Cough and Cold

Moderate to severe sinus congestion; moderate cough; rare or low-grade fever; mild/rare myalgias; prominent rhinorrhea and sore throat

Common cold

Rare/mild sinus congestion; severe/prominent cough; high-grade, sudden onset fever; severe/systemic myalgia; variable rhinorrhea/sore throat

Influenza

Variable/prominent sinus congestion; variable/intermittent cough; no fever; no myalgia; sneezing/itching prominent

Allergies

These medications inhibit the breakdown of bradykinin, substance P, and prostaglandins, leading to localized airway inflammation and a dry, persistent cough

ACE Inhibitors

Alternative to ACE inhibitors that do not elevate bradykinin levels, therefore not causing cough

ARBs

These medications block pulmonary Beta-2 receptors, triggering smooth muscle contraction and bronchospasm

Nonselective beta-blockers

To manage coughing from non-selective beta-blockers, switch to a ________ Beta-1 blocker or alternative antihypertensive class

Cardioselective

These medications inhibit COX-1, shunting arachidonic acid metabolism toward the lipoxygenase pathway, thereby increasing leukotriene activity and precipitating bronchospasm

Aspirin and NSAIDs

These medications are associated with parenchymal lung injury and fibrotic tissue remodeling leading to chronic cough

Amiodarone, Methotrexate, and Bromocriptine

Includes detailed description of main complaints (e.g., dry vs. wet cough, thick green/yellow/tan purulent secretions indicating bacterial infection)

Symptoms

Exposure history (e.g., close contact with a sick individual within the past 5 days); nature of discomfort (e.g., sinus pressure, temporal headache, chest wall muscular ache secondary to coughing)

Characteristics

Duration of symptoms (e.g., >7-10 days); overuse or failure of non-prescription products; recent medication alterations; underlying chronic conditions (e.g., uncontrolled asthma, COPD, heart failure)

History

Timing and acute versus gradual emergence of symptoms

Onset

Specific anatomical involvement (nasal passages, sinuses, pharynx ,lower respiratory tract, temporal head region)

Location

Exacerbating conditions (e.g., nasal congestion worsening when lying flat; cough/sore throat worsening with cold air exposure)

Aggravating factors

Alleviating measures (e.g., sitting upright for nasal congestion; warm liquids for sore throat/cough; rest/sleep for systemic fatigue and temporal headache)

Relieving factors

Refer if temperature is above ______ degrees F

101.5

Refer for _______ _______ such as shortness of breath, dyspnea, or severe chest pain

Respiratory distress

Refer for symptoms persisting for more than ___ days without improvement

7-10

Refer for coughing up thick green, yellow, or tan secretions as this suggests an ________

Infection

Refer if history of _______ asthma, COPD, or heart failure

Uncontrolled

Refer if diagnosis of AIDs, active cancer therapy, or concurrent _______ ______

Immunosuppressant therapy

Infants less than ___ months of age are an absolute referral

9

While children >2 years may be evaluated, most OTC cough and cold products are not FDA-approved for children under ___ years of age

4

Refer peds to a provider if symptoms exceed ____ days

5

Frail elderly patients (age >80 years with multiple chronic conditions) should be referred due to heighted susceptibility to drug ____ ______

Side effects

Pregnancy/lactation requires cautious product ________ and monitoring

Selection

Maintain robust systemic hydration; use a cool mist vaporizer; apply Breathe Right strips; administer saline nasal sprays; apply topical camphor/menthol/eucalyptus ointments

Nasal congestion

Systemic hydration; non-medicated throat lozenges; warm liquid with lemon and honey

Cough

Honey must NEVER be administered to infants under 1 year of age due to the high risk of ______ ________

Infant botulism

Warm fluid intake; warm saltwater gargles

Sore throat

Constrict mucosal blood vessels, reducing tissue swelling, hyperemia, and edema in nasal passages

Decongestants

Examples are pseueoephedrine, phenylephrine, and oxymetazoline

Decongestants

Tightens blood vessels to reduce swelling around the nose

Decongestants

Can cause CNS stimulatioN (wakefulness, nervousness), tachycardia, and elevated BP

Decongestants

Side effect if topical nasal decongestants are used for more than 3 consecutive days

Rebound congestion

Should not be used with Monoamine Oxidase inhibitors due to severe hypertensive crisis risk

Decongestants

This medication can significantly decrease maternal milk supply

Pseudoephedrine

These medications are contraindicated in pregnancy

Decongestants

Patients with controlled hypertension (<130/80) may use systemic _______ under clinical supervision and blood pressure monitoring

Decongestants

Block histamine at H1-receptor sites; first-generation agents possess potent antimuscarinic properties, effectively drying up nasal secretions

Antihistamines

Blocks chemicals that cause your nost to run

Antihistamines

Adverse effects include sedation, drowsiness, and anticholinergic (anti-SLUD) effects; dry mouth, urinary retention, constipation, blurred vision

Antihistamines

Strictly indicated for dry, non-productive cough; centrally acts on the medullary cough center of the brainstem to increase the cough threshold and suppress the cough reflex

Antitussives

Examples are detromethorphan (DM), codeine, diphenhydramine, and benzonatate

Antitussives

Blocks brain signals to prevent coughing

Antitussives

Antitussive that must be avoided in patients taking MAOIs or multiple serotonergic antidepressants due to the risk of Serotonin Syndrome

Dextromethorphan

Indicated for wet, productive coughs with viscous sputum; increases respiratory tract fluid volume and decreases mucus viscosity, loosening secretions

Expectorants

Example of an expectorant

Guaifenesin

Loosens and thins out mucus in your airway to help you cough it up

Expectorant

Used for sore throat pain, fever, sinus headache, and muscular aches

Analgesics

Acetaminophen and Ibuprofen

Systemic analgesics

Stops the body from sending pain signals

Analgesics

Avoid benzocaine-containing products in patients with a benzocaine _______ (not necessarily lidocaine)

Allergy

Cepacol lozenges should be dissolved slowly in the mouth; do not ____ or swallow whole

Chew

Therapy selection must be prioritized by the symptoms that are most problematic for the ______

Patient

Treatment should be initiated with saline nasal spray or a systemic/nasal decongestant

Nasal congestion

If oral decongestants cause CNS stimulation or insomnia, switch to ______ nasal decongestant sprays

Topical

Aches and pains should be treated with systemic _______

Analgesics

Fever should be treated with systemic _______

Antipyretics

________ should be treated with local anesthetic sprays or lozenges

Pharyngitis

Non-pharm recommendations include hydration, cool mist vaporizers, Breathe Right strips, saline nasal sprays, frequent hand washing, and surface disinfection

Nasal congestion

Used to treat dry cough

Antitussive

Used to treat wet cough with cold symptoms

Guaifenesin

Green of yellow mucus present with cough requires immediate medical referral after day ___

6

Wet cough without cold symptoms should be treated with these meds

First generation antihistamines

If chest is site of origin, use ____________

Guaifenesin

If cough is triggered by irritation at the back of the throat or is severely bothersome, add this with guaifenesin

Dextromethorphan

In this population, use sugar-free and alcohol-free formulations; avoid medications whose side effects mask symptoms of low blood sugar

Diabetes

FDA does not recommend nonprescription cough and cold products for children under ___

2

Manufacturers restrict nonprescription cough and cold products to children over ___ years of age

4

In this population, avoid systemic medications (oral decongestants) that elevate blood pressure and heart rate

Cardiovascular disease

In this population, avoid systemic medications and prefer non-pharmacological therapies and locally acting agents (saline sprays, lozenges, ointments)

Pregnant

In this population, avoid first generation antihistamines due to anticholinergic side effects; avoid sedating drugs; evaluate drug-drug interactions

Geriatrics

This systemic decongestant is significantly more effective than phenylephrine

Pseudoephedrine