Phar 362 - Cough & Cold: Treatment Options

Front 1

Which drugs are recommended for a patient with a headache ?

Back 1

1) Acetaminophen

2) NSAIDs: ASA, Ibuprofen, Naproxen

Front 2

Why should ASA not be given to children under the age of 19 with viral infections?

Back 2

Circumstantial evidence of an increased incidence of Reye's Syndrome

Front 3

"Acetaminophen has been shown to decrease Nasal Obstruction and Rhinorhea" True or False?

Back 3

TRUE

Front 4

"Acetaminophen has been shown to decrease sneezing, coughing and sore throat" True or False?

Back 4

FALSE, no effect has been shown on any of these symptoms

Front 5

"NSAIDS have shown to decrease symptoms of Headache, Ear Pain and muscle and joint pain" True or False?

Back 5

TRUE

Front 6

Are 1st Gen Antihistamines effective for Runny Nose and Sneezing?

Back 6

Side effects generally outweigh the benefits (studies show benefit for Rhinorhea only)

Front 7

Are 2nd Gen Antihistamines effective for Runny Nose and Sneezing?

Back 7

No benefit

Front 8

Are 1st Gen Antihistamines + Decongestant effective for Runny Nose and Sneezing?

Back 8

Side effects generally outweigh benefits (small benefits for Rhinorrhea and Nasal Obstruction)

Front 9

Is Intranasal Ipratropium effective for Runny Nose and Sneezing?

Back 9

Studies have limitations and show small benefit compared to placebo

Front 10

Are Antitussives (DM/ Codeine) effective for Cough in Children?

Back 10

Showed no effect between placebo and study group

Front 11

Are 1st Gen Antihistamines effective for Cough in Children?

Back 11

No benefit and increased drowsiness in all groups

Front 12

Are 1st Gen Anthistamines effective for Rhinorrhea?

Back 12

Small possible benefit but increased side effects

Front 13

Are Antihistamines and Decongestants effective for Cough in Children?

Back 13

No benefit

Front 14

Are Antihistamines and Decongestants effective for Runny Nose and Congestion in Children?

Back 14

Possible benefit in older children but the increased side effects outweigh benefits

Front 15

Are decongestants effective in Children?

Back 15

Insufficient data to conclude

Front 16

Are Expectorants effective in Children?

Back 16

No benefit

Front 17

"Health Canada restricts use of Cold Medicine to children greater than _____ years old"

Back 17

6

Front 18

What are the unacceptable dosage forms for Children 6-12 yrs old? (2)

Back 18

1) Modified Dose Release (Oral SR, EC, Bilayer products)

2) Novel dosage forms (multiple ingredient thin strips, lollipops, freezer pops)

Front 19

What are the general non drug measures for Common Cold? (7)

Back 19

1) Wash hands with soap and water

2) Chicken soup (with lots of vegies)

3) Warm Beverages: Honey Lemon Drink, Warm Juice (warm more effective than room temp)

4) Bed Rest

5) Vaporizers

6) Humidifier

7) Fluids

Front 20

What are the non drug measures of Common Cold for Children?(5)

Back 20

1) Saline Nasal Drops (1-2 gtts each nostril QID) 2) Nasal Bulb Aspirator (for<4 yrs old)

3) Upright Positioning

4) Increase Humidity

5) Cool Mist

Front 21

What are the non drug measures for sore throat? (6)

Back 21

1) Fluids

2) Hard, sugarless candies

3) Salt Water Gargle: (1/4-1/2 teaspoon of salt in 250ml warm water)

4) Honey Lemon Drink

5) Lozenges

6) Throat Spray & Gargles

Front 22

What are the non drug measures for Fever?(2)

Back 22

1) Remove layers of clothing as appropriate

2) Tepid waters sponge bath

Front 23

Why should a sponge bath for fever be tepid not cold?

Back 23

Because if it is cold, it can shut down body's ability to cool itself

Front 24

What are the non drug measures for Runny Nose? (2)

Back 24

1) Elevate Head of Bed

2) Use tissues (e.g. Anti-viral tissue)

Front 25

When do we refer a dry cough to a physician?

Back 25

If the duration of dry cough is greater than 7 days

Front 26

What are the non-drug measures of dry cough ?(4)

Back 26

1) Salt Water Gargle

2) Fluids/Hot Drinks

3) Hard(sugarless) Candies

4) Honey

Front 27

What are the typical doses of Honey?

Back 27

2-5yo: 2.5mL

6-11yo: 5mL

12-18yo: 10mL

Front 28

"Frequent use of honey may result in _____"

Back 28

Caries

Front 29

Why should honey be avoided in <1 year old?

Back 29

Due to fears of chocking and Infant Botulism

Front 30

"Anaphylaxis to honey has been reported" True or False?

Back 30

TRUE

Front 31

Are lozenges effective for Dry cough?

Back 31

No evidence to suggest

Front 32

Are 2nd Gen Antihistamines effective for Dry Cough?

Back 32

No evidence for benefit

Front 33

Are 2nd Gen Antihistamines+Pseduoephedrine effective for Dry Cough?

Back 33

No evidence for benefit

Front 34

Are 1st Gen Antihistamines+Pseduoephedrine effective for Dry Cough?

Back 34

Statistically significant but unaware if clinically significant

Front 35

Is Naproxen effective for Dry Cough?

Back 35

Cochrane review suggests no benefit for cough

Front 36

Is Codeine effective for Dry Cough?

Back 36

No evidence for benefit

Front 37

Is Honey effective for Dry Cough?

Back 37

No data in adults but is still recommended

Front 38

Is DextraMethorphan effective for Dry Cough?

Back 38

Enough evidence to recommend (30mg)

Front 39

"There is high occurrence of cross-reactivity with Dextromethorphan and Codeine" True or False?

Back 39

False, similar structure but cross reactivity isnt common

Front 40

When do we refer a productive cough to a physician?

Back 40

When sputum is green, yellow or containing blood (since it indicates bacterial infection)

Front 41

What are the non-drug measures of Productive Cough?(2)

Back 41

1) Fluids to stay hydrated

2) Humidifier

Front 42

Is Guaifenesin effective for Productive Cough?

Back 42

Aids in expectroation of sputum and decreases in cough frequency

Front 43

"DM-E in combination is not commonly recommended because antitussives aren't effective" True or False?

Back 43

TRUE

Front 44

What is the only one situation where DM-E in combo is recommended?

Back 44

When a wet cough is keeping the patient up at night

Front 45

What are the non drug measures for Nasal Congestion? (3)

Back 45

1) Humidifier/ Vaporizers

2) Saline Nasal Spray/Drops

3) Nasal saline irrigation/neti-pots

Front 46

Is vick's VapoRub effective for Nasal Congestion?

Back 46

Helps in cough frequency severity, congestion severity and helps the ability to sleep

Front 47

Is Vick's VapoInhaler effective for Nasal Congestion?

Back 47

Lack of efficacy data, limited duration of action

Front 48

Is Vick's Breathe Right effective for Nasal Congestion?

Back 48

No solid evidence but frequently used by athletes

Front 49

"Vick's VapoRub should not be used under ___ years"

Back 49

2

Front 50

"Vick's VapoInhaler should not be used under ___ years"

Back 50

6

Front 51

Is oral Pseudoephedirne effective for Nasal Congestion?

Back 51

Has beneficial effect

Front 52

Is oral Phenylephrine effective for Nasal Congestion?

Back 52

Has doubtful effect

Front 53

Is topical Oxymetazoline effective for Nasal Congestion?

Back 53

Has positive efficacy

Front 54

Is topical Xylometzoline effective for Nasal Congestion?

Back 54

Has positive efficacy

Front 55

Is topical Phenylephrine effective for Nasal Congestion?

Back 55

Has positive efficacy

Front 56

Which topical decongestant has the shortest duration of action?

Back 56

Phenylephrine

Front 57

Why should topical decongestants be limited to 3-5 days?

Back 57

Rhinitis Medicamentosa occurs with prolonged topical use which leads to rebound congestion, which could be worse than the initial congestion

Front 58

Is vitamin C effective for prophylaxis for Cough and Cold?

Back 58

No clinical relevant effect in incidence of common cold. But helps reduce duration and severity of the cold

Front 59

Is vitamin C effective for the treatment of Cough and Cold?

Back 59

No difference when Vit C is started after symptoms onset

Front 60

Which groups of patients benefit from Vitamin C prophylaxis? (3)

Back 60

1) Marathon Runners

2) Skiers

3) Soldiers on Subarctic exercises

Front 61

Is Echinacea effective for prevention of Cough and Cold?

Back 61

No evidence of benefit for prevention after taking product for 8-12 weeks

Front 62

Is Echinacea effective for treatment of Cough and Cold?

Back 62

Some evidence that aerial parts of E.purpurea might be effective for early treatment of colds in adults

Front 63

"A patient would need to take Cold-FX (American Ginseng) 200mg BID x 4months to prevent 0.25 colds" True or False?

Back 63

TRUE

Front 64

Is Zinc effective for prevention of Cough and Cold?

Back 64

When used for 5 months (in children 5-8) reduces colds, and school absenteeism

Front 65

Is Zinc effective for treatment of Cough and Cold?

Back 65

If administered within 24hrs of onset of symptoms, reduces duration of symptoms and severity of symptoms in adults. Unclear in children

Front 66

"Zinc Lozenges are tolerated better than Syrup" True or False?

Back 66

False, Syrup is better tolerated then lozenges

Front 67

Why would you avoid Intranasal Zinc?

Back 67

Anosmia (Absence of Smell)

Front 68

Does Vitamin D benefit Cough and Cold?

Back 68

Likely no benefit according to 2 RCTs

Front 69

"Acetaminophen is considered safe in all trimesters of pregnancy" True or False?

Back 69

TRUE

Front 70

"Low Dose ASA (<150mg/day) is unsafe in pregnancy" True or False?

Back 70

FALSE

Front 71

Are NSAIDS safe in pregnancy?

Back 71

No, risk of spontaneous abortions. Should also be avoided if trying to conceive

Front 72

"Dextramethorphan can be used in any trimester of pregnancy" True or False?

Back 72

TRUE

Front 73

"Oral Pseudoephidrine are considered safe in pregnancy" True or False?

Back 73

False, Risk Factor C, small increase in birth defects of vascular disruption

Front 74

"Diphenhydramine/Chlorpheniramine are considered safe in pregnancy" True or False?

Back 74

TRUE

Front 75

"Guaifenesin is not safe for pregnancy" True or False?

Back 75

FALSE

Front 76

"Pseudoepedrine may decrease breast milk production" True or False?

Back 76

TRUE

Front 77

Which common medical conditions are contraindicated for Oral Decongestants? (7)

Back 77

1) Heart Disease

2) Hyperthyroidism

3) Diabetes

4) Angle Closure Glaucoma

5) Prostatic Hyperplasia

6) Urinary Retention

7) Uncontrolled Hypertension

Front 78

Which common medical conditions are contraindicated for Topical Decongestants? (2)

Back 78

1) Heart Disease

2) Angle Closure Glaucoma

Front 79

Which common medical conditions should be monitored closely with Topical Decongestants? (4)

Back 79

1) Hypertension

2) Diabetes

3) Prostatic Hyperplasia

4) Urinary Retention

Front 80

Which common medical conditions are contraindicated for First Gen Antihistamines? (3)

Back 80

1) Heart Disease

2) Hyperthyroidism

3) Angle Closure Glaucoma

Front 81

Which common medical conditions should be monitored closely with First Gen Antihistamines? (3)

Back 81

1) Asthma/COPD

2) Prostatic Hyperplasia

3) Urinary Retention

Front 82

Which common medical conditions are contraindicated for Dextramethorphan? (1)

Back 82

1) Asthma/COPD

Front 83

Which classes of medications interact with Oral Decongestants?(2)

Back 83

1) MAOIs + Linezolid (Hypertensive Crisis)

2) SNRIs (Increased BP, HR)

Front 84

Which classes of medications interact with Topical Decongestants?(2)

Back 84

1) MAOIs + Linezolid

2) SNRIs (Increased BP, HR)

Front 85

Which classes of medications interact with First Gen Antihistamines? (6)

Back 85

1) CNS Depressants (additive depression)

2) MAOIs + Linezolid

3) TCAs

4) SNRIs

5) SSRIs

6) Potassium Salts

Front 86

Which classes of medications interact with Dextramethorphan? (4)

Back 86

1) MAOIs + Linezolid (SS syndrome) 2) SNRIs (SS syndrome) 3) SSRIs (SS syndrome) 4) Strong CYP450 2D6 inhibitors (increased DM conc)