Krinsky- smoking cessation and cough/cold

both of krinsky's pp for exam 1 10 Q

What is the difference between a productive and nonproductive cough?

productive- wet

nonproductive- dry

Usually, a nonproductive cough is due to…

an underlying condition

For cough, what OTC products can be used during pregnancy? Of those, which is the most commonly used?

• Dextromethorphan

• Diphenhydramine- most common

For cough, in the elderly, what is most commonly used?

guaifenesin

What are the ADRs of systemic decongestants like pseudoephedrine and phenylephrine?

• CV stimulation

• CNS stimulation

• rebound congestion

What is the difference between antitussives and protussives?

anti-tussives: cough SUPPRESSANTS

protussives: EXPECTORANTS

Are antitussives or protussives recommended for non-productive coughs?

anti-tussives

Which of the following are anti-tussive/cough suppressants?

SATA:

a. codeine

b. dextromethorphan

c. diphenhydramine

d. guaifenesin

a, b, c

What are 2 examples of expectorants?

• guaifenesin

• WATER—→ the BEST expectorant

What are some non-pharm treatments for a cold?

• fluids, sleep, good diet

• humidification

• saline nasal sprays/drops

• salt gargles, hot tea, oils

• breathing strips

If a patient has a cold, what is the best/recommended treatment for it?

non-pharm measures first!

What are some common products used for tx of a cold?

“Decongestants”

• pseudoephedrine

• phenylephrine

What is the national telephone number for the toll-free tobacco quit line?

1-800-QUIT-NOW

What are the 5 “A’s” approach to helping patients quit smoking?

“5 A’s”

1. Asking pts. whether they use tobacco

2. Advising tobacco users to quit

3. Assessing patients’ readiness to quit

4. Assisting patients with quitting

5. Arranging follow-up care

What are the symptoms of nicotine withdrawal?

• irritable, anger, depression, anxiety

• cough, insomnia, dizzy

• +more

How does nicotine work in the brain?

activates nicotinic cholinergic receptors and releases NTs

What is the significance of secondhand smoke?

• associated w/ rapid increases in endothelial dysfunction and inflammation

  • leads to CV events and thrombosis

• significant in kids

What are some of the benefits of smoking cessation?

• blood pressure decreases

• circulation improves

• coughing, congestion, fatigue, SOB decreases

• reduces the risk of coronary heart disease

• reduce stroke risk

• reduces lung cancer risk

What are the 3 OTC nicotine replacement dosage forms?

• gum

• lozenge

• transdermal patch

The recommended dosage of nicotine gum and lozenges is based on what?

“time to first cigarette” (TTFC) of the day

Nicotine Gum are Lozenges are available in what strengths?

If TTFC is 30 min or less you should take ____ mg.

If TTFC is more than 30 min you should take _____ mg.

Available in 2 mg and 4 mg.

If TTFC is 30 min or less you should take 4 mg.

If TTFC is more than 30 min you should take 2 mg.

The dosing of nicotine transdermal patches is based on what?

how many cigarettes you smoked per day

True or False: For Non-Rx/ OTC treatment combo therapy should be considered 1st-line treatment.

true

What nicotine replacement therapy has the fastest onset but most ADRs?

nasal spray (krinsky doesn’t recommend)

What nicotine replacement therapy products require a prescription?

• nasal sprays

• inhalers

What 2 prescription drugs can be prescribed to help quit smoking?

• bupropion

• Varenicline

True or False: Nicotine is not one of the most addictive substances available.

false- it is

What is the dosing for Bupropion?

• 150 mg ER for 3 days

• then 150 mg BID for 7-12 weeks

Should the dose of Varenicline be tapered or a consistent amount over 12 weeks?

tapered over 12 weeks

Which of the following are ADRs of Varenicline?

SATA

a. CNS

b. GI

c. Hepatic

d. Renal

a, b