Adult Cough, Cold, and Allergy

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Author:
giddyupp
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82594
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Adult Cough, Cold, and Allergy
Updated:
2011-04-28 23:34:52
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Adult Cough Cold Allergy PHPR524 Test8
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Adult Cough, Cold, and Allergy
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  1. What are the differences between cold and flu sx?
    • Cold:
    • 1-3d onset
    • Occasional low grade fever
    • Possible mild headache
    • Mild myalgias, if present
    • Mild to moderate cough and chest congestion days 4-5
    • Mild sore throat days 1-3
    • Runny nose typical
    • Mild fatigue, if present
    • Rare extreme exhaustion
    • Fever:
    • Onset within several hours
    • Fever typical above 101F
    • Severe headache
    • Myalgias typical and severe
    • Frequent and severe cough and chest congestion
    • Occasional sore throat
    • Occasional runny nose
    • Fatigue common, may be severe
    • Extreme exhaustion common early on
  2. What complications are associated with cough?
    • Fatigue/insomnia
    • Muskuloskeletal pain
    • Hoarseness
    • Urinary incontinence
  3. What are the nonpharmacologic options for colds?
    • Increase fluid intake
    • Adequate rest
    • Increase humidification
    • Nasal strips
    • Nasal irrigation
    • Saline gargle
    • Saline nasal spray or drops
  4. What are the nonpharmacologic option for cough?
    • Non-medicated lozenges or hard candy
    • Humidifiers/vaporizers
  5. What are the oral decongestants used for colds?
    • Phenylephrine
    • Pseudoephedrine
  6. What are the short-acting topical sprays used for colds?
    • Naphazoline
    • Phenylephrine
    • Epedrine
  7. What are the intermediate-acting topical sprays used for colds?
    Xylometazoline
  8. What are the long-acting topical sprays used for colds?
    Oxymetazoline
  9. What are the nasal inhalers used for colds?
    • Propylhexedrine
    • Levmetamfetamine
  10. What is the dosing of phenylephrine for colds?
    10-15mg q 4-6h
  11. What is the dosing of pseudoephedrine for colds?
    60mg q 4-6h
  12. What is the dosing of topical nasal decongestants?
    • Oxymetazoline 2-3 units
    • Xylometazoline 2-3 units
    • Everything else 1-2 units
  13. What are the SE of decongestants?
    • Increased BP
    • Tachycardia
    • Palpitations
    • Arrhythmias
    • Restlessness/insomnia
    • Anxiety
    • Tremors
    • Hallucinations
    • Burning
    • Stinging
    • Local dryness
    • Sneezing
    • Trauma from the device
  14. What is rhinitis medicamentosa?
    • Rebound congestion from nasal decongestant use longer than 3-5d
    • More common with short-acting agents
  15. How do you treat rhinitis medicamentosa?
    • Slow withdrawal one nostril at a time
    • Topical nasal saline
    • Topical steroids adn systemic decongestants as needed
    • Membranes return to normal within 1-2wks
  16. What are the DI associated with decongestants?
    • MAOIs
    • TCAs
    • Sympathomimetic agents
  17. What is the preferred nasal decongestant during pregnancy?
    Oxymetazoline
  18. What is the preferred decongestant for breastfeeding women?
    Pseudoephedrine
  19. What are the characteristics of acute cough?
    • < 3 wks duration
    • Viral URT infection
    • Pneumonia
  20. What are the characteristics of subacute cough?
    • 3-8 wks duration
    • Post-infection cough
    • Bacterial sinusitis
    • Asthma
  21. What are the characteristics of chronic cough?
    • > 8 wks duration
    • Upper airway cough syndrome
    • Asthma/COPD
    • GERD
    • ACE Inhibitors
  22. What is the drug of choice for nonproductive choice?
    Antitussive (suppressant)
  23. What is the drug of choice for productive cough?
    Protussive (expectorant)
  24. What are the expectorants used for cough?
    Guaifenesin
  25. What are the SE of expectorants?
    • NVD
    • Dizziness
    • HA
    • Drowsiness
    • Preg C
  26. What are the suppressants used for cough?
    • Codeine
    • Hydrocodone
    • Dextromethorphan
    • Diphenhydramine
    • Benzonatate
  27. What are the SE of opioid cough suppressants?
    • NV
    • Sedation
    • Dizziness
    • Constipation
    • Preg C and breast milk
  28. What are the SE of dextromethorphan?
    • NV
    • Drowsiness
    • Constipation
    • Preg C
  29. What cough suppressant is a codeine analog?
    dextromethorphan
  30. What are the DI of dextromethorphan?
    • MAOIs (blocks serotonin reuptake)
    • 2D6
  31. How does diphenhydramine act as a cough suppressant?
    Probably anticholinergic activity (NOT antihistamine action)
  32. What is the dose of codeine used for cough?
    10-20mg q 4-6h
  33. What is the dose of dextromethorphan for cough?
    10-20mg q 4-6h
  34. What is the dose of diphenhydramine for cough?
    25mg q 4h
  35. What are the topical suppressants used for cough?
    • Camphor
    • Menthol
  36. What are the SE of topical cough suppressants if ingested?
    • NV
    • Restlessness
    • Delirium
    • Seizures
    • Death
  37. How much topical antitussive is lethal for children?
    4tsp of a normal dose
  38. What are the sx of mild intermittent allergic rhinitis?
    • Sx do not impair sleep or daily activities
    • No troublesome sx
  39. What are the sx of moderate to severe intermittent allergic rhinitis?
    • One or more of the following occurs:
    • impairment of sleep
    • impairment of daily activities
    • troublesome sx
  40. What are the sx of mild persistent allergic rhinitis?
    • sx do not impair sleep or daily activities
    • no troublesome sx
  41. What are the sx of moderate to severe persistent allergic rhinitis?
    • One or more of the following occurs:
    • impariment of sleep
    • impairmient of daily activities
    • troublesome sx
  42. What are the characteristics of intermittent allergic rhinitis?
    sx occur no more than 4d per wk OR for no more than 4 wks in duration
  43. What are the characteristics of persistent allergic rhinitis?
    sx occur more than 4d per wk AND for more than 4 wks
  44. What are the environmental controls used to reduce or prevent allergic rhinitis?
    • Close windows and doors during pollen season
    • Use air conditioning
    • Avoid fans that pull outside air in
    • Shower and change clothes after outdoor activities
    • Avoid being outside during high pollen counts
    • Clean moldy surfaces inside
    • Fix indoor water leaks
    • Keep indoor humidity < 40%
    • Avoid walking through uncut fields
    • Avoid working with dry soil and raking leaves
    • Encase mattress, boxspring and pillows
    • Clean bedding in hot water weekly
    • Reduce carpet use
    • Remove stuffed animals from bedroom
    • Keep pet out of room
    • Keep pet from carpet and upholstery
    • Wash pet weekly
    • Prevent cockroaches
  45. What are the SE of first generation antihistamines?
    • Paradoxal excitation
    • Confusion
    • Hypotension
    • Fall risk
    • Anticholinergic - constipation, dry eye, blurred vision, dehydration
    • Cross BBB (lipid soluble)
  46. What are the SE of second generation antihistamines?
    • Drowsiness
    • Dizziness
    • HA
    • NO anticholinergic effects!
  47. What is the ophthalmic antihistamine/mast cell stabilizer used for allergic rhinitis?
    Ketotifen
  48. What are the first generation antihistamines used for allergic rhinitis?
    • Chlorpheniramine
    • Brompheniramine
    • Clemastine
    • Diphenhydramine
    • Carbinoxamine
    • Promethazine
    • Hydroxyzine
    • Cyproheptadine
  49. What are the second generation antihistamines used for allergic rhinitis?
    • Cetirizine
    • Levocetirizine
    • Loratadine
    • Desloratadine
    • Fexofenadine
  50. What is the only antihistamine approved for air traffic controllers?
    fexofenadine
  51. What is the intranasal mast cell stabilizer used in allergic rhinitis?
    Cromolyn
  52. What are the SE of cromolyn?
    • stinging and burning
    • itching
    • rhinorrhea
  53. What are the preferred agents for allergic rhinitis in pregnancy?
    • chlorpheniramine
    • cetirizine
    • loratadine
    • cromolyn can be continued if already on it
  54. What is the preferred agent for allergic rhinitis in pregnancy?
    cromolyn
  55. If sx are still not controlled after appropriate therapy for allergic rhinitis, what is the next step?
    • Montelukast
    • Immunosuppressant tx?

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