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What are the differences between cold and flu sx?
- Cold:
- 1-3d onset
- Occasional low grade fever
- Possible mild headache
- Mild myalgias, if present
- Mild to moderate cough and chest congestion days 4-5
- Mild sore throat days 1-3
- Runny nose typical
- Mild fatigue, if present
- Rare extreme exhaustion
- Fever:
- Onset within several hours
- Fever typical above 101F
- Severe headache
- Myalgias typical and severe
- Frequent and severe cough and chest congestion
- Occasional sore throat
- Occasional runny nose
- Fatigue common, may be severe
- Extreme exhaustion common early on
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What complications are associated with cough?
- Fatigue/insomnia
- Muskuloskeletal pain
- Hoarseness
- Urinary incontinence
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What are the nonpharmacologic options for colds?
- Increase fluid intake
- Adequate rest
- Increase humidification
- Nasal strips
- Nasal irrigation
- Saline gargle
- Saline nasal spray or drops
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What are the nonpharmacologic option for cough?
- Non-medicated lozenges or hard candy
- Humidifiers/vaporizers
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What are the oral decongestants used for colds?
- Phenylephrine
- Pseudoephedrine
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What are the short-acting topical sprays used for colds?
- Naphazoline
- Phenylephrine
- Epedrine
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What are the intermediate-acting topical sprays used for colds?
Xylometazoline
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What are the long-acting topical sprays used for colds?
Oxymetazoline
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What are the nasal inhalers used for colds?
- Propylhexedrine
- Levmetamfetamine
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What is the dosing of phenylephrine for colds?
10-15mg q 4-6h
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What is the dosing of pseudoephedrine for colds?
60mg q 4-6h
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What is the dosing of topical nasal decongestants?
- Oxymetazoline 2-3 units
- Xylometazoline 2-3 units
- Everything else 1-2 units
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What are the SE of decongestants?
- Increased BP
- Tachycardia
- Palpitations
- Arrhythmias
- Restlessness/insomnia
- Anxiety
- Tremors
- Hallucinations
- Burning
- Stinging
- Local dryness
- Sneezing
- Trauma from the device
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What is rhinitis medicamentosa?
- Rebound congestion from nasal decongestant use longer than 3-5d
- More common with short-acting agents
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How do you treat rhinitis medicamentosa?
- Slow withdrawal one nostril at a time
- Topical nasal saline
- Topical steroids adn systemic decongestants as needed
- Membranes return to normal within 1-2wks
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What are the DI associated with decongestants?
- MAOIs
- TCAs
- Sympathomimetic agents
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What is the preferred nasal decongestant during pregnancy?
Oxymetazoline
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What is the preferred decongestant for breastfeeding women?
Pseudoephedrine
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What are the characteristics of acute cough?
- < 3 wks duration
- Viral URT infection
- Pneumonia
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What are the characteristics of subacute cough?
- 3-8 wks duration
- Post-infection cough
- Bacterial sinusitis
- Asthma
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What are the characteristics of chronic cough?
- > 8 wks duration
- Upper airway cough syndrome
- Asthma/COPD
- GERD
- ACE Inhibitors
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What is the drug of choice for nonproductive choice?
Antitussive (suppressant)
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What is the drug of choice for productive cough?
Protussive (expectorant)
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What are the expectorants used for cough?
Guaifenesin
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What are the SE of expectorants?
- NVD
- Dizziness
- HA
- Drowsiness
- Preg C
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What are the suppressants used for cough?
- Codeine
- Hydrocodone
- Dextromethorphan
- Diphenhydramine
- Benzonatate
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What are the SE of opioid cough suppressants?
- NV
- Sedation
- Dizziness
- Constipation
- Preg C and breast milk
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What are the SE of dextromethorphan?
- NV
- Drowsiness
- Constipation
- Preg C
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What cough suppressant is a codeine analog?
dextromethorphan
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What are the DI of dextromethorphan?
- MAOIs (blocks serotonin reuptake)
- 2D6
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How does diphenhydramine act as a cough suppressant?
Probably anticholinergic activity (NOT antihistamine action)
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What is the dose of codeine used for cough?
10-20mg q 4-6h
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What is the dose of dextromethorphan for cough?
10-20mg q 4-6h
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What is the dose of diphenhydramine for cough?
25mg q 4h
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What are the topical suppressants used for cough?
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What are the SE of topical cough suppressants if ingested?
- NV
- Restlessness
- Delirium
- Seizures
- Death
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How much topical antitussive is lethal for children?
4tsp of a normal dose
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What are the sx of mild intermittent allergic rhinitis?
- Sx do not impair sleep or daily activities
- No troublesome sx
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What are the sx of moderate to severe intermittent allergic rhinitis?
- One or more of the following occurs:
- impairment of sleep
- impairment of daily activities
- troublesome sx
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What are the sx of mild persistent allergic rhinitis?
- sx do not impair sleep or daily activities
- no troublesome sx
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What are the sx of moderate to severe persistent allergic rhinitis?
- One or more of the following occurs:
- impariment of sleep
- impairmient of daily activities
- troublesome sx
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What are the characteristics of intermittent allergic rhinitis?
sx occur no more than 4d per wk OR for no more than 4 wks in duration
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What are the characteristics of persistent allergic rhinitis?
sx occur more than 4d per wk AND for more than 4 wks
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What are the environmental controls used to reduce or prevent allergic rhinitis?
- Close windows and doors during pollen season
- Use air conditioning
- Avoid fans that pull outside air in
- Shower and change clothes after outdoor activities
- Avoid being outside during high pollen counts
- Clean moldy surfaces inside
- Fix indoor water leaks
- Keep indoor humidity < 40%
- Avoid walking through uncut fields
- Avoid working with dry soil and raking leaves
- Encase mattress, boxspring and pillows
- Clean bedding in hot water weekly
- Reduce carpet use
- Remove stuffed animals from bedroom
- Keep pet out of room
- Keep pet from carpet and upholstery
- Wash pet weekly
- Prevent cockroaches
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What are the SE of first generation antihistamines?
- Paradoxal excitation
- Confusion
- Hypotension
- Fall risk
- Anticholinergic - constipation, dry eye, blurred vision, dehydration
- Cross BBB (lipid soluble)
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What are the SE of second generation antihistamines?
- Drowsiness
- Dizziness
- HA
- NO anticholinergic effects!
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What is the ophthalmic antihistamine/mast cell stabilizer used for allergic rhinitis?
Ketotifen
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What are the first generation antihistamines used for allergic rhinitis?
- Chlorpheniramine
- Brompheniramine
- Clemastine
- Diphenhydramine
- Carbinoxamine
- Promethazine
- Hydroxyzine
- Cyproheptadine
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What are the second generation antihistamines used for allergic rhinitis?
- Cetirizine
- Levocetirizine
- Loratadine
- Desloratadine
- Fexofenadine
-
What is the only antihistamine approved for air traffic controllers?
fexofenadine
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What is the intranasal mast cell stabilizer used in allergic rhinitis?
Cromolyn
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What are the SE of cromolyn?
- stinging and burning
- itching
- rhinorrhea
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What are the preferred agents for allergic rhinitis in pregnancy?
- chlorpheniramine
- cetirizine
- loratadine
- cromolyn can be continued if already on it
-
What is the preferred agent for allergic rhinitis in pregnancy?
cromolyn
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If sx are still not controlled after appropriate therapy for allergic rhinitis, what is the next step?
- Montelukast
- Immunosuppressant tx?
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