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What is the definition of a COUGH?
A voluntary OR involuntary RESPIRATORY tract REFLEX
What is the CLASSIFICATION and CAUSE of an ACUTE cough?
- LESS than 3 weeks
- Caused by: Viral URI or OTHER conditions (pulmonary emboli, pneumonia)
- Related to POST NASAL DRIP
What is the CLASSIFICATION and CAUSE of a SUBACUTE cough?
- 3-8 Weeks
- Caused by: Post infectious Cough, Bacterial Sinusitis
What is the CLASSIFICATION and CAUSE of a CHRONIC cough?
- 8 Weeks
- Most COMMON: Post Nasal Drip, Pulmonary Conditions (asthma), GERD
- ALSO: CHF, Medications (ACEI--20% due to inhibition of bradykinin break down, Non-selective Beta-blockers---due to bronchioconstriction)
What are the CAUSES of a CHRONIC cough in children?
- Foreign body ASPIRATION
- Esophageal MOTILITY Disorders
Why do ACE INHIBITORS cause a COUGH?
They STOP the breakdown of BRADYKININ
Why do Non-selective BETA-BLOCKERS cause a COUGH?
They cause BRONCHIOCONSTRICTION
What are the TWO TYPES of Coughs?
What is a PRODUCTIVE Cough?
- Wet or "CHESTY"
- CLEARS secretions from LRT
- Coughing up MUCUS
What is a NONPRODUCTIVE Cough?
- Dry or "HACKING"
- No PHYSIOLOGIC purpose
What are (6) COMMON Complications with a COUGH?
- Muscle Pain
- Excessive Sweating
- Urinary Incontinence
What are (4) LESS COMMON Complications with a COUGH?
- Heart Arrythmias
- Syncope--- passing out
- Stroke--- due to increased Intracranial Pressure
- Rib Fractures--- due to Osteoporosis
A TRIAD of symptoms that usually occur with the common COLD, FLU, & ALLERGY?
- Nasal Congestion
What is the MECHANISM of the COUGH REFLEX?
Irritants/Particulates----(Inflammatory Mediators)---- Sensory Nerve Stimulation---- CNS Cough Reflex Center= MEDULLA
What is the COUGH REFLEX Center?
What can TRIGGER (5) the COUGH REFLUX?
- Enviro Pollutants
- Job Exposures
- Mucosal [Ion]/osmolarity
The ____________________________ is the SENSORY nerve ENDINGS of respiraory epithelium.
AFFERENT Nerve Pathway
The Afferent Nerve Pathway contains receptors SENSITIVE to ___________________________ & __________________________.
- MECHANICAL Stress
- Specific CHEMICAL Transmitters
__________________________ are activates by ONE OR MORE mechanical stimuli.
Rapidly Acting Stretch Receptors (RAR)
What MECHANICAL Stimuli activate RARs?
- Lung Inflation
- Light Touch
- Physical changes---triggered by histamine from mast cells
________________________________ are activated DIRECTLY or SENSITIZED by a wide range of chemicals, but are realtively INSENSITIVE to mechanical stimuli.
Whats CHEMICALS activate Chemoreceptors?
- Substance P
- Neurokinin A
What FIBERS carry informations from CHEMORECEPTORS?
Bronchopulmonary C-fibers (Slow, thin unmyelinated nerve fibers)
Bronchopulmonary C-fibers RELEASE ________________________.
TACHYKININS------Substance P, Neurokinin A, Bradykinin
What FIBERS carry information from STRETCH & CHEMORECEPTORS?
Broncopulmonary A-delta fibers (Fast, thick myelinated nerve fibers)
Where to BOTH FIBERS (C & A-delta) JOIN to carry senssory Info to the CNS?
Afferent Branch of the VAGUS NERVE
Where do extensive SYNAPSES from the VAGUS occur?
The nulceus of the TRACTUS SOLITARIUS--associated with the Solitary Nucleus
Where is the Nucleus of the TRACTUS SOLITARIUS Located?
Upper MEDULLA OBLONGATA (each side)
What FUNCTIONS does the Nucleus of the TRACTUS SOLITARIUS play a role in?
- BP regulation
- Cough Reflex
- Gag Reflex
- Sneeze Reflex
What happens with the SUPPRESSION of the Medulla Oblongata?
- Increased Threshold to elicit Cough
- Decreased Cough Reflex
What is the COORDINATION of Nerve Impulses in the EFFERENT PATHWAY?
- CLOSE Epiglottis (following deep inspiration)
- SYNCHRONIZED Contraction (of diaphragm, intercostal and abdominal muscles)
- COUGH Rapidly (expel 2-3L of air)
What (4) MAJOR NERVES are involved in the EFFERENT Pathway of a COUGH?
- Vagus--coordinates muscles
- Glossopharngeal--closes epiglot, controls pharynx
- Phrenic--enervates diaphragm
- Trigeminal--afferent sensory fxn from scalp to chin
What are the PHARMACOLOGICAL Interventions of the CNS for a COUGH?
- Opiod Receptor Agonists--Codeine, Hydrocodone
- Antihistamines--diphenhydramine, chlorpheniramine, brompheniramine, promethazine
What are the PHARMACOLOGICAL Interventions used LOCALLY for a COUGH?
- Local anethetics
- Tachykinin receptor antagonists
EXCLUSIONS to Self-Care:
- Fever (if only symptoms are fever and cough)
- Unintended Weightloss
- Drenching PM Sweats
- Hx or Symp of underlying disease with Cough
- Foreign Object Aspiration
- Drug-associated (suspected)
- Cough > 7days
NON-PHARMACOLOGICAL Therapy for a COUGH?
- Cool Mist Humidifiers & Vaporizers
- Lozenges/Hard Candy
Avoid using COUGH & COLD medications in KIDS under the AGE ____________.
The 3 OPIOID Receptors TYPES?
- Mu, Kappa, Delta
- ---GPCRs w/ 7 transmembrane domains
Which RECEPTOR SUBTYPE for Opioids is associated with the MOST effects?
Mu--Analgesia, Sedation, Respiratory Depression, Decreased GI Motility
What are (8) IMPORTANT Opioid Receptor Agonists?
- Euphoria--dream-like sense of well-being
- Sedation & Drowsiness
- Respiratory Depression