Cough and Cold

Sudafed

pseudoephedrine

Sudafed PE

phenylephrine

Sudafed and Sudafed PE can be used in

Adults, children 2+

what is the MOA for sudafed and sudafed pe

stimulates alpha-adrenergic receptors in the nose/sinuses to constrict blood vessels

what does the MOA for sudafed and sudafed pe do in the nose/sinuses?

it decreases the sinusoid vessel engorgement and mucosal edema

what symptoms does sudafed and sudafed pe treat?

nasal/sinus congestion and cough with post-nasal drip (not the first choice)

why does sudafed/sudafed pe cause raised BP, rapid heart rate, and arrythmias?

due to beta stimulation and norepinephrine

why does sudafed/sudafed pe cause insomnia, anxiety, nervousness, restlessness, tremor, and anorexia?

due to stimulation of the CNS and crossing the blood brain barrier

why does sudafed/sudafed pe cause urinary retention?

since they are alpha/beta agonist, they stimulate the urethra/prostate smooth muscle

what is the onset for sudafed/sudafed pe?

30 min-2 hours

avaliable in short acting and long acting tabs (12 hrs, 24 hrs)

why should patients with hyperthyroidism be cautious with taking sudafed/sudafed pe?

because they are stimulating to the cardiovascular and central nervous system

why should patients with BPH/prostate enlargement be cautious in taking sudafed/sudafed pe?

because they contract smooth muscle around the urethra and can inhibit urination further

what is a very rare side effect of taking sudafed/sudafed pe?

acute angle-closure crisis/closed-angle glaucoma aka emergency vision loss

who is contraindicated in taking sudafed/sudafed pe?

pregnancy/lactation due to potential birth defects and decreased milk production and patients taking MAOIs

Afrin

oxymetazoline

Neosynephrine

phenylephrine

what class is Oxymetazoline, phenylephrine, and naphazoline in?

topical decongestant

what is the MOA for Oxymetazoline, pheylephrine, and naphazoline?

they stimulate alpha-adrenergic receptor in the nose/sinuses which causes the blood vessels to constrict. this causes the decrease in sinusoid vessel engorgement and mucosal edema

what symptoms does Oxymetazoline, phenylephrine, and naphazoline alleviate?

nasal/sinus congestion

what side effects does Oxymetazoline, phenylephrine, and naphazoline cause?

dry nose, bleeding due to dryness, and rhinitis medicamentosa (rebound congestion)

what is the onset for oxymetazoline, phenylephrine, and naphazoline?

rapid acting, within minutes

what decongestant medications lack systemic side effects and is better for pregnancy, breastfeeding, heart problems, and BPH?

oxymetazoline, phenylephrine, and naphazoline

what is the dose for oxymetazoline?

twice a day

what is the dose for phenylephrine and naphazoline?

every 4-6 hours

what decongestants cause local irritation (sneezing/burning/stinging) and trauma from improper use?

oxymetazoline, phenylephrine, and naphazoline

what is the counseling point for oxymetazoline, phenylephrine, and naphazoline?

viral contamination can occur if product is shared so bottle needs to be kept clean and seperate

what age should a patient be in taking Afrin?

6+

Neilmed irrigation Ayr, Ocean sprays

nasal saline

what age should a patient be taking nasal saline?

any age

what is the max irrigation for nasal saline?

twice a day

what class is nasal saline under?

moisturizer

what is the MOA for nasal saline?

relieves nasal irritation and dryness and aids in removal of thick/dried mucus from nose

what symptoms does nasal saline alleviate?

nasal congestion and dryness and withdrawal from nasal decongestants

what is the onset of action for nasal saline?

immediate

what is more effective? nasal spray/drops or nasal saline

nasal saline

what brand of menthol camphor is for kids?

Vicks, Mentholatum

what is in the dosage form for menthol camphor as lozenges?

menthol

what is the dosage form for menthol camphor for a chest rub?

menthol and camphor

what is the class for menthol camphor?

local anesthetic, topical antitussive

what is the general MOA for menthol camphor?

stimulates TRPM8 receptors to work as an anesthetic

what is the MOA for menthol camphor as an antitussive?

lozenges decrease throat irritation and increase saliva to reduce cough and cough reflex sensitivity

what is the MOA for menthol camphor as a nasal/chest decongestant?

stimulate sensory nerve endings within the nose/chest and mucosa to create a local anesthetic sensation and sense of improved airflow

what dosage form of menthol camphor can be used in adults and children 2+?

ointment

what dosage form of menthol camphor can be used in adults and children 6+?

lozenges

what dosage form of menthol camphor would help with dry cough?

rub

what dosage form of menthol camphor would help with sore throat?

menthol lozenges

what dosage form of menthol camphor would help with nasal and chest congestion?

rub

what dosage form of menthol camphor is compatible with breastfeeding/pregnancy but not recommended?

rub

what dosage form of menthol camphor is safe for pregnancy/breastfeeding?

lozenges

where should you apply menthol camphor on young children so they dont accidently ingest it?

on the feet

Robitussin, Delsym, Robitussin AC

dextromethorphan

what is the dose for dextromethorphan for 4-6 years old?

max 30mg/day

what is the dose for dextromethorphan for 6-12 years old?

max 60 mg/day

what is the dose for dextromethorphan for patients greater than 12 years old?

max 120mg/day

what class is dextromethorphan?

antitussive

what is the MOA for dextromethorphan?

nonopioid acts centrally in the medulla to increase cough threshold

what is the MOA for dextromethorphan codeine?

opioid acts centrally on the medulla (cough control center) to increase cough threshold

what side effects can be expected from dextromethorphan?

stomach discomfort, drowsiness/CNS depression, robotripping

what side effects can be expected from dextro +codeine

robotripping, n/v, sedation, dizziness, constipation, overdose

what type of cough does dextromethorphan not work for?

productive cough

what is the d-di for dextromethorphan?

MAOIs

what form of dextromethorphan cannot be used in pregnancy?

codeine

what schedule is dextromethorphan codeine?

CS-V

Benadryl

diphenhydramine

Chlortrimeton

chlorpheniramine

Dimetapp

brompheniramine

Doxylamine

multi-ingredient products

Actifed, Aprodine

triprolidine + pseudoephedrine

what class do Benadryl, Chlortrimeton, Dimetapp, Doxylamine, and Actified/Aprodine in?

sedating/1st generation antihistamines

what is the MOA for Benadryl, Chlortrimeton, Dimetapp, Doxylamine, and Actified/Aprodine?

blocks histamine centrally and peripherally at histamine-1 receptor sites

what is the MOA for Benadryl, Chlortrimeton, Dimetapp, Doxylamine, and Actified/Aprodine nasally?

peripherally in the nose to dry up nasal secretions (anticholinergic)

what is the MOA for Benadryl, Chlortrimeton, Dimetapp, Doxylamine, and Actified/Aprodine for cough?

centrally in medulla to increase cough threshold and peripherally to dry up post-nasal drip and reduce cough

what is the MOA for Benadryl, Chlortrimeton, Dimetapp, Doxylamine, and Actified/Aprodine for insomnia?

crosses the BBB to cause sedation

antihistamines are okay for adults and children 2+ but only recommended for

6+ years

what symptoms does antihistamines alleviate?

dry cough, rhinorrhea, and sleep

what type of histamines are not effective for cough/cold?

2nd generation histamines

what are the 2nd generation histamines?

Claritin, Zyrtec, Allegra

since 1st generation antihistamines are anticholinergic, what side effects do they cause?

no see, no pee, no spit, no sh**, sedation, cognitive impairment, and paradoxical reactions

what is the onset of action for 1st-generation antihistamines?

15-30 minutes

what type of medications do antihistamines complement?

decongestants

what type of anti-histamines are safe in pregnancy?

1st generation single ingredient

what is the contraindications for taking antihistamines?

breast feeding and MAOIs

when is honey a non-pharm product?

when it comes from the kitchen and not in a box labeled for cough

what is the class of honey?

antitussive

what is the MOA for honey?

coats the throat to decrease irritation and reduce coughing frequency/microbial properties

what type of cough does honey alleviate?

dry cough

what is true about honey?

it may be more effective than dextromethorphan and is good for nocturnal cough for children under 6

is honey safe in pregnancy and breastfeeding?

yes

Mucinex Robitussin

guaifenesin

maximum dose for guaifenesin 2-6 years old

600 mg/day

maximum dose for guaifenesin 6-12 years old

1200mg/day

maximum dose for guaifenesin >12 years

1200-2400 mg

what is the class of guaifenesin?

protussive/expectorant

what is the MOA for guaifenesin for chest congestion?

thins mucus and increases volume of expectorated sputum

what is the MOA for guaifenesin for nasal congestion?

thins nasal secretions

what protussive/expectorant has minimal side effects and no ddi so it can be used with almost anyone?

guaifenesin

what is true about tylenol and NSAIDs for fever/pain in the throat, muscle, and headache?

it is more effective than topical agents for sore throat and muscle pain

what class are benzocaine, phenol?

local anesthetic

what dosage form does benzocaine, phenol come in?

lozenges and sprays

Cepacol, Chloraseptic

benzocaine, phenol