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99 Cards in this Set
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- Back
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Exclusions for self tx of cold
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fever > 101.5
chest pain SOB worsening symptoms cardiopulmonary disease including asthma, COPD, CHF AIDS/chronic immunosuppressant therapy frail patients of advanced age < 9 months of age hypersensitivity to drugs |
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common cold
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majority caused by rhinoviruses
self-limiting low grade fever effiecent mode of transmission is self-innoculation of nasal mucosa also aerosol transmission |
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common cold symptoms
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1st sore throat
nasal symptoms by day 2/3 -secretions become thicker as infection progresses and may turn yellow/green (secretions are clear and watery when cold resolves) usually nonproductive cough by day 4/5 rhinovirus symptoms persisit for 1-2 wks |
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allergic rhinitis symptoms
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watery eyes
itchy nose/throat repetitive sneezing nasal congestion watery rhinorrhea red/irritated eyes |
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asthma
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cough
dyspnea wheezing |
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bacterial throat infections
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sore throat of moderate to severe pain
fever exudate enlarged lymph nodes (cervicle adenopathy) |
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influenza
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myalgia
arthralgia high grade fever > 100 sore throat nonproductive cough moderate-severe fatigue |
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pnuemonia/bronchitis
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chest tightness
wheezing dyspnea productive cough changes in sputum color persistent fever |
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sinusitis
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tenderness over sinuses
facial pain aggravated by vlasalva's maneuver/postural changes fever > 101.5 tooth pain URT symptoms > 7 days and poor response to decongestants |
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rare complications of colds
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sinusitis
middle ear ifections bronchitis bacterial pnuemonia exacerbations of asthma/COPD |
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vit. C
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started early in therapy may decrease duration of illness by less than 1 day
doses > 4 gm/day cause diarrhea and are not recommended |
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tx nasal congestion for cold
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oral/topical decongestants
pseudoephdrine better than phenylephrine use topicals no more than 3-5 days to avoid rhinitis medicamentosa (rebound congestion) |
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tx. rhinorrhea and sneezing
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combo products
decongestant and 1st generation antihistamine |
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tx pharyngitis
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local anestheitc (benzocaine/dyclonine HCL)
lozenges and sprays Q 2-4 hours PRN systemic analgesics can also be used |
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tx cough
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ACCP recommends 1st generation anti-histamine + decongestant to treat the virus-induced post-nasal drip that causes the cough
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local antiseptics
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cetylpyridinium CL & hexylresorcinol are not effective for pharyngitis
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2nd gen. antihistamines, antitiussives, & expectorants
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no evidence to use to tx common cold symptoms
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Decongestant AEs
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CV stimulation (increase BP, tachycardia, papitations, arrhythmias) & CNS stimulation (restlessness, insominia, anxiety, tremors, fear, hallucinations
AEs more common w/systemic agents |
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decongestants
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have HT use under MD supervision only if HT is controlled!
can excerbated DM, heart disease, elevated intraocular pressore, and BPH through adrenergic stimulation |
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1st generation antihistamines AEs
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sedating
depress CNS anticholinergic effects(dryness of mucus membranes, blurred vision, urinary hesitancy and retention, constipation, & tachycardia) CNS stimulatory effects (anxiety, hallucinations, appetitie stimulations, muscle dyskinesias, and activation of epileptogenic foci) |
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1st generation anti-histamines
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use w/caution in older patients, more prone to AEs
contraindicated in narrow-angle glaucoma, acute asthma exaceration, stenosis peptic ulcer, BPH, bladder neck obstruction, or pyloroduodenal obstruction use cautiously in patients w/ emphysema or chronic bronchitis) |
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diphenhydramine
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1st generation antihistamine & antitussive
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DIs w/decongestants
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antiacids/alkalinizers (decrease elimination of pseudophedirne)
MAOIs (increase bp) methlydopa (increase bp) TCA (increase bp/decrease decongestant activity) |
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DIs w/ 1st generation antihistamines
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CNS depressants (increase depression)
MAOIs (prolong/intensify anticholinergic and CNS depressive effects phenytoin (decreased elimination of phenytoin) |
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preganancy
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tx not recommended
systemic decongestants decrease fetal blood flow psuedophedrine linked to abdominal wall defects in new poors |
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tx cold w/pregnancy
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oxymetazoline is preffered topical decongestant because it is poorly absorbed
chlorpheniramine is preferred 1st generation antihistamine (long hx of safetly) do use ASA/NSAIDs in the 3rd trimester! |
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breastfeeding
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decongestants may decrease milk production (drink more fluids)
pseudoephdrine is DOC decongestant avoid xylometazoline and anphazoline and 1st generation anti-histamines and ASA |
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drugs can use in breast feeding
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dextromethorphan
guaifnenesin benzocaine dyclonine camphor menthol |
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cough and cold products
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do not use in children < 4 yr
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tx cold w/ honey
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2-5 yr. tx w/1/2 a teaspoon
6-11 yr. tx w/1 teaspoon 12 yr or older tx w/1 teaspoon |
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Refer to MD for cold if
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sore throat persists for several days or is severe or is associated w/fever/HD/N/V
cough doesn't improve in 1-2 wks symptoms worsen w/OTC mes signs of bacterial infection (thick secretions, temp > 101.5, SOB, chest congestion, wheezing, rash, or ear pain |
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Do not self tx allergies
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< 12 yr ol
preganant/lactating OM, sinusitis, bronchitis, other infection undiagnosed asthma, COPD (wheezing, SOB) moderate-severe persistent allergic rhinitis unresponsive to tx |
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Intermittent allergic rhinitis
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occurs less than 4 days/week
or less than 4 weeks |
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persisitant allergic rhinitis
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occurs greater than 4 days/week
or grater than 4 weeks |
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mild symptoms
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do not impair activities or sleep
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moderate-severe symptoms
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impairment of sleep/daily activities
troublesome sympotms |
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symptoms of allergic rhinitis
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frequent paroxysmal sneezing
watery anterior rhinorrhea itching of eyes, nose and/or palate conjunctiviitis (red, irritated eyes) may have nasal congestion worse in the AM |
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complications of allergic rhinitis
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sinusitis
OM w/effusion (acute) Chronic -nasal polpys, sleep apnea, hyposmia |
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tx sneezing, itching and rhinorrhea
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WHO recommends 2nd generation anti-histamines as 1st line tx
loratadine than cetrizine (10% patients found sedating) |
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tx allergic rhinitis
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combo tx w/2nd generation anti-histamine and decongestant
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intranasal cromolyn Na
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mast cell stablizer
w/decongestant w/orw/o 2nd generation anti-histamine |
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D/C anti-histamines
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4 days prior to allergy testing
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12 and 24 hr sustained release loratadine/pseudoephedrine products are contraindicated in
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esophageal narrowing
abnormal esophageal peristalsis hx difficulty swallowing TABs can cause esophageal obstruction and peforation |
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1st generation anti-histamines
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photosensitizing
wear sunscreen more likely to have CNS depression effects in elderly |
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anti-histamines and cromolyn Na
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use ATC not PRN
relief usually seen in 3-4 days but complete relief can take 2-4 wks treat 1 week prior w/intermittent allergic rhinitis & continue while allergen is present persisitant allergic rhinitis continue tx indefinitly |
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2nd generation antihistamine DIs
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cimetidine
erythromycin ketoconazole (increase loratidine concentration) theophyline > 400 mg increase cetirizidine concentration |
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DOC for older patients w/allergic rhinitis
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cromolyn sodium
loratidine |
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most common cause of nonallergic rhinitis
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pregos
1st line tx: cromolyn sodium & chlopheniramine (1st gen antihistamine) if not tolerated use loratidine/cetirizine |
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breast feeding
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not anti-histamines, pass into breast milk (if must use short-acting chlorpheniramine and loratadine)
DOC: cromolyn sodium intranasal |
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allergies in children < 12
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refer to MD due to concern of undiagnosed asthma
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DOC of allergies in peds
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loratidine then cetirizine
1st generation anti-histamines are contraindicated and should be avoided in older children due to paradoxical excitiation |
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cromolyn sodium
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safe for children > 5 years of age
may be difficult to administer |
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viral
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mild-moderate throat pain
no fever no swelled lymph nodes rhinorrhea |
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bacterial
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enlarged lymph nodes
fever rash |
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referr to MD if
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ear pain to rule out OM
creamy white exudates on tonsil (mono) creamy white patches (candidiasis) pain persists/worsens |
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problems w/swallowing reflex
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use systemic analgesics
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local anesthetics
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benzocaine phenol
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minor antiseptics
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cetylpyridinium
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induction of saliva/antiseptic
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eucalyptus oil/thymol
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counterirritant, antiseptic, eak anesthetic
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menthol
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dyclonine
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local anesthetic
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influenza
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unlike cold usually an abrupt onset
extreme malaise nonproductive cough myalgia/arthragia in H1N1 also N/V and diarrhea (usually affects 12-24 unlike seasonal which is young and old) |
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pneumonia
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labored breathing
fever chest pain sweating cough |
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sinusitis
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tenderness over sinuses
facial pain fever > 101.5 tooth pain poor response to decongestants |
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bacterial pharyngitis
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severe throat sore
enlarged lymph nodes fever sudden onset |
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eustachian tube congestion
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congestion w/o runny nose
tx w/ alpha adrenergic agonists |
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nasal decongestant contraindications
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MAOIs
severe CVD |
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pseudoephedrine dosage
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60 mg Q 4-6 hours
120 mg ER Q 12 hours 240 mg ER QD max dose is 240 mg QD Children: 6-12 its 30 mg Q4-6 hr mas of 120mg 2-4 its 15 mg q 4-6 hour w/max dose of 60 mg |
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topical decongestants
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phenlyephrine
propylhexedrine lemetamfetamine oxymetazoline (mucinex nasal spray) 2 sprays in each nostril |
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phenylephrine 3 strengths
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0.25 ( usually sufficient)
0.5 1 |
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phenylephrine dose
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10 mg Q 4 hours in children > 12 yr.
less bioavailability than psuedophedrine inconsistent effiicacy |
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1st generation antihistamines
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benadryle can reduce cough through AE anticholinergic effect
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oklahoma
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1st state to restrict sales of pseudoephedrine to methampetamine production
schedule V limits: 3.6 gm in 24 hours 9 grams in a months |
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Zn MOA
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block adhesion of rhinoviruse s to nasal epithelium
? benefit can't use Zn products in nose! |
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acute cough
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last for 3 wks or less
viral illness HF excerbation |
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subactue cough
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3-8 wks in duration
post-infectious cough sinusitis asthma |
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chornic cough
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duration > 8 wks
upper airway cough syndrome from post-nasal drip uncontrolled asthma/COPD drug related smokers |
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clear productive cough
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bronchitis
initially for rhinovirus |
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discolored productive cough
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pneumonia
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nonproductive cough
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viral respiratory infections
allergic rhintiis sinusisits post-nasal drip GERD DRUGS |
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self care exclusions for cough
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yellow/green sputum
fever > 101.5 unintended weight loss hemopysis duration >7 days new symptoms worsening during tx chidlren < 14 accroding to ACCP chronic disease |
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tx productive cough
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DOC: expectorants do not use robitussion DM (irrational has an antitussive & expectorant)
dextromethorphan/guaifenesin no enough evidence together use guaifenesin for acute productive coughs |
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tx nonproductive cough
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cough suppressant/antitussive
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guafenesin dosing
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need minumum of 1200 mg/day
200-400 mg Q 4 hours max 2400 gm/day Robitussin = guafenesin syrup mucinex = 600 mg of guafenesin |
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dextromethorphan
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antitussive
acts centrally on respiratory center in the medulla abuse potential need to be 18 to buy coricidin and dlysm mucinex DM |
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dextromethorphan dosing
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10-20 mg q 4-8 hours
max is 120 mg QD 6-12 YR. 5-10 MG Q 4 HOURS max dose is 60 mg QD 2-6 yr. 2.5-5 mg q 4 hours max dose is 30 mg |
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diphenhydramine
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1st generation antihistamine
benadryl 25 mg Q 4 hours activity is related to cholinergic effect (for cough) use for common cold, virus induced post-nasal drip can also tx w/naproxen |
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honey
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not in children < 2 years old
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self care exclusions for allergies
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< 12 years of age
pregos/actating asthma symptoms OM symptoms sinusitis symptoms severe allergic rhinitis unresponsive to tx symptoms of non-allergic rhinitis |
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tx sneezing, rhinorrhea, tiching
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2nd generation anti-histamines or mast cell stabilizers
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anti-histamines MOA
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antagonize H1 receptore reduces sensory nerve stimulation, mucus secretion and vascular permability
histamine is primary trigger in allergies |
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anti-histamine AEs
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anithcholingeric effects - not for patients > 65 years
paradoxial excitation - in kids |
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pregnancy category B
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chlorampheniramine
loratidine diphenydrameine clemastine cetirizine |
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cetrizine
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indicated for relief of symptoms due to hay fever (seasonal allergies due to pollen) or other allergies
> 2 years of age |
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ethanolamines
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clemastine
diphenydramine (bendadryl) doxylamine sedative w/high anticholinergic activity (tx cough) |
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alkylamines
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bromophiramine
chlorophenirmaine -phenirmaines moderate antihistamine and anticholinergic activity |
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piperidines
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loratidine
high antihistamine acitivty |
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piperazine
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high antihistamine
some sedative actiivity |
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cromolyn sodium
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prevents mediator release
mast cell stabilizer most effective if started prior to symptoms 1 spray/nostril 3-4x/day local effect 2-4 wks for max benefit |
