Cough and Cold

Characterized by prominent sore throat, sinus congestion, and moderate cough; fever is absent/rare, myalgias are minimal/absent, and headache is mild to moderate

Common cold

Characterized by sudden onset of high fever, severe myalgias/bone pain, severe dry cough, and moderate headache; sinus congestion is absent and sore throat is mild/moderate

Influenza

Characterized by severe sinus congestion/stuffy nose, clear rhinorrhea, and absence of fever or myalgias; cough and sore throat are variable and usually secondary to post-nasal drip

Allergic rhinitis

During days 3-5 nasal secretions typically change _____ to yellow or green

Color

Yellow of green nasal secretions do not automatically indicate a _______ infection; this transition represents normal viral respiratory tract shedding and neutrophil leukocytic infiltration

Bacterial

If nasal secretions are discolored after day 6, refer to doctor as there may be a _____ infection

Bacterial

Refer if constant, persistent fever above _______ degrees F

101.5

Refer if ________ of ______, dyspnea, wheezing, or true chest pain are present

Shortness of breath

Refer if symptoms last longer than ____ days, or development of worsening/new symptoms during self-treatment

7-10

Refer if production of thick green, yellow, or tan purulent sputum accompanied by _______ signs like fever and chills

Systemic

Uncontrolled asthma/COPD, heart failure or uncontrolled cardiovascular disease, and immunocompromised status are reasons for _______

Referral

Refer if cough is suspected to be _______-induced

Medication

Infants under ___ months of age get immediate referral for cough/cold

9

FDA recommends avoiding nonprescription cough/cold formulations in children under ___ years of age

2

Pediatric symptoms persisting for more than ___ days require provider referral

5

Geriatric patients over 80 often require referral due to presence of _______ complex medical conditions and higher likelihood of suffering from side effects

Multiple

What are the three main classes of drugs associated with medication-induced cough?

ACE inhibitors, Nonselective beta-blockers, and NSAIDs

Inhibit the breakdown of bradykinin, substance P, and inflammatory prostaglandins, leading to persistent, dry, nonproductive cough

ACE inhibitors

Medication-induced cough from ACE inhibitor can be managed by switching the patient to an ____

ARB

Blockade of pulmonary Beta-2 receptor induces bronchial smooth muscle constriction/bronchospasm

Nonselective Beta-blockers

Shunts arachidonic acid metabolism down the 5-lipoxygenase pathway, increasing leukotriene production and triggering bronchospasm

NSAIDs

Three medications associated with pulmonary fibrosis

Amiodarone, Methotrexate, and Bromocriptine

Interventions include systemic hydration to thin secretions, cool-mist vaporizers/humidifiers, external nasal dilator strips, saline nasal sprays, and ointments containing topical camphor, menthol, or eucalyptus

Nasal congestion

After using saline nasal spray, wait ____ minutes to blow nose

10

Interventions include increased fluid intake, non-medicated demulcent lozenges, warm liquids containing lemon and honey

Cough

This must never be administered to infants <1 year of age due to the severe risk of infantile botulism

Honey

Interventions include warm salt-water gargles and warm liquids

Sore throat

Includes routine disinfection of high-touch household/workplace surfaces

Infection control

Constricts dilated vascular smooth muscle in the nasal mucosa (Alpha-1 receptor activation), reducing capillary permeability and mucosal edema

Decongestants

Exhibits significantly higher oral bioavailability and clinical efficacy compared to phenylephrine

Pseudoephedrine

Increases systolic BP by an average of 1 mmHg (greatest spikes occur with scheduled, short-acting, high-dose regimens)

Pseudoephedrine

Adverse effects include CNS stimulation, insomnia/wakefulness, restlessness, tachycardia, elevated blood pressure, and palpitations

Decongestants

______ decongestants should be avoided in uncontrolled hypertension/cardiovascular disease

Systemic

This medication can significantly decrease maternal milk supply

Pseudoephedrine

Provides rapid local decongestion with minimal systemic side effects; can be used in place of oral decongestants to avoid sleeplessness/insomnia

Nasal decongestants

Nasal decongestants must be restricted to ___ days maximum

3

Prolonged use of nasal decongestants causes downregulation of vascular receptors, leading to severe ______ _______

Rebound congestion

Competitively blocks histamine-1 receptors. First-gen agents possess significant antimuscarinic/anticholinergic properties, which dry hypersecretory nasal mucosa and centrally increase the cough threshold

Antihistamines

Adverse effects include sedation, drowsiness, dry mouth, blurred vision, urinary retention, and constipation

First-Generation Antihistamines

Avoid in geriatric patients: high risk of confusion, urinary retention, delirium, and falls; also avoid in patients with narrow-angle glaucoma or BPH

First-generation antihistamines

Centrally act on the cough center in the medulla to increase the threshold for coughing; indicated strictly for dry, nonproductive, bothersome coughs

Antitussives

Absolute contraindication with MAOIs or concurrent serotonergic antideprssants due to the severe risk of Serotonin Syndrome

Dextromethorphan

Avoid in patients with uncontrolled asthma or COPD (suppressing the cough reflex impairs clearance of retained secretions)

Dextromethorphan

Acts as an antitussive to centrally suppress cough via medullary action in addition to its drying anticholinergic properties

Diphenhydramine

Increases respiratory tract fluid volume and decreases bronchial secretion viscosity

Guaifenesin

Loosens and thins thick mucus in your airways so your coughs can clear it out more effectively

Guaifenesin

Used for productive, chesty coughs with thick, tenacious mucus

Guaifenesin

Blocks nerve impulse conduction along local axons to diminish throat pain signals

Cepacol Lozenges

Contraindicated in patients with benzocaine allergy; allow lozenges to dissolve slowly in themouth; do NOT chew or swallow

Cepacol Lozenges

Provides temporary local oral analgesia via direct spray application

Chloraseptic

First-line treatment for cough secondary to allergies

First-generation antihistamine

First-line treatment for productive cough

Guaifenesin

First-line treatment for dry cough

Dextromethorphan

Recommended therapies are saline nasal sprays, topical decongestants, and non-pharm remedies

Uncontrolled hypertension

Avoid systemic decongestants (pseudoephedrine, phenylephrine, Nyquil, Sudafed PE)

Uncontrolled hypertension

Choose sugar-free and alcohol-free products

Diabetics

Prefer non-pharmacological therapies (hydration, vaporizers, saline sprays, nasal strips, local lozenges)

Pregnancy and lactation

Systemic decongestants are contraindicated in ________

Pregnancy

Prefer saline sprays, cool mist, hydration; refer if symptoms persist for more than 5 days

Pediatrics

Prefer non-pharmacological measures and second-generation antihistamines if allergy-driven

Geriatrics

Avoid ____-generation anticholinergic antihistamines and sedating agents in geriatric patients

First

Brand names are Mucinex and Robitussin

Guaifenesin

Expectorant; loosens/thins mucus and phlegm

Guaifenesin

What is the MDD for Guaifenesin?

2.4 g/day

Contraindicated in children <2 years, pregnancy, and MAOIs; should feel thinning of mucus and reduction of chest congestion in around 30 mins

Guaifenesin

Brand names are Delsym and Mucinex DM

Dextromethorphan

Antitussive; acts in brain cough center

Dextromethorphan

What is the MDD for Dextromethorphan?

120 mg/day

What is the MDD for Mucinex DM?

4 tabs/day

Contraindicated in children <2 years and MAOIs; don’t drive or operate heavy machinery; relief in around 30 mins

Dextromethorphan

Brand names are Cepacol Dual Relief Spray and Cepacol Sore Throat Sugar Free lozenges

Benzocaine

Local anesthetic; blocks nerve signal transmission

Benzocaine

What is the MDD for Cepacol spray?

4 times/day

What is the MDD for Cepacol lozenges?

12/day

Contraindicated in perforated tympanic membrane or ear discharge; takes 10-15 minutes to feel pain relief

Benzocaine

Brand names are VIcks VapoDrops, Vicks VapoRub

Menthol

What products are in Vicks VapoRub?

Camphor, menthol, and eucalyptus

Local anesthetic and counterirritant; triggers cold receptors

Menthol

What is the MDD for VIcks VapoRub?

3 times/day

Contraindicated in children <12 years, mint allergy, gallbladder/biliary occlusion, severe liver damage

Menthol

Do not use on open wound; do not apply heat to areas; feel relief in 2-5 minutes

Menthol

Brand name is Chloraseptic spray

Phenol

Local anesthetic and antiseptic; depresses local throat receptors

Phenol

What is the MDD for Phenol?

12 sprays/day

Contraindicated in children <2 years, epiglottitis, pregnancy; patient may experience tingling in mouth; pain reduction in 5-10 minutes; do not swallow

Phenol

Brand name is Afrin

Oxymetazoline

Topical decongestant; constricts nasal mucosa vessels

Oxymetazoline

What is the MDD for oxymetazoline?

2-3 sprays BID

Can cause rebound congestion if used >3 days; caution in hypertension, DM, BPH; feel relief in 5-10 minutes

Oxymetazoline

Brand names are Neo-Synephrine spray and Sudafed PE tablet

Phenylephrine

Decongestant; constricts blood vessels

Phenylephrine

What is the MDD for oral phenylephrine?

60 mg/day

Contraindicated in pregnancy, severe hypertension, narrow-angle glaucoma, v-tach; feel relief in 5-10 mins

Phenylephrine

Brand name is Sudafed

Pseudoephedrine

Systemic decongestant; constricts nasal blood vessels

Pseudoephdrine

What is the MDD for pseudoephdrine?

240 mg/day

Contraindicated in pregnancy, severe CAD, severe HTN, MAOIs, avoid taking at or near bedtime to help with difficulty sleeping; improvement in around 30 mins

Pseudoephedrine

Brand name is Ocean Nasal spray

Sodium chloride

Nasal irrigant/humectant; prevents drying/crusting

Sodium chloride

Non-medicated, so safe to use as needed; keep bottle tip clean; press opposite nostril shut to assist with keeping medication in nose

Sodium chloride