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Topicals
- gargle warm salt water
- topical anesthetics: sprays, lozenges, oral disintegrating strips (just numb for a bit!) - benzocaine, dyclonine Hcl
- use q 2-4 hours
- volatile oils: vicks vapo rub
-
throat lozenges
- coat throat with a soothing barrier to prevent cough receptor irritation
- go for sugar-free
- only work while in mouth
- ZINC lozenges & vitamin C may decrease cold severity
- intranasal zinc = BAD!!!! (stick with lozenge!!!!)
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adrenergic agonists
- aka: sympathomimetics
- stimulate alpha-receptors: constrict blood vessels (so you can breathe easier), decrease sinusoid vessel engorgement, decrease mucosal edema
- direct & indirect
- **watch for pts with high bp & heart issues
-
Decongestants
- temporary relief of nasal and Eustachian tube congestion, and cough associated with post-nasal drip
- ORAL: pseudoephedrine (Sudafed), phenylephrine (Sudafed PE) --> can't be converted, short acting, less effective
- Make sure you're not doubling up on stimulants
-
Pseudoephedrine Access
- Behind the pharmacy counter
- Qty: 3.6 gm/day (120 tabs) & 9 gm/30 days (300 tabs)
- Nexafed - new pseudophed product
-
Topical Decongestants: Nasal
- *alternative to pseudophedrine
- Short acting (4-6 hrs): neo-synephrine, privine, vicks inhaler, Benzedrex inhaler, dristan decongestant)
- Intermediate acting (8-10 hrs): Otrivin
- Long acting (12 hrs): Afrin, Duration, Neo-Synephrine 12 hr)
- Other choices: nasal steroids, saline NS
-
rebound congestion
- take topical nasal decongestant no longer than 3-5 days!
- have the WORST clogged nose ever
- people get hooked on this medication
- more common w/ short acting
-
antihistamines
- *Inhibit mechanically triggered cough
- --> FIRST generation ONLY
- (NOT Allegra, Zyrtec, or Claritin)*Reduce secretions & post-nasal-drip associated with URI
- *LOTS of side-effects (sedation, drying...)
- Combo (decongestant/antihistamine) have positive results!!
-
Diphenhydramine (antihistamine)
- Only antihistamine that is also an FDA approved anti-tussive
- *workes centrally on medulla to increase cough threshold
- suppression of non-productive cough caused by chemical/mechanical respiratory tract irritation
-
Histamines - generation difference
- 1st gen side effects = drying (reduces rhinorrhea)
- 2nd gen have NO effects on symptoms
- **ACCP recommends combo of 1st generation H1 WITH decongestant for cough associated with the common cold
-
OVERALL RECOMMENDATION FOR CONGESTION?
pseudophedrine + antihistamine
or just a decongestant (pseudophedrine)
-
OVERALL FOR A COUGH?
- same as congestions + naproxen (NSAID)
- pseudophedrine + antihistamine + naproxen
-
Cough - exclusion from self-care
- could worsened during self-care/new symptoms
- fever > 101.5F
- thick yellow/green phlegm
- duration >7 days
- weight loss, night sweats, hemoptysis
- ACE inhibitor: BP med has a side effect of a cough that will never go away!
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Cough Assessment
- - Productive (wet) vsnon-productive (dry)
- - Effective vs in-effective (cannot expel secretions)
- - “Pro-Tussive” = Expectorant, thins things out
- - "Anti-Tussive” = Cough Suppressant, stops tickle in throat
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