APT II Exam 1 Cough/Cold

What is not a common mode of transition of viral particles that can cause the common code?

Exchange of bodily fluids

What 3 medications can induce a cough?

ACEi, Nonselective B/B, Aspirin/NSAIDs

What are the non-selective B/Bs?

Carvedilol, Labetalol, Nadolol, Propanolol, Timolol

What medications are associated with pulmonary fibrosis?

Amiodarone, Methotrexate, Bromocriptine

What are the symptoms of a cold?

Sinus congestion, Cough, Myalgia, Sore throat and Headache

What are the symptoms of the flu?

Cough, Fever, Myalgia, Sore throat

What are the symptoms of allergies?

Cough, Sore throat

What is the timing of symptom resolution in a cold?

Days 1-2: Clear, thin secretions, Days 3-5: Yellow/green thick secretions, Days 6+: Clear, thin secretions

Exclusions for self-treatment of a cold:

• Constant fever (>101.5)

• SOB

• Thick/green/yellow secretions

• Uncontrolled (Asthma, COPD, HF, diabetes)

• Immunocompromised (HIV/meds)

• Symptoms lasting > 7-10 days

• Chest pain and bone pain

• Overuse of non-prescription product

Special populations (that may also lead to exclusion):

• Pediatrics (Less than 9 mos.)

  • >2 years OK but most products not approved in under 4 years

• Pregnancy/Lactation

  • Limited non-prescription options

  • Refer if symptoms >5 days

• Geriatrics (fall risk and increased ADRs)

Sumeeta is requesting assistance selecting a cough syrup for her son. He has been coughing for 3 days. Had a slight fever but went away after Tylenol. He is 26 months old and weighs 27 pounds. Is he a candidate for self-care?

No- He had a fever (would need to know more detail) AND he is 2 years and 2 months old so there is not going to be any medicine available.

Carlos would like help picking something for his cough. He has a history of asthma and his inhaler is not helping enough. He describes a wet cough that started 4 days ago. Is he a candidate for self-care?

No- uncontrolled asthma AND inhaler not helping (this is defined as use greater than twice a week)

3 approaches to prevent spread of a cold:

• Wash hands

• Wear a mask

• Disinfecting (home/phone/doorknobs)

Non-pharm therapies for cough/cold:

• Nasal congestion (Hydrate, humidifier, breathrite strips, saline, Vicks)

• Cough (Hydrate, Lozenges, warm liquid)

• Sore throat (Warm liquid, warm salt water gargle)

What type of medication treats sinus congestion?

Sympathomimetics (decongestants)

What is the MOA of sympathomimetics (decongestants)?

Stimulate alpha-adrenergic receptors to constrict BV - reduces mucosal edema - reduce sinusoid vessel engorgement

What type of medications treat pain?

Analgesics

What is the MOA of analgesics?

Inhibit effects of PG by inhibiting their production or blocking R’s - Reduce inflammation and block pain pathways

What type of medication treats Rhinorrhea (runny nose)?

Inhibit the effects of histamine at the H1 receptor, prevent the release of histamine - Anticholinergic/antimuscarinic properties = dry secretions

What type of medication treats a Dry cough?

Antitussives and antihistamines

What is the MOA of antitussives/antihistamines in treating dry cough?

Centrally act to increase cough threshold/suppress cough reflex

What type of medication is used to treat a sore throat?

Analgesics and local anesthetics

What is the MOA of analgesics and anesthetics when treating sore throat?

Reduce transmission of pain signals

What type of medication treats a wet cough?

Expectorants

What is the MOA of expectorants in treating wet cough?

Increase bronchial secretions and reduce viscosity- improved clearance out of airway

What are absolute containdications to sudafed?

• Pregnancy (fetal malformations, increased miscarriage risk)

• History of uncontrolled HBP

In what patients should DM be avoided in?

• Uncontrolled asthma

• MAOI use (Isocarboxazid (Marplan), Phenelzine (Nardil), Selegiline (Emsam patch or oral), Tranylcypromine (Parnate))

• Children under 4

List the order of treating Congestion and Rhinorrhea:

1. Saline nasal spray or decongestant

2. Complaint of sleeplessness? (sudafed) use nasal decongestant

3. Symptoms resolved after 7 to 14 days? No - switch therapies/refer

List the order of treating aches and pains(from cold): (also applies to fever)

1. NSAIDs

2. Nasal decongestant (IFN)

3. Symptoms resolved after 7 to 14 days? No - switch therapies/refer

List the order of treating Pharyngitis:

1. Local anesthetic spray or lozenges

2. Nasal decongestant (IFN)

3. Symptoms resolved after 7 to 14 days? No - switch therapies/refer

If cough onset is less than 7 days what is the order of treatment?

1. Dry vs wet? Dry = antitussive

2. Wet with cold symptoms or w/o? Without = 1st gen antithistamine

3. With cold symptoms, color and duration?

4. Colorless OR days 2-5 yellow/green= guaifenesin w/ or w/o DM - >day 6 green/yellow = refer

What is important when recommending OTCs to people with diabetes?

Sugar-free, alcohol free and avoid medications that can mask the symptoms of low BS

What is important when recommending OTCs to people with cardiovascular disease?

Avoid systemic medications that can increase BP and HR

What is important when recommending OTCs in pregnancy and lactation?

Avoid systemic medication, Non-pharm preferred, Locally acting preferred (ointment, lozenge)

What is important when recommending OTCs to geriatrics?

Avoid anticholinergic medication, Avoid drowsiness ADR, D-D intxns

Guaifenesin AC syrup class and drug:

Codeine/guaifenesin - antitussive

Contraindications of guaifenesin AC (codiene)

• History of substance abuse

• Hypersensitivity to codeine

• Caution in >65

Counseling points of Guaifenesin AC (codeine):

• Drowsiness/impair mental abilities

• Constipation/nausea/vomiting

• Avoid taking this medication with other narcotics and alcohol

• Call your provider if you experience severe dizziness, SOB, hallucinations or chest pain

What homeopathic remedy has shown to decrease the duration of a cold?

Zinc (Zicam)

What is the brand and class of guaifenesin?

Mucinex;Expectorant

What is the MOA of guaifenesin?

Loosens and thins mucus/phlegm to allow the individual to cough it up

What are contraindications of guaifenesin?

• Do not use within 14 days of MAOI use

• Not indicated for chronic cough (COPD/asthma/smokers cough)

• Children under 2

• Pregnancy

What are some counseling points of guaifenesin?

• May upset stomach or vomiting

• Drink a lot of water

• MDD 2.4 grams

• Onset: 30 mins

• If cough >7 days, see a doctor

What is the Brand and Class of dextromethorphan?

Delsym/Mucinex DM - Antitussive

What is the MOA of Dextromethorphan?

It works in the brain and tells it to stop or lower the amount of coughing

What are contraindications of Dextromethorphan?

• Do not use within 14 days of MAOI use

• Children under 2

• Not indicated for chronic cough (COPD/asthma/smokers cough)

What are counseling points of dextromethorphan?

• May cause dizziness/tiredness

• Don’t drive or operate heavy machinery until you know how it affects you

• Onset: 30 mins

• If cough >7 days, see a doctor

What is the Brand and class/use of benzocaine?

Cepacol; Local anesthetic; sore throat

What is the MOA of Benzocaine?

Prevents the nerves of the body from sending signals to the brain which helps to reduce pain

What are counseling points of benzocaine (cepacol)?

• May cause skin rash/taste

• Wait until it wears off to eat

• Onset 10-15 minutes

Menthol/peppermint oil MOA:

Triggers receptors in body to think its cold without changing body temperature = local pain relief

Menthol is contraindicated in…

Children under 12

Menthol counseling points:

• Do not use in excess during pregnancy

• Do not use on open wounds/irritated skin

• Do not apply heat after using

• Relief in 2-5 minutes

• Do not use > 3x per day

• Do not inhale products or apply to mucus

Brand name, class and indication of Phenol:

Chloraseptic, local anesthetic, sore throat

MOA of chloraseptic:

Depresses local pain receptors in throat

Counseling points for phenol:

• Do not use for more than 7 days

• May experience tingling in mouth]

• onset 5-10 mins

• Do not swallow

Oxymetazoline Brand and class

Afrin - decongestant (adrenergic agonist)

Afrin MOA:

Tightens blood vessels in the nose wall which results in less swelling and mucus

Contraindications of Afrin:

Uncontrolled hypertension or severe heart disease or DM

Counseling points of Afrin:

• Prime before first use

• Keep head upright, insert nozzle, depress firmly and inhale

• Onset: 5-10 mins

• Do not use more than 3 days

Phenylephrine brand and class

Sudafed PE or Neo-synephrine - decongestant

Phenylephrine contraindications:

• Uncontrolled HP

• Pregnancy

• Glaucoma

Phenylephrine counseling points:

• onset: 5-10 mins

• Do not use for more than 3 days

Pseudoephedrine class and brand

Sudafed;Decongestant

Sudafed contraindications:

• Uncontrolled HTN

• Pregnancy

• MAOI use

Counseling points of sudafed:

• May cause fast heart rate, difficulty sleeping, anxiety, nervousness

• Avoid taking at or near bedtime

• Onset: 30 mins

Saline nasal spray MOA, counseling:

Moisturizes nose, can be used as often as needed, clean tip after each use, press opposite nostril to assist with keeping inside nose

Doxylamine Brand, MOA, Class, counseling:

Unisom or ingredient in NyQuil; antihistamine; blocks chemicals in body that are created during allergic reaction; use for sleep; Avoid alcohol, causes drowsiness, take 30 minutes before bedtime

What causes the symptoms of a cold?

Virus binds to respiratory epithelial cells in nose and nasopharynx then replicates in cells which release pro-inflammatory mediators (vasodilation, secretions, cough/sneeze reflex)

Why aren’t colds treated with antibiotics?

Antibiotics are only used in the case of bacteria, the risks outweigh the benefits (more ADRs)

Viruses that cause the common cold can live up to _ hours on human skin/objects

3

A pregnant/breastfeeding patient presents with: Generalized pain, sore throat, cough, nasal congestion and sneezing/rhinorrhea, what are the treatment options (in order of symptom):

Tylenol, Cepacol/Chloraseptic spray (benzocaine), DM, Afrin, Loratadine/Cetirizine

A patient with controlled Asthma/COPD presents with: Generalized pain, sore throat, cough, nasal congestion and sneezing/rhinorrhea, what are the treatment options (in order of symptom):

Tylenol (maybe NSAID), Cepacol/Chloraseptic spray (benzocaine), DM, Sudafed, Antihistamines

A diabetic patient presents with: Generalized pain, sore throat, cough, nasal congestion and sneezing/rhinorrhea, what are the treatment options (in order of symptom):

Tylenol (NSAID if ok renal), Cepacol (SF), DM/guaif (SF), Sudafed or Afrin, Antihistamine (but counsel on masking hypo)

A patient with HTN presents with: Generalized pain, sore throat, cough, nasal congestion and sneezing/rhinorrhea, what are the treatment options (in order of symptom):

Tylenol, Cepacol/Chloraseptic, DM/guaif, Afrin/short acting sudafed (if well controlled), Antihistamines

A geriatric patient presents with: Generalized pain, sore throat, cough, nasal congestion and sneezing/rhinorrhea, what are the treatment options (in order of symptom):

Tylenol, Cepacol/Chloraseptic, DM/Guaif, sudafed/afrin, Fexofenadine???