Therapeutics Iii Exam 2- Cold

Front 1

3 main viruses that cause colds (and 2 uncommon ones)

Back 1

Rhinoviruses, RSV (respiratory syncitial virus) and coronaviruses in children (occasionally: parainfluenza and coxsackie viruses)

Front 2

etiology of cold (2 steps)

Back 2

Viral infection of upper respiratory tract (ciliated epithelial mucosa) and occasionally lower respiratory tract

The body's defense mechanisms produce an inflammation at the site (the upper airways) of infection and colonization by trying to fight off the invading agent with the release of mediators.

Front 3

transmission of cold

best prevention?

Back 3

viral contact with nasal mucosa or ocular conjunctiva


freq. hand washing

Front 4

influenza viruses (4)

Back 4

Caused by one of the influenza viruses (A, B or C and 2009 H1N1↔swine flu)

Front 5

location of infection in a flu

Back 5

It is a viral lower respiratory infection.

Front 6

3 things influenza is not...

Back 6

It is NOT a cold.
It is NOT a stomach/GI infection.
It is NOT Hemophilis influenzae (…that’s a bacteria)

Front 7

best prevention for influenza

Back 7

Best prevention is vaccination!

Front 8

A few simple steps to reduce their risk of exposure to this and more common viruses: (4)

Back 8

cover your nose and mouth when sneezing
stay home if sick
wash your hands often
avoid touching eyes,nose,mouth- spreads germs

Front 9

Common cold: Symptom onset and course (4)

Back 9

Abrupt (“I was fine yesterday but today...” or “I woke up this morning with a…”)
1-3 days of increasingly worsening symptoms
2-4 days of intense symptoms
1-3 days of resolving symptoms

Front 10

General Supportive Treatment for colds (3)

Back 10

rest
nutrition
fluids (maintains hydration even tho you pee it all out)

Front 11

how to treat cold?

Back 11

treat according to the bothersome symptoms

Front 12

6 main sx to target in a cold

Back 12

Cough
Rhinitis
Sore throat
Fever
Aches & pains
General malaise

Front 13

antitussives- indication

Back 13

Only non-productive coughs that interfere with sleep or life-style should be suppressed

Front 14

FDA public health advisory on cough meds for kids (2)

Back 14

FDA recommends that Over-the-Counter (OTC) cough and cold products not be used for infants and children under 2 years of age (antihistamines, decongestants, antitussives and expectorants)

FDA is reviewing data for children 2-11 years of age (concerned about serious side effects)

Front 15

Dextromethorphan dosing
max dose

Back 15

12 years of age and older: 10 to 30mg every 6 to 8 hours, don't exceed 120mg/day

Front 16

Dextromethorphan side effect

Back 16

drowsiness

Front 17

codeine- dosing
max dose

Back 17

12 years of age and older: 10 to 20mg every 6 to 8 hours, don't exceed 120mg/day.

Front 18

side fx of codeine

Back 18

drowsiness

Front 19

honey study in cough

Back 19

rated most favorable by parents

Front 20

Systemic decongestants for cold (avail. doses)

Back 20

sudafed
30 and 60mg rapid release and 120mg extended release

Front 21

Topical decongestants: for cold

Back 21

oxymetazoline

Front 22

Topical anticholinergics for cold

Back 22

0.06% ipratropium

Front 23

topical vs. systemic decongestants for cold- indications

Back 23

Topical agents should only be used for the treatment of infectious rhinitis.
Systemic agents may be used for infectious rhinitis

Front 24

phenylephrine dosing

Back 24

1-2 drops/sprays in each nostril every 4-6 hours.

Front 25

Xylometazoline dosing vs oxymetazoline dosing

which is preferred?

Back 25

2-3 drops/sprays in each nostril every 8 hours

2-3 drops/sprays in each nostril every 12 hours* preferred due to duration of action

Front 26

INTRANASAL IPRATROPIUM indication for cold

Back 26

infectious rhinitis

Front 27

intranasal ipratropium dosing

Back 27

2 sprays in each nostril 3 - 4 times a day; 4 day maximum

Front 28

intranasal ipratropium nasal inhaler priming- how to prim, when to reprime (2)

Back 28

7 pumps will prime inhaler; 2 pumps if not used for 24 hours; re-prime nasal inhaler if not used for 7 days

Front 29

5 steps for admin of intranasal decongestants

Back 29

1. Patient should "blow nose" to clear mucus
2. Instill medication and "sniff" (if possible) simultaneously in one nostril while blocking the other nostril.
3. Aim towards the back of the head
4. Repeat procedure in "b" for other nostril
5. Repeat "b" and "c" until total dose is administered.

Front 30

drop delivery topical decongestant - indicated in who?

Back 30

Drop delivery topical decongestants (Should be used only in those patients unable to effectively utilize a spray delivery.)

Front 31

4 steps to instilling nasal drop decongestant

Back 31

1. Patient should "blow nose" to clear mucus
2. Patient should be laying on a flat surface
3. Instill a drop of medication in each nostril
3. Gently roll head back and forth & side to side
4. Repeat "b" and "c" until total dose is administered.

Front 32

purpose of expectorants

Back 32

Supposed to increase the flow of mucus

Front 33

guaifenesin dosing

Back 33

(100-400mg every 4 hours)

Front 34

non pharmacological expectorant

Back 34

Maintain hydration (…but excess water removed by kidneys)

Front 35

iodine - use? (2)

Back 35

Avoid the use of iodine containing therapies because of possible toxicity (goiter)
Previously used as expectorant and/or mucolytic

Front 36

mucolytics (2) examples
use in cold?

Back 36

No evidence to support use in a “cold.”

dornase alpha
n-acetylcysteine

Front 37

Analgesics and Antipyretics (3)

Back 37

apap
ibuprofen
aspirin (NOT IN KIDS)

Front 38

ibuprofen- dosing
kid dosing (mg/kg/dose)
max dose

Back 38

200-400mg every 4-6 hours (1200mg/day max) kids: 7.5mg/kg/dose

Front 39

APAP adult dosing
max dose

Back 39

325-650mg every 4 hours (4000mg/day max);

Front 40

kids (over 2yo) dose (APAP)

Back 40

≈10-15mg/kg/dose up to every 4 hours

Front 41

Aspirin (NOT in children) dosing and max dose

Back 41

650-1000mg every 4-6 hours (4000mg/day max)

Front 42

humidifiers- work best when? (2)

Back 42

Work best when used with whole house forced air ventilation (heating and a/c) system
when drawing clean, fresh (drinking) water

Front 43

sore throat- general treatment
useful examples (3)

Back 43

Local Anesthetics and Antiseptics
benzocaine
sugarless hard candies (keep it moist)
antiseptics? like honey? gargling? less evidence

Front 44

zinc dosing

when to admin for it to be helpful?

route

Back 44

Zinc gluconate lozenges with 13.3 mg elemental zinc given every 2 waking hours
only helps at ONSET of sx

Oral (systemic) delivery not proven helpful (uh idk what route then)

Front 45

MoA of zinc? maybe?

Back 45

Blocks viral adhesion to mucosal cells (?)

Front 46

Topical URI treatment (3)

Back 46

Camphor - meh
Menthol
Eucalyptus

Front 47

camphor y u no giev to childrens

Back 47

(AAP recommends against using in children); may be associated with seizures

Front 48

which med did parents like da best in nocturnal coughing

Back 48

Parents rated VR most favorable for nocturnal cough, congestion and sleep difficulty associated with URI

Front 49

4 unproven treatments for cold

Back 49

Vitamin C (doesn’t hurt, but…)
Goldenseal (herbal)
Echinacea (herbal)
Airborne®

Front 50

when treating cold sx...

Back 50

Treat only those symptoms which are bothersome

Front 51

combo cold products- when are they appropriate?

Back 51

Combination products are convenient ways to administer different medications if the dose is appropriate and the medications are needed

Front 52

non pharm cold treatment (6)

Back 52

Increased fluid intake
Adequate rest
Nutritious diet as tolerated
Humidification (?)
Saline nasal sprays or drops
Chicken soup…

Front 53

how long before you refer cold sx to PCP?

Back 53

If a cold does not completely resolve in 10 to 14 days, further medical evaluation is warranted.