438 Exam 2

What is a productive cough and what are the 2 types?

A cough that is wet or chesty

Effective - Easy to expel secretions

Ineffective - Not easy to expel secretions

What is a non-productive cough

Cough that is dry, described as “hacking”

What causes non-productive cough (5)

Virus, GERD, bacteria, CV, some medications

What secretion appearance does a URTI have

Clear

What secretion appearance does a bacterial infection have

Purulent

What causes an acute cough (7)

Viral, bacterial, pertussis, COPD, allergic rhinitis, pneumonia, environmental irritants

What causes a subacute cough (3)

Post-infection, CHF, fluid in lungs

What causes chronic cough (4)

Asthma, COPD, GERD, bronchitis

Why do you need to refer when a fever is above 100.4*F

Cough and 100.4*F is a risk factor for community-acquired pneumonia

When should you refer for a cough

• Temp >100*F for 3+ days

• Worsens after 3-5 days, no improvement after 7 days of self-care, or persists after 2-3 weeks

• <4 y/o

• Immunocompromised

• TB exposure

• Returns after resolving

• Chronic conditions

What is the primary goal for treating cough

Reduce number and severity of episodes

What is the secondary goal for treating cough

Prevent complications

What is the MOA of all antitussives

Act on medulla to increase cough threshold  

Should you suppress a productive cough

No

Who should you not give honey to and why

Infants less than 1 year old; risk of botulism

In terms of effectiveness, how does honey compare to placebo, diphenhydramine, and dextromethorphan

Equal to dextromethorphan

Better than placebo and diphenhydramine

How does a nonmedicated lozenge/hard candy alleviate cough

Stimulate saliva to decrease throat irritation

How does humidification alleviate cough

Increase air moisture of inspired air to soothe airways

Can corn syrup be substituted for honey

Yes

What kind of device is preferred for humidification and why

A cool mist vaporizer; fewer bacteria grow and no scalding risk

What are the tools used for nasal drainage in adults

Neti pot, syringe a+ saline

What are the tools used for nasal drainage in young children

Rubber bulb syringe

How do you prepare saline (3)

• 1-2 cups of water

• ¼ to ½ tsp of non-iodized salt

• pinch of baking soda

How does hydration alleviate cough

Promotes less viscous secretions

What is the indication for all oral antitussives

Alleviate nonproductive cough

Are oral antitussives used for nonproductive cough

Yes

Are oral antitussives used for productive cough

No

What is the onset and duration of codeine

Onset: 15-30 minutes

Duration: 4-6 hours

What is the dosing for codeine

12+: 10-20mg/4-6h; max 120mg/day

6-12: 5-10mg/4-6h; max 60mg/day

What are the side effects of codeine (6)

n/v, dizziness, respiratory depression, constipation, sedation, addiction risk

What interactions does codeine have (2)

Alcohol and CNS depressants

Who/when should avoid codeine (3)

P/BF, impaired lungs

What is the onset and duration of dextromethorphan

Onset: 15-30 minutes

Duration: 3-6 hours

What is the dosing for dextromethorphan

12+: 10-20mg/4-6h or 30mg/8h; max 120mg/day

6-12: 5-10mg/4-6h or 15mg/8h; max 60mg/day

What are the side effects of dextromethorphan (3)

n/v, drowsiness, constipation

What interactions does dextromethorphan have (3)

MAOI, SSRI, CYP2D6 inhibitors

Who should avoid taking dextromethorphan (2)

Prior dependence, taking drugs that interact, hypersensitivity

What is the onset and duration of diphenhydramine

Onset: 15 minutes

Duration: 4-6 hours

What is the dosing for diphenhydramine

12+: 25mg/4h; max 150mg/day

6-12: 12.5mg/4h; max 75mg/day

What are the side effects of diphenhydramine (7)

Drowsiness, respiratory depression, blurred vision, urinary retention, dry mouth, impaired coordination, dry respiratory secretions

What interactions does diphenhydramine have (5)

Alcohol, CNS depressants, narcotics, benzodiazepines, tranquilizer agents

Who should avoid taking diphenhydramine

Medical conditions are worsened by anticholinergics

Why do you need to avoid taking dextromethorphan with MAO inhibitors

Can cause serotonergic syndrome; avoid dextromethorphan use at least 14 days after discontinuing an MAOI

What is robotripping and what medication is associated with it

Abuse of dextromethorphan causing psychosis and mania

What topical counterirritant causes a sensation of heat

Methyl salicylate

What topical counterirritants cause a sensation of coolness

Menthol and camphor

What is the MOA for topical antitussives

Inhaling vapors leads to local anesthetic sensation in nose which improves airflow

What are the SE of topical antitussives

Skin, nose, and eye burning/irritation

What drug interactions does menthol have

Warfarin, causes decreased INR

What drug interactions does camphor have

None

When/where should you avoid using a topical antitussive

When: 1h before or 30 min after showering

Where: eye, nostril, damaged skin, tight bandages, heat/microwave

What is the dosing/administration of camphor and menthol

Administration

• Ointment: Apply to chest and neck up to 3x/day PRN, don’t cover tightly

• Lozenge: dissolve slowly, repeat hourly PRN

• Inhalation: Up to 3x/day PRN

Dosing

• Camphor: 4.7-5.3% ointment, 6.2% inhalation

• Menthol: 2.6-2.8% ointment, 5/10mg lozenge, 3.2% inhalation

What medication is an expectorant

Guaifenesin

What is the MOA for guaifenesin

Loosen and thin secretions

What is the indication for guaifenesin

Symptomatic relief of acute, ineffective, nonproductive cough

What are the SE of guaifenesin (7)

N/v, dizziness, drowsiness, HA, rash, diarrhea, stomach pain

When should you avoid using guaifenesin

History of hypersensitivity

Are expectorants used for productive or nonproductive cough

Productive

What is the dosing of guaifenesin in 12+

200-400mg/4h PRN; max 2400mg/day

What is the dosing of guaifenesin in 6-12

100-200mg/4h PRN; max 1200mg/day

What is the dosing of guaifenesin in 2-6

50-100mg/4h PRN; max 600mg/day

Is there evidence that oral antitussives and expectorants are effective at treating acute cough

No

In what age group should you avoid use of cough medications

Older adults

What are acute wounds usually from

Injury

When should you refer when treating a wound

Deep puncture, animal bite, gaping, showing fat/muscle/bone, contain foreign material, severe pain or numbness, inability to move structures below wound, bleeding disorder or diabetes, chronic wound, infected (swelling, redness, pus, warmth, red streaks)

What is the purpose of bleeding

To clean the wound

How do you stop minor wound bleeding (3)

1) Remove large objects from wound

2) Cut clothing/remove jewelry

3) Apply direct steady pressure for 15 minutes and elevate area

If blood soaks through, apply another layer of cloth

If an object is stuck, apply pressure around the object

How should you clean a wound

If available use tap water with sufficient pressure

Use washcloth, soap, alcohol, iodine, hydrogen peroxide around wound only

Clean actual wound only once

Should you use alcohol, peroxide, or iodine to clean a wound and why/why not

No. Disrupts granulation tissue leading to increased scarring and thicker scab formation

When should you clean a wound

Only once, the first time you clean; can use alcohol/peroxide/iodine around wound to keep clean

What is the purpose of antibiotics/antiseptics

Prevent infection

When should you stop using antibiotics on a wound

When the wound is sealed over

When/how often should you use antibiotics to treat a wound

Within 4 hours of the wound and 1-3 times daily

When should you refer for a wound when using antibiotics

If there is no improvement after 5 days

Where should you use local anesthetics

On unbroken skin only

What is the nonpharmacologic option to anesthetics

Cold/ice; 20 min on, 20 min off

What is the MOA of super adhesive polymers

Seal off nerve endings

What is the purpose of primary wound dressing

Light absorbency, protection, aesthetics

What is the purpose of secondary wound dressing

Mod-heavy absorbency, compression, advanced protection

How do you apply primary wound dressing

Apply directly over wound and secure with gauze/tape

How do you apply secondary wound dressing

Apply over primary dressing

Are secondary wound dressings for self care?

No, for surgical patients

Between gauze and nonadherent gauze, which is better and why

Gauze can dry out wound; nonadherent gauze is porous and does not stick as much

How do you remove residue from tape

Alcohol or nail polish remover on a cottonball

Rank the tapes from worst to best allergy

Waterproof, plastic, cloth, paper

Rank the tapes from least to greatest adhesion

Paper, cloth, plastic, waterproof

Rank the tapes from cheapest to most expensive

Plastic, paper, cloth, waterproof

How do you self-treat a bite wound

• Wash w/ soap/water

• Apply pressure if bleeding

• Antibiotic ointment after bleeding stops

• Cover w/ bandage/gauze

• Systemic analgesic

When should you seek care for a bite wound (5)

• Wild animal

• Shots not up to date

• Break in skin

• Face, head, neck, foot, near joint

• Infected

How do you treat stitches

• Wash 1-3 days after and dry well

• Elevate

  • decrease pain, swelling; increase healing

• Apply antibiotic ointment to cover stitches

  • reduce scarring and thickness of scab

• Broad spectrum sunscreen w/ SPF 30-50 for 6 months

Describe RICE therapy

Rest after injury until pain decreases

Icing ASAP for 10-15 minutes 3-4 times daily up to 72 hrs

Compression: unwind 12-18 inches, relax wrap, wrap distal to injury, decrease tightness as wrap

Elevate at or above heart 2-3 hours daily

What is the max dose for ibuprofen

1200 mg/day

What is the MOA of methyl salicylate (3)

• Rubefacient - cause mild, local inflammation to provide relief to another site

• vasodilation of cutaneous blood vessels

• Central and peripheral inhibition of prostaglandin synthesis

What is the difference between fever and hyperthermia

Fever is regulated, hyperthermia is not

Where is fever regulated

In the hypothalamus

What is the pathophysiological pathway of fever

Exogenous (infection) or endogenous (cytokines) pyrogens —>

Increased PGE2 levels —> vasoconstriction —> cold extremities —> warmth seeking behaviors

What are the exclusions of self-treatment for fever

• <6 months old w/ rectal temp>101

• >6 months old w/ rectal temp>104

• Lasts longer than 3 days

• Impaired O2 disease states

• Serious SE of infection

• Impaired immune function/CNS damage

• Kids w/ hx of febrile seizures

• Rash, low fluid intake, extreme lethargy or vomiting in kids

What are non-pharmacologic treatments for fever

• Proper fluid intake

• Light clothing

• Comfortable room temp

• Remove blankets

What is the MOA of OTC fever treatment

Inhibit PGE2 synthesis by blocking COX enzyme in CNS

What is the max time for use of OTC antipyretics

3 days