Self Care Exam 2 pt2

preventing the common cold

-wash hands (soap and water preferred)

-avoid touching face

-avoid contact with infected

-clean surfaces

cholinergic stimulation

a runny nose due to the COMMON COLD is due to _______________________ which increases mucous gland activity

1 week

the typical common cold lasts around ______________

if inoculated w common cold, ___________ of people will experience symptomatic illness

sore throat (common cold)

early symptom, can treat with oral analgesics

runny nose (common cold)

brief early symptom, can treat with 1st gen antihistamines

nasal congestion (common cold)

almost all patients experience, can treat with decongestants

cough (common cold)

end stage symptom, treatment depends on the type

systemic complaints like fever and malaise (common cold)

not common but if present can treat with oral analgesics

oral analgesic for common cold

NSAIDs or acetaminophen

BUT

NSAIDs must be taken with food so acetaminophen is preferred

drink fluids

someone with a common cold should ___________________ to relieve symptoms

NO NO NO NO NO NO ITS CHOLINERGIC

histamine is the cause of runny nose due to a common cold

1st generation antihistamines

MIGHT relieve runny nose from common cold due to anticholinergic activity

adverse effects of 1st gen antihistamines

-sedation

-narrow angle glaucoma

-can worsen BPH

doxylamine

nyquil, unisom

MOST sedating 1st gen antihistamine

diphenhydramine

benadryl

2nd most sedating 1st gen antihistamine

brompheniramine

Dimetapp

3rd most sedating 1st gen antihistamine

chlorpheniramine

Chlor-Trimeton

LEAST sedating 1st gen antihistamine

age for 1st gen antihistamines

>6 years old

dosage forms for treating nasal CONGESTION

-oral

-topical (nasal sprays and vapor inhalers)

age for ORAL decongestants

>4 years old

pseudoephedrine

Sudafed

the best oral nasal decongestant

cardiovascular disease

oral nasal decongestants should NOT be used in patients with _________________________

oral decongestant side effects

-jitters

-insomnia

-anxiety

immediate release pseudoephedrine tablets

30mg q 4-6 hours

MAX 4 doses/24 hours

Max dose of pseudoephedrine

240 mg/day

sustained release pseudoephedrine tablets

120mg q 12 h

extended release pseudoephedrine tablets

240mg q 24 h

issues w/ pseudoephedrine

-quantity limit

-CNS stimulation

-SR and ER products do not last as long as they say

phenylephrine

Sudafed PE

bad oral decongestant

immediate release phenylephrine tablets

10mg q 4 h

MAX 6 doses/day

oral decongestants contraindications

-antidepressant drugs MAO inhibitors

-cardiovascular disease

-pregnancy

decrease milk production

pseudoephedrine is okay in pregnancy but it is known to ____________________________

TOPICAL nasal decongestants

vasoconstrictors that act locally on nasal mucosa and act quickly

oxymetazoline

Afrin, topical decongestant

use every 10-12 hours

MAX 2 doses in 24 hours

Cautions for Topical Nasal Decongestants

-cardiovascular disease

-enlarged prostate that causes urination issues

-rebound congestion

3 days

topical nasal decongestant sprays should not be used for more than ________________ due to risk of rebound congestion

rhinitis medicamentosa

Rebound congestion from overuse of nasal decongestants.

levmetamfetamine

Vicks Vapo Inhaler

Topical Decongestant

MAX 7 day use due to rebound congestion

propylhexadrine

Benzedrex

topical decongestant vapor inhaler

MAX 3 day use due to rebound congestion

3 months

once a vapor inhaler is opened it MUST be used within ____________________

OKAY

vapor inhalers for nasal decongestion are ______________ in cardiovascular disease

symptom

a cough is a ____________ and NOT a disease

productive cough

Cough that produces mucus or phlegm

you do NOT want to suppress this type of cough

non-productive cough

a dry cough without secretions

OKAY to suppress this type of cough

expectorants/protussive ingredients

encourages coughing up mucus in a productive cough

guaifenesin

Mucinex, Robitussin

expectorant

MAX 2400mg/day

age for guaifenesin

>4 years old

guaifenesin adverse effects

-nausea

-GI upset

a full glass of water

guaifenesin MUST be taken with ______________________

cough suppressant (antitussive ingredient)

can only be used in a dry/unproductive cough

dextromethorphan

Delsym

antitussive cough suppressant

can be addictive at very high doses

age for dextromethorphan

>4 years old

dextromethorphan contraindications

-MAO-I antidepressants (14 days)

-increases risk of serotonin syndrome

-MUST be 18 to purchase

common cold characteristics

-gradual onset

-low grade fever (less than 100)

-runny nose and congestion very common

influenza characteristics

-sudden onset

-high grade fever (102-104)

-headache and myalgia present

-extreme fatigue

-non productive dry cough

high risk people for influenza

-65 years or older

-anyone with a chronic medical condition

-pregnant women

-young children

ibuprofen age

6 months and older

acetaminophen age

2 years and older

2nd gen antihistamines age

2 years and older

oral decongestants age (sudafed, phenylephrine)

4 years and older

cough products age (guafenasin, dextromethorphan)

4 years or older

1st gen antihistamines age

6 years or older

naproxen age

12 years and older

dyspepsia

epigastric discomfort, also called indigestion

heartburn

warm or burning sensation in the chest which may spread to the neck/throat and occasionally to the back

episodic/intermittent heartburn

occurs infrequently or only occasionally

frequent heartburn

2 or more days per week

GERD (gastroesophageal reflux disease)

disease with symptoms and/or esophageal tissue damage resulting from abnormal reflux of stomach acid into the esophagus

symptoms of GERD

-frequent heartburn (2 or more days/week) lasting for 3 or more months

-regurgitation

-water brash (mouth fills with saliva)

DO NOT self treat these heartburn pts

-frequent heartburn lasting more than 3 months

-persistent heartburn even after otc drug treatment

-heartburn that continues after 2 weeks of H2RA or PPIs

-SEVERE heartburn

-heartburn that interrupts sleep

-anyone 45 years old (or older) with new onset symptoms

heartburn treatment goals

-relief of existing symptoms

-reduce symptom reoccurrence

non-drug therapy for heartburn

-avoid dietary triggers

-avoid large meals

-avoid laying down 2-3 hours after eating

-elevate the head of the bed

-lifestyle changes (weight loss, stop smoking, limit caffeine/alcohol)

OTC drug therapy for heartburn

-antacids

-H2 receptor antagonists

-proton pump inhibitors (PPIs)

antacids

neutralize the gastric acid to help symptoms of heartburn

antacids characteristics

-FAST onset

-SHORT acting

types of antacids

-calcium carbonate

-magnesium hydroxide

-aluminum hydroxide

-sodium bicarbonate

calcium carbonate

Tums, antacid for heartburn

can also be used as a calcium supplement

magnesium hydroxide

milk of magnesia, antacid for heartburn

causes diarrhea!

aluminum hydroxide

Amphogel, antacid for heartburn

causes constipation!

sodium bicarbonate

baking soda, antacid for heartburn

most rapid acting but not recommended due to increased gas and risk of gastric rupture

treatment

antacids are only FDA approved for the _______________ of heartburn and NOT the prevention

ANC

acid neutralizing capacity

scale used to measure antacids and their ability to neutralize gastric acid

best antiacid in regards to ANC

calcium carbonate (TUMS)

antacids onset

5 minutes

antacids counseling

chew thoroughly followed with a full glass of water

rolaids

calcium carbonate + magnesium hydroxide

antacids duration

20-30 mins

can be increased to 3 hours if taken with food

antacids drug interactions

can impact absorption of other meds, separate from other drugs 2-4 hours

antacids okay in pregnancy

-calcium

-magnesium

14 days

calcium and magnesium antacids can only be used for ______________ in pregnant women

alginic acid

Gaviscon

forms a barrier or raft in stomach for 4 hours if the person remains in an upright position

H2 receptor antagonists

reversibly bind to H2 receptors on parietal cells to decrease secretion of gastric acid

H2RA duration

slight delayed onset (1 hour) but longer duration of action

treat AND prevent

H2RAs are FDA approved to ______________________ heartburn

H2RAs products

-famotidine (Pepcid)

-cimetidine (Tagamet)

Ranitidine (Zantac)

H2 receptor antagonist that was taken off the market due to presence of NDMA

cimetidine drug interactions

-warfarin

-theophylline

-phenytoin

H2RAs age

12 years or older

proton pump inhibitors (PPIs)

irreversibly bind to actively working H/K/ATPase (proton pump) of parietal cells to block final step in acid secretion