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Flashcards in Cough Meds Deck (24)
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1

How do you define acute cough? What treatment is required?

Acute cough: < 3wk duration

Generally does not require pharm tx, especially in children

Suppression of cough may be harmful

Eliminate underlying causes and any precipitating factors

2

Tell me about Honey, Honey

Single nocturnal dose to relieve airway irritation and decrease cough

As effective in suppressing cough as dextromethorphan (DM)

3

What's the origin of DM?

OTC derivative of morphine w/no analgesic or addictive properties at recommended doses

May reduce cough severity

Has NOT been shown to be effective or safe in young children

4

What are DM ADRs?

Normal dose:
- CNS (confusion, excitement, irritability, nervousness)

High dose: NV, HA

Extreme high dose: euphoria and robo tripping

5

Codeine Pk

Codeine --> 2D6 --> Morphine

Effective in suppressive cough

May produce analgesic and antitussive effects

6

Who should you avoid using codeine in?

Do NOT use in pt < 18yo

Concerns of respiratory depression and death in children

7

What is a prescription alternative to opioids for suppression of SEVERE cough?

Benzonatate
- liquid-filled capsule
- C.I. in kids < 10yo

8

Benzonatate ADRs

Risks associated w/benzonatate clearly outweigh its benefits**

- Nausea
- CNS (dizzy, HA, sedation, confusion, hallucination)
- chest numbness

** FDA warning - single capsule can be fatal for young children **

9

What is Guaifenesin MOA?

Increase volume of secretions in respiratory tract --> facilitate removal of viscous mucus by coughing

ER tab C.I. < 12yo
Rec dose = generally considered safe

10

When would you use antihistamines for cough?

PND

Reduce cough by reducing postnasal drip

ADRs: classic anticholinergic effects

11

When would you use decongestants for cough?

PND

May help reduce coughing by reducing PND

Not rec for children < 4yo

C.I. w/in 14d of MAOI

12

What is the main OTC decongestant?

Phenylephrine

Pseudoephedrine (METH HEAD) products are more difficult to obtain

13

Decongestants ADRs

(Act as sympathomimetics)

1. increase HR/BP
2. transient CNS effects (excitability, insomnia, HA, nervousness, confusion, dizziness)
3. dry nose/throat, rebound nasal congestion

14

When would you use SABAs or SAMAs to treat cough?

If the cough has a bronchospastic component

15

When would you use corticosteroids for a cough?

Inhaled & PO corticosteroids have been used for tx of cough in pt w/out asthma

16

Cough General Recommendations

NONpharm

1. Saline nasal sprays & fluids
2. Mist inhaler (e.g. humidifier)
3. Sialagogues
4. Honey (up to 2tbs) qhs (if > 12mo)
5. Menthol or camphor rubs are okay for adults (Vicks VapoRub)

17

Adults: Cough Secondary to Common Cold/PND

Step 1. Antihistamine-decongestant combos
- combo w/1st gen antihistamine have more drying effects
- pseudoephedrine > phenylephrine

Step 2. Naproxen** (reduce inflammation)

Step 3. Inhaled ipratropium - cough persisting 3-8wk)

Step 4. ICS, if ipratropium does not work

Step 5. DM or codeine NOT rec for acute cold cough

18

Kids: Cough Secondary to Common Cold/PND (stepwise)

Step 1. Saline nasal spray/fluid to relieve nasal congestion/dryness

Step 2. Topical antitussives (Vicks, VapoRub) - inhaling camphor/menthol/eucalyptus helps w/cough and congestion
- local anesthetic sensation and improved airflow

Step 3. Honey can relieve cough by increasing saliva --> coats larynx and relieves irritation
- NO Honey in < 1yo (botulism)

Do NOT rec Codeine or DM containing products

19

Adults: Acute bronchitis & Cough

Acute bronchitis - cough lasts up to 3wk, only sometimes productive

- DON'T routinely prescribe Abx
- Short-term Codeine or DM MIGHT help
- Save bronchodilator for pt who wheezes

20

Adults: Chronic bronchitis & Cough

Chronic bronchitis: productive cough occurring most days for 3 or more months/yr for at least 2 years

- eliminate irritants
- treat per COPD

21

Describe when you would use guaifenesin with bronchitis?

Don't give expectorants (guaifenesin)

Not enough evidence they are effective

22

Who should you avoid cough & cold meds in?

These meds withdrawn d/t concerns about efficacy and safety (e.g. seizures, OD)

NOT recommended in kids < 4yo

23

How can you use saline nasal sprays/fluids in children?

Infants: saline drops to loosen mucus, then suction w/bulb syringe

Humidifiers/vaporizers add moisture to air to help ease cough/congestion

24

What is the warning regarding topical antitussives (Vicks VapoRub)?

Do NOT use topicals w/camphor for children <2y d/t absorption concerns and LIVER damage