not to be used in kids, pregnancy/bf

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine Dosing

Ages 2+, only recommend 6+ due to paradoxical rxns

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine MOA gen.

Class: sedating (crosses BBB)/1st gen antihistamines

MOA: blocks histamine at C and P histamine 1 receptor sites

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine MOA cough

Acts centrally in medulla to increase cough threshold and decreases post-nasal drip to reduce cough (hits both cough mechs and helps sleep)

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine MOA nasal

acts P in nose to dry up nasal secretions (anticholingeric)

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine MOA insomnia

Crosses BBB to cause sedation

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine treats

Dry cough, rhinorrhea, sleep

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine side effects

dry eyes/nose (no see), urinary retention (no pee), dry mouth (no spit), constipation (no shit), sedation, cognitive impairment

Diphenhydramine, Chlorpheniramine, Brompheiramine, Doxylamine, Triprolidine + Pseudoephrine pro/cons

P: onset of action 10-15min, available in combo products, can treat multiple symptoms and sleep, single ingredient first gen antihistamines safe in pregnancy

Caution: pts with BPH, when mental alertness is needed, pts with Alzehimers/Dem., pts with closed cangle glaucoma, all older adults, using alcohol

CON: breastfeeding, pts taking MAOIs

Honey Dosing

Ages >1, less than one poses botulism risk

Honey MOA

Class: antitussive

MOA: acts as a cough suppressant by coating the throat decreasing irritation and reducing cough frequency; also has antimicrobial properties

Honey treats

Dry cough

Honey side effects

Upset stomach from sugar content

Honey Pros and cons

P: data supports effectiveness (buckwheat honey), may be good alternative for children under 6, safe in pregnancy/bf

CON: children under 1

Guaifenesin dosing

2+ FDA, 4+ Manufacturer

Effective Dose:

2-6 600mg/day

6-12 1200mg/day

>12 2400mg/day

Guaifenesin MOA

Class: protussive, expectorant

For minimally productive cough, thins mucus and increases the volume of expectorated sputum

MOA nasal congestion: thins nasal secretions

Guaifenesin treats

Wet cough, ineffective productive cough, nasal congestion

Guaifenesin side effects

things mucus throughout whole body

Guaifenesin Pros and cons

P: available in various forms, no DDIs, can be used in all pts really, cannot overdose, pregnancy/bf

C: not much data to support

APAP, Ibuprofen, Naproxen

Best for sore throats, fever, muscle pain, headaches

Benzocaine/Phenol dosing

ages 4-6+

Benzocaine/Phenol MOA

Class: local anesthetic

MOA: decreases permeability of sodium ions/depresses cutaneous receptors, which results in blockage of nerve conduction to cause numbing

Benzocaine/Phenol treats

local pain/sore throat

Benzocaine/Phenol Pros and Cons

P: well tolerated, can use with systemic analgesics, safe in pregnancy/bf

C: effects only last 10-15 mins but cannot redose for 2-4 hours, cannot use with caine allergy

Caution: choking risk

Zinc Dosing

ages 12+

must start within 24-48hr of symptoms onset

Zinc MOA

Class: supplement (treatment of cold)

MOA: prevents the adhesion of human rhinovirus to the nasal epithelium

• inhibits viral replication by disrupting viral capsid formation

Zinc treats

cold symptoms

Zinc side effects

Upset stomach

Zinc Pros/Cons

P: Can reduce cold symptoms if taken within 24hrs of onset symptoms, safe in pregnancy/lactation if doses are less than 40mg/day

C: doses need to be taken every 2-4hrs max times 4-6 a day

Echinacea Dosing

ages 12+

Echinacea MOA

Class: prevention and treatment of cold

MOA: complementary med, may exhibit antiviral activity to boost immune function

Echinacea treats

cold symptoms

Echinacea side effects

GI discomfort, rash, worsening of asthma, allergic rhinitis, and eczema

Echinacea Pros and Cons

C: most likely to be adulterated of all cough/cold products, must be taken at first sign of symptoms to benefit

Avoid in: pts with asthma, children under 12, immunocompromised, and pregnancy/bf