Respiratory Disorders

alchemist04's version from 2018-03-28 03:07

Colds and Allergy, pathophysiology of Colds

What are the sensory in the nose?Cholinergic and sympathetic Nerves
What are the mediators that sensory fibers respond to in the nose?histamine and bradykini
Bradykinin isa peptide that causes blood vessels to dilate and therefore causes blood pressure to fall. It is an inflammatory mediators just like histamine, but responded to cold.
T or F, Cholinergic constricts while sympathetic dilates?F, Cholinergic dilates while sympathetic stimulates
Cold are caused by virus or bacteria, which one?Viruses
When do the peak viral concentrations occur?2-4 days after initial infection
How long in days do viruses present in the nasopharynx?16 - 18 days
Viral infection ends once enough neutralizing antibody like ......, ......, leaks into the mucosa to end viral replicationIgA and Serum IgG

Clinical Presentation of Colds

Symptoms in day 1Sore throat
Symptoms in day 2-3nasal symptoms
Symptoms in day 4-5cough

Colds vs other Resp. Disorders (Pg. 178)


IllnessSigns and Symptoms
Allergic RhinitisWatery eyes; itchy nose/eyes/throat; repetitive sneezing; nasal congestion; watery rhinorrhea; red/irritated eyes w/ conjunctival infection
AsthmaCough, dyspnea (difficult or labor breathing), wheezing
Bacterial throat infectionSore throat w/ mild to moderate pain, fever, exudate, tender anterior cervical adenopathy
ColdsSore throat w/ mild to moderate pain; nasal congestion; rhnorrhea, sneezing common; low grade fever; chills; headache; malaise; myalgia; and cough possible
CroupFever, rhinitis, and pharyngitis initially, progressing to cough (maybe "barking" cough), stridor, and dyspnea (difficult or labored breathing.)
InfluenzaMyalgia, arthralgia, fever greater or equal to 100F - 102F, sore throat, nonproductive cough, moderate to severe fatigue
Otitis mediaEar popping, ear fullness, otalgia, hearing loss, dizziness
Pneumonia or bronchitis sinusitischest tightness, wheezing, dyspnea, productive cough, changes in sputum color, persistent fever
SinusitisTenderness over the sinuses, facial pain aggravated by Valsalva's maneuver or postural changes, fever greater than 101.5F, tooth pain, halitosis, upper respiratory tract symptoms for more than 7 days with poor response to decongestants
West Nile virus infectionFever, headache, fatigue, rash, swollen lymph glands, and eye pain initially, possibly progressing to GI distress, CNS changes, seizures, or paralysis
Whooping coughInitial catarrhal phase w/ rhinorrhea, mild cough, sneezing for 1-2 weeks, followed by 1-6 weeks of paroxysmal coughing.

Rx for Cold, Treat symptoms (Soar throat, Nasal Symptoms and Cough)

DecongestantsDurationsExamplesSystemic or Topical
EphedrineShort ActingEphedrine Sulfate injection and BronkaidSystemic (injections) and Topical Bronkaid
EpinephrineShort ActingEpiPenSystemic
NaphazolineShort ActingNaphCon A (allergy eye drop)Topical
PhenylephrineShort ActingSudafed PE, Sudephrine PE, all Nasal Spray/Decongestant PESystemic
TetrahydrazolineShort ActingVisine eye drop, Optic Clear, and all red eye clearTopical
XylometazolineIntermediate ActingNasal Crom, Sinex and all nasal decongestantsTopical
OxymetazolineLong ActingAfrin Nasal Spray, No Drips Nasal Spray, and few Nasal SpraysTopical

Dosage guidelines for NonRx Systemic Nasal Decongestants

Systemic DrugDosage and Max dosage for 12 years and aboveDosage and Max Dosage for 6-11 yearsDosage and Max dosage for 2-5 yearsOTC/BTC
Phenylephrine (PE) HCL10 mg q4h (60 mg)5 mg q4h (30 mg)2.5 mg q4h (15 mg)OTC
Pseudoephedrine60 mg q4-6h (240 mg)30 mg q4-6h (120 mg)15 mg q4-6h (60 mg)BTC

Pseudoephedrine regulations

Where will you find Pseudoephedrine products, OTC or BTC?BTC
What is the legal age to purchase Pseudoephedrine products?!8 yo
What are the purchase limits of Pseudoephedrine products?9 g/mo or 3.6g/day/patient

Systemic Decongestants and Drug-Drug Interactions (DDI)/Contraindications

MOA, Monoamine OxidaseCauses rapid metabolism of systemic decongestants
COMT, Catechol-O-MethyltransferaseCauses rapid metabolism of systemic decongestants, found in the GI mucosa, liver, and other tissues
MAOI, MAO inhibitorcauses increase in blood pressure/HBP, wait 14 days after MAOIs is discontinued, e.g procarbazine, isocarboxazid etc

Systemic Decongestants Patient Counseling

SituationCounseling, Solution, Comment
PregnancySystemic decongestants are Category C, may decrease fetal blood flow, use alternative agents like hypertonic saline solution
LactationMay decrease breast milk production
Sleephas stimulant effects and may disturb sleep; take 2-3 hrs before sleep
Category patients (HTN, DMT, CAD, Hyperthyroidism, MAOI use, BPH and Glaucoma)avoid use; might increase BP and consult your primary provider
Continuous usage after 7 daysStop use and talk to your doctor

Alternative Option to Nasal Decongestants

Ocean, AYR, NeilMed Sinus RinseHypotonic Sodium Chloride solutionRehydrates nasal mucosa, liquefy dry secretions, maybe used for treatment of rebound congestion, Drug of choice (DOC) for pregnant women with nasal congestion

Topical Nasal Decongestants Adverse Effects and Cautions

Why is adverse effects are more associated w/ Systemic Decongestants than Topical Nasal DecongestantsBecause Systemic decongestants are more absorbed while Topical decongestants are minimally absorbed.
Rhinitis MedicametosaRebound Congestion; occurs only in Topical Decongestants; limit us to no more than 72 hours (3 days)
Temporary discomfortburning, stinging, sneezing, increase nasal discharge
Incorrect or Excessive dosescan cause drain into the stomach and lead to systemic absorption
Caution with special patientsPatients w/ HTN, Hyperthyroidism, Diabetes Mellitus, Glaucoma, Prostatic hypertrophy, Coronary Artery Disease (CAD)