TBL 2: Cold, Cough, and Allergy

pseudoephedrine, phenylephrine

available systemic decongestants

systemic decongestants

stimulate alpha-adrenergic receptors, causing systemic vasoconstriction of blood vessels

15, 60

pseudoephedrine should be given ______ mg every 4-6 hours as needed with a maximum daily dose of _______ mg for patients aged 2 to

30, 1-2

the onset of action for pseudoephedrine is at ________ min, while the peak effect is at _______ hours

pseudoephedrine

Sudafed, Nexafed

phenylephrine HCL

Sudafed PE

30, 120

pseudoephedrine should be given ______ mg every 4-6 hours as needed with a maximum daily dose of _______ mg for patients aged 6 to

60, 240

pseudoephedrine should be given ______ mg every 4-6 hours as needed with a maximum daily dose of _______ mg for patients aged 12 and older

15-30 minutes

onset of action for phenylephrine HCL (Sudafed PE)

2.5, 15

phenylephrine HCL should be given ______ mg every 4 hours as needed with a maximum daily dose of _______ mg for patients aged 2 to

5, 30

phenylephrine HCL should be given ______ mg every 4 hours as needed with a maximum daily dose of _______ mg for patients aged 6 to

10, 60

phenylephrine HCL should be given ______ mg every 4 hours as needed with a maximum daily dose of _______ mg for patients aged 12 and older

systemic decongestants

nervousness, irritability, and insomnia are common side effects of __________________

pseudoephedrine, phenylephrine

while uncommon, ________________ may cause increased heart rate and _________________ may cause decreased heart rate

MAOI

contraindication of systemic decongestants: should not be used within 14 days of a ___________

systemic decongestants

precautions for ___________________:

-cardiovascular disease

-intraocular pressure/glaucoma

-BPH/urinary incontinence

-hyperthyroidism

-drug interactions (MAOIs, SSRIs)

photo ID

a ______________ is required to purchase pseudoephedrine

oxymetazoline, phenylephrine

available products for topical decongestants

topial decongestants

act by stimulating alpha adrenergic receptors in the nasal passages, causing local vasoconstriction of blood vessels

6

oxymetazoline (Afrin) is not recommended for children under the age of _________

oxymetazoline (Afrin)

____________________ dosing: 2-3 sprays of 0.05% solution in each nostril at least 10-12 hours apart with a maximum daily dose of 2

0.125%

children 2 to

0.25%

children 6 to

0.5%

children 12 years and older can use _______________ phenylephrine HCL

phenylephrine HCL (Neo-Synephrine)

_________________ dosing: 2-3 sprays in each nostril at least 4 hours apart; no maximum daily dose

topical decongestants

common side effects of ________________________:

burning, stinging, local irritation, sneezing

topical decongestants

precautions for _____________________:

-risk of rebound congestion (limit to 3-7 days of use)

-endocrine disorders (hyperthyroidism and DM)

-drug interactions

oral

topical decongestants are toxic through ______ ingestion - may cause nausea, vomiting, drooling, lethargy, sedation, or coma

oral antihistamines

act as an H1 receptor antagonist (second gen bocks mast cell mediator release); alleviates itching, sneezing, rhinorrhea/post-nasal drip, and helps manage immediate hypersensitivity reactions

first gen antihistamines

highly lipophilic; can cross the blood brain barrier, allowing for their sedative and anticholinergic properties

second, first

_________ generation antihistamines are effective for allergic rhinitis, while ___________ generation are effective for cough/cold + allergic rhinitis

diphenhydramine

sedating 1st gen antihitamine

cetirizine, levocetirizine

less-sedating 2nd gen antihistamine

loratadine, fexofenadine

non-sedating 2nd gen antihistamines

second generation antihistamines

lipophobic; do not cross the blood brain barrier, making them less sedative and have no anticholinergic properties

piperazines

less-sedating 2nd gen antihistamines: cetirizine (Zyrtec) and levocetirizine (Xyzal)

piperidines

non-sedating 2nd gen antihistamines: loratadine (Claritin) and fexofenadine (Allegra)

alkylamines

less-sedating 1st gen antihistamines: brompheniramine and chlorpheniramine

ethanolamines

most-sedating 1st gen antihistamines: diphenhydramine and doxylamine

6

first generation antihistamines CANNOT be given to children under the age of _________

25-50

children 12 and up should take ______________ mg of diphenhydramine (Benadryl) ever 4-6 hours with a max dose of 300 mg

12.5-25

children 6 to

2

second generation antihistamines should not be given to children under the age of _________

10

12 and up dose for cetirizine: _______ mg every 24 hours

5

12 and up dose for levocetirizine: _______ mg every 24 hours

10

6 and up dose for loratadine: ______ mg every 24 hours

60, 180

12 and up dose for fexofenadine: _____ mg every 12 hours OR _____ mg every 24 hours

1st gen antihistamines

precautions for __________________________:

-elderly patients at risk of sedative effects

-drug interactions: CNS depressants

1st gen antihistamines

contraindications for ______________________:

-hypersensitivity to medication or ingredients

-concurrent use of MAOIs

-narrow-angle glaucoma

-symptomatic BPH

1st gen antihistamines

________________________ side effects:

-sedation

-impaired functionality or performance

-anticholinergic properties cause dry mouth, eyes, blurred vision, constipation, or urinary retention

-confusion

-paradoxical effects

intranasal antihistamines

H1 receptor antagonist that also blocks mast cell mediatory release; alleviates itching, sneezing, rhinorrhea/post-nasal drip - just came to the market as an OTC med in 2022

6

azelastine HCL (Astepro Allergy) should not be used for children less than ____ years old

intranasal antihistamines

________________________ common side effects: bitter taste, runny nose, headache, sedation (less likely due to local admin)

INCS (Intranasal Corticosteroids)

available products include fluticasone propionate, fluticasone furoate, triamcinolone, and budesonide

INCS (Intranasal Corticosteroids)

act by inhibiting cell mediators to help stop the "allergic cascade", causing relief of nasal symptoms in allergic rhinitis and is also approved for ocular effects

1, 2

most INCS start at _____ spray in each nostril once daily and may increase upt to ____ sprays per day if needed

INCS (Intranasal Corticosteroids)

_________________ common side effects include headache, nasal/local irritation such as burning and stinging

INCS (Intranasal Corticosteroids)

____________________ less common side effects include adrenal suppression, immunosuppression, serious local irritation

cromolyn sodium

acts as a mast cell stabilizer, preventing mediatory release resulting in prevention/treatment of allergic rhinitis

3-7

cromolyn may take ____________ days to achieve clinical improvement - maximum therapeutic benefit may take up to 2 to 4 weeks

cromolyn (NasalCrom)

_________________ dosing: 1 spray in each nostril 3-6 times per day in regular intervals for 2 weeks

cromolyn

___________ side effects: sneezing, stinging, burning, and local irritation; safe for pregnancy

nasal spray administration

1) prime pump and/or shake and wash hands

2) blow nose before administering and keep head upright

3) insert nozzle tip in nostril - aim tip away from nasa septum

4) sniff deeply while spraying, repeat with other nostril

5) wipe down nozzle/tip with dry tissue

codeine, dextromethorphan

available antitussive products

antitussives

act by centrally increasing the cough threshold (DXM is an NMDA antagonist) to suppress cough

15-30 minutes

onset for codeine and dextromethorphan

1 mg/kg/day

codeine dose for children 2 to

5-10

children 6 to

10-20

children 12 and older should be given ____________ mg of codeine or DXM every 4-6 hours with a max dose of 120 mg

codeine

common side effects include nausea, vomiting, sedation, and constipation

dextromethorphan

common side effects include drowsiness and GI upset; generally well tolerated

codeine

contraindication include:

-hypersensitivity

-severe respiratory depression

-GI obstruction

-use of MAOIs

C-V

schedule of codeine

codeine

________________ precautions:

-asthma/COPD or any respiratory depression

-drug addiction

-regular alcohol use

-drug interactions (other CNS depressants or CYP2D6 inhibitors)

500-1000 mg

lethal codeine dose for adults - causes respiratory depression and cardiopulmonary collapse

dextromethorphan

______________ contraindications:

-use of MAOIs

-hypersenstivity

dextromethorphan

_______________ precautions:

-diabetes

-drug interactions (SSRIs, CYP2D6 inhibitiors)

Guaifenesin (Mucinex)

protussive

protussives

act as expectorants, increasing respiratory tract hydration and thins mucus

200-400 mg

dose of guaifenesin (Mucinex; Robitussin) for children 12 and older

12

do not use extended release protussives in children less than _____ years old

protussives

_____________ side effects:

-nausea

-vomiting

-dizziness

-headache

-rash

-diarrhea

-drowsiness

-stomach pain

systemic analgesics

acetaminophen, NSAIDs, aspirin

nasal saline

relieves dryness mucosal irritation; decreases nasal stiffness, rhinorrhea, and sneezing; removes dried, encrusted, or thick mucus

10

max number of local anesthetics (cough drops) that a child under 12 can have in a day