Self Care Mid Term Exam Lecture 6 Review

alchemist04's version from 2018-10-07 04:32


Mechanism of actionCentrally mediated suppression of cough
Adult dose10–20 mg q4–6h (120 mg/day maximum)
Role in therapyPrimarily for night cough; contraindicated in children < 12 years of age
Side effectsSedation, nausea, constipation; avoid during lactation
What is mg/mL?must contain no more than 200 mg of codeine per 100 mL
List the cytochromes responsible for the metabolism of codeine.CYP 2D6, CYP3A4, and UGT 2B7
LactationAvoid codeine and diphenhydramine because of risk of excessive sedation leading to breathing problems, possibly fatal, in infants and difficulty with breastfeeding.


Mechanism of actionCentrally mediated suppression of cough
Adult dosage10–30 mg q4–8h (120 mg/day maximum)
Role in therapyNonproductive cough
Side effectsDrowsiness, gastrointestinal (GI) effects
Drug interactionsMonoamine oxidase (MAO) inhibitors
Explain the relationship of dextromethorphan and codeineDextromethorphan, the methylated dextrorotatory analogue of levorphanol (itself a codeine analogue), acts centrally in the medulla to increase the cough threshold
Explain the concern of taking dextromethorphan when a patient is taking fluoxetine or paroxetine (anti-depression/anti-anxiety medications)Fluoxetine and Paroxetine are strong CYP2D6 inhibitors, Fluoxetine (Prozac) and Paroxetine (Paxil) may decrease DM metabolism and increase the psychoactive effect of DM
DM w/ PregnancyDextromethorphan is viewed as probably safe.


Question Answer
Mechanism of actionCentrally mediated suppression of cough center and anticholinergic
Adult dosage25 mg q4h (75 mg/day maximum)
Side effectsDiphenhydramine may cause excitability, especially in children, intensifies the anticholinergic effect of MAOIs and other anticholinergics.
LactationAvoid codeine and diphenhydramine because of risk of excessive sedation leading to breathing problems, possibly fatal, in infants and difficulty with breastfeeding.

Expectorant (Guaifenesin)

Mechanism of actionThinning of mucus to enhance clearance
Dosage Immediate-release200–400 mg q4h (maximum 2,400 mg/day)
Dosage Extended-release600–1,200 mg q12h (maximum 2,400 mg/day)
Role in therapyProductive cough (Ineffective)
Side effectsGI discomfort
Patient educationIncrease fluid intake.

Topical antitussives

Of the volatile oils, which two are approved by the U.S. Food and Drug Administration (FDA)Only camphor and menthol
Mechanism of actionLocal anesthetic effect in nasal mucosa
Product availabilityLozenge, ointment, steam inhalation
Patient educationOintment and solution are toxic if ingested.

Sore throat remedies (Sprays and Lozenges)

BenzocaineChloraseptic and Cepacol lozenges
DyclonineSucrets Maximum Strength lozenges
PhenolChloraseptic spray
MentholVicks VapoDrops

Signs and Symptoms of Disorders Associated W/ Cough

Question Answer
Acute bronchitisPurulent sputum; cough that lasts 1–3 weeks; mild dyspnea, mild bronchospasm and wheezing; usually afebrile, although a low-grade fever may be present
AsthmaWheezing or chest tightness; shortness of breath, coughing predominantly at night; cough in response to specific irritants, such as dust, smoke, or pollen
Chronic bronchitisProductive cough most days of the month at least 3 months of the year for at least 2 consecutive years
COPDPersistent, progressive dyspnea; chronic cough (may be intermittent or unproductive), chronic sputum production
GERDHeartburn; sour taste in mouth; worsening of symptoms in supine position; improvement with acid-lowering drugs
HFFatigue; dependent edema; breathlessness
Lower respiratory tract infectionFever (mild to high); thick, purulent, discolored phlegm; tachypnea, tachycardia
UACSMucus drainage from nose; frequent throat clearing
Viral URTISneezing; sore throat; rhinorrhea; low-grade fever

Other cough questions

Explain the concern of using honey for the treatment of cough in children less than 1 year of ageshould not be given to children younger than 1 year because of the risk of botulism from ingestion of honey
Explain the evidence-based recommendations provided by the American College of Chest Physicians for the treatment of cough and how this may differ from what is available OTC in common “cough products”The ACCP guidelines state that central cough suppressants are ineffective in cough associated with the common cold, and they recommend a combination of a first-generation antihistamine (diphenhydramine) with a decongestant to treat the viral infection–induced postnasal drip that is most likely the cause of the cough, guidelines suggest that the anti-inflammatory naproxen may reduce viral-associated cough. Guaifenesin is not recommended for any indication. The guidelines do not address chlophedianol.
Treatment of Cough associated w/ acute and chronic bronchitis and post-infectious subacute cough, useDM or Codeine
Treatment of cough associated w/ upper airways cough syndrome, use1st generation Antihistamine and decongestant combination
Viral Infection associated w/ cough, useNaproxen
Viral infection w/ post nasal drip, use1st generation + Decongestant