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Home Your library Expert Solutions Ask Quizlet anything Profile Picture Free trial Flashcards Learn Test Match Cough, Cold, Flu Matrix Leave the first rating In-class activity Classic Live Checkpoint Self-study activity Flashcards Learn Test Match Phenylephrine and pseudoephedrine
(Sudafed PE = phenylephrine, Sudafed) Adults, children 2+ Can be used in children 2 years old and older per FDA standards, but manufacturing voluntarily increased age to 4+ due to risk of overdose and lack of efficacy data 1 / 93 Profile Picture gyasinina4 Top creator on Quizlet Share Students also viewed Pharm Mod 2 64 terms Profile Picture sarahoff15 Preview State Board Practice Test 6 terms
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CHEM 256 Chapter 20 27 terms Profile Picture isabellaterrones Preview HHP-4013 : FInal Exam 56 terms Profile Picture Gracie__77 Preview Terms in this set (93) Original Phenylephrine and pseudoephedrine (Sudafed PE = phenylephrine, Sudafed) Adults, children 2+ Can be used in children 2 years old and older per FDA standards, but manufacturing voluntarily increased age to 4+ due to risk of overdose and lack of efficacy data Phenylephrine and pseudoephedrine drug class/mech of action Class: systemic decongestant; sympathomimetic MOA: stimulates alpha-adrenergic receptors in the nose/sinuses and constricts blood vessels, decreasing sinusoid vessel engorgement and mucosal edema
The side effects come from Systemic alpha and beta agonist effects ***Phenylephrine is typically less effective than pseudoephedrine Which is more effective: phenylephrine or pseudophedrine? Pseudophedrine What symptoms do Phenylephrine and pseudoephedrine treated? -nasal/sinus decongestion -cough with post-nasal drip even though it is not drug of choice for this, but it may help a little FYI: can help with eustachian tube congestion eustachian tube congestion condition where the tubes that connect your middle ears to your upper throat become blocked. What are the side effects of taking Phenylephrine and pseudoephedrine -raised BP, rapid heart rate, arrhythmias - all from beta stimulation/norepinephrine -insomnia, anxiety, nervousness, restlessness, tremor, anxiety, anorexia (from the stimulation of CNS - crossing the BBB (blood brain barrier)) -urinary retention - stimulation of urethra/prostate smooth muscle (alpha agonism)
-dry nose (bleeding due to dryness) Phenylephrine and pseudoephedrine pros (most of these apply to pseudoephedrine as phenylephrine is not very potent) onset within 30min-2hrs, available as short-acting and long acting (12, 24 hr tabs) Phenylephrine and pseudoephedrine cons -concern for abuse - pseudoephedrine can be used to make meth, so it's behind the counter -caution: hyperthyroidism (stimulating to CV and CNS) -caution w/ pts that have cardiac problems or uncontrolled HTN due to CV stimulation (increased BP, HR, palpitation, arrhythmia) -caution: in pts who can't sleep, have anxiety due to CNS stimulation -caution: Patients w/ BPH or enlarged prostate because this drug contracts smooth muscle around urethra and can inhibit urination further) -caution with patients with diabetes due to the drug's potential for peripheral vasoconstriction -caution in older adults as they may have concomitant disease states and may be more sensitive to side effects -caution: not for pregnant women because the drug has a potential for birth defects and in lactation the drug can decrease milk production
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-warning: can very rarely cause acute angle-closure crisis/closed-angle glaucoma (vision loss) -contraindicated in pts taking MAOIs (antidepressants) Phenylephrine and pseudoephedrine other notes An oral decongestant Vasoconstriction **Sports: stimulant = enhance lungs (think about drug testing in athletes) Oxymetazoline, phenylephrine, naphazoline Brand: Afrin, Neosynephrine Adults and children 2 year old or older Oxymetazoline 6y/o or older Oxymetazoline, phenylephrine, naphazoline drug class/MOA Class: topical decongestant MOA: stimulates alpha-adrenergic receptors in the nose/sinus and constricts blood vessels decreasing sinusoid vessel engorgement and mucosal edema
What symptoms will be Oxymetazoline, phenylephrine, naphazoline treat Nasal/sinus congestion side effects of taking Oxymetazoline, phenylephrine, naphazoline -dry nose -bleeding due to dryness -rhinitis medicamentosa (rebound congestion that occurs with overuse of the drug or using the drug for too long) pros of taking Oxymetazoline, phenylephrine, naphazoline -rapid acting within minutes -lack of systemic side effects making this drug the best choice for a patient who is pregnant, breastfeeding, has heart problems or BPH -oxymetazoline is least absorbed systemically making it great for pateits with the condition listed above and is long acting - dosed bid (q12 hrs) vs others medication which are dosed q4-6 hrs Oxymetazoline, phenylephrine, naphazoline cons -other Side effects include local irritation causing sneezing/burning/stinging and trauma from improper use - can cause rhinitis medicamentosa (rebound congestion) if used more than 3-7 days
-the medication bottle needs to be kept clean and need to use separate bottles for separate people because of the viral contamination that can occur Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) anyone at any age can use this drug Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) drug class/MOA Class: moisturizer MOA: relieves nasal irritation and dryness and help remove thick/dried mucus from nose symptoms that Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) treats -nasal congestion and dryness -withdrawal from nasal decongestants side effects of using Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) side effects -runny nose, mild stinging/burning -water more comfortable (approx. 30 sec) pros of using Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) -has immediate onset of action, it's cheap, and very well-tolerated -nasal rinse/irrigation is more effective than nasal spray -anyone can use it there are no age restrictions or contraindication for pregnant and lactating mothers
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which is more effective: Nasal spray or Nasal rinse/irrigation Nasal Rinse cons of using Nasal Saline (Neilmed irrigation Ayr, Ocean Sprays) (Neti pot) -max irrigation use bid -nasal rinses can be uncomfortable -need boiled/distilled water Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton) Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine) adults and children 2 years old or older can use this drug, but it is recommended for the child to be 6 years old or older 6+ due to paradoxical reactions in children (has opposite effect on kids than adults - stimulant, doesn't make them tired, but more hyper) Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton)
Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine) drug class/MOA Class: sedating/first-generation antihistamines MOA: blocks histamine at central and peripheral histamine-1 (H1) receptor sites MOA nasal: acts peripherally in nose to dry up nasal secretions (anticholinergic) MOA cough: acts centrally in medulla to increase cough threshold AND decrease/dries up post-nasal drip (peripherally) to reduce cough MOA insomnia: crosses BBB (blood brain barrier) to cause sedation anticholinergic blocks parasympathetic nerve impulses; decreases oral and respiratory secretions (atropine, Artane) symptoms that Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton) Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine)treats
-dry cough -rhinorrhea (runny nose) -sleep ***second generation antihistamines (e.g. Claritin, Zyrtec, Allegra) not effective for cough/cold side effects of using Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton) Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine) due to Anticholinergic properties: -dry eyes/blurred vision (no see) -urinary retention (no pee, relaxes bladder muscle exacerbating BPH) -dry mouth (no spit) -constipation (no sh**) -sedation by crossing the BBB) -cognitive impairment by crossing BBB and blocks necessary acetylcholine in brain in older adults) Paradoxical reactions (excitability, restlessness, irritability) in elderly and children 6 yo and younger; rarely seizure in infants
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pros of using Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton) Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine) -onset of action 15-30 min -available in combination products and complements decongestants for nasal symptoms -can treat multiple symptoms and help sleep -single ingredient antihistamines are safe to use in pregnancy Diphenhydramine (Benadryl) Chlorpheniramine (Chlortrimeton) Brompheniramine (Dimetapp) Doxylamine (multi-ingredient products) Triprolidine + pseudoephedrine (Actifed, Aprodine) cons -caution in patients with BPH or difficulty with urination, geriatric pts, glaucoma, and in pts where mental alertness is required and those who have dementia/Alzheimer's -caution: pharmacodynamic drug interactions with alcohol, other sedating drugs and blocks effect of Alzheimer's drugs -warning: can very rarely cause acute angle-closure crisis/closed-angle glaucoma (emergency vision loss) -contraindication: breast feeding - can dry up breast milk and pass on to the baby (paradoxical effect and rarely seizures)
-contraindication: pts taking MAOIs (rarely used antidepressants) Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays (6+) Adults, children 4-6 years old and older (choking hazard) Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays drug class/MOA Class: local anesthetic MOA: decreases permeability of sodium ions/depresses cutaneous receptors, which results in blockage of nerve conduction to cause numbing Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays symptoms that will be treated local pain and sore throat Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays side effects
-may cause numbing in mouth and tongue, biting mouth accidentally, choking, bad taste -methemoglobinemia from benzocaine - typically from overuse Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays pros -well-tolerate -works w/in 20 sec -when used correctly, both are safe during pregnancy and breastfeeding -can be used with systemic analgesics Benzocaine, Phenol (Cepacol, Chloraseptic) Lozenges and sprays cons -effects only last 10-15 min but cannot redose for 2-4 hrs, so pts may accidentally overdose -cannot use benzocaine if have a "caine" allergy -choking risk with lozenges in children < 6 years old and sometime older adults Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) adults, children 2 years old and older- they use ointment
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adults and children 6years old and older they use lozenges to avoid the chocking hazard Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) drug class and MOA Class: local anesthetic/topical antitussive MOA general: menthol stimulates TRpM8 receptors as an anesthetic) MOA cough: lozenges decrease throat irritation and increase saliva to reduce cough and suppress cough reflex sensitivity MOA nasal/chest congestion: chest rub containing menthol/camphor vapors stimulate sensory nerve endings within the nose/chest and mucosa creating a local anesthetic sensation and sense of improved airflow Antussive Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) symptoms that will be treated -dry cough -nasal congestion -chest congestion
Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) side effects In Lozenges -cold sensation/numbness in mouth -bad taste from menthol, numb taste buds which can reduce taste of foods in Chest rub (ointments) -ointments are greasy -localized skin irritation may occur with topical products Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) pros safe to use in pregnancy and lactation with short term use Menthol Camphor (Vicks, Mentholatum for kids, other brands of lozenges) Lozenges (menthol) and chest rub (menthol and camphor) cons -lacking evidence of effectiveness in treatment of acute cough -may cause burns if ointment is heated up/vaporized and gets on skin
-caution: children can overdose if they eat the ointment (due to camphor - as little as 4 tsps can be deadly -caution: apply to feet of young children so they don't accidentally eat it -choking risk with lozenges in children < 6 and sometime older adults Acetaminophen (Tylenol) available is combo products for multi-symptom relief (see previous matrix for other things not mentioned) APAP drug class and MOA APAP symptoms that will be treated Fever Pain: throat, muscle, HA APAP: Side effects APAP Pros APAP Cons
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Ibuprofen Naproxen (Advil, Motrin, Aleve) available is combo products for multi-symptom relief (see previous matrix for other things not mentioned) Ibu and Naproxen Drug class and MOA nsaids- block prostaglanding synthesis by blocking cox 1 and 2 in cns and pns Ibu & Naproxen symptoms that will be treated Fever Pain: throat, muscle, HA Ibu and Naproxen side effects Ibu and naproxen cons ibu and naproxen pros Guaifenesin (Mucinex, Robitussin) dosing
2 year olds can take it per FDA guidelines 4 years old per manufacturer guidelines -2-6 yrs 600mg/day -6-12 yrs 1200mg/day ->12 yrs 1200-2400 mg/day for adults Guaifenesin (Mucinex, Robitussin) drug class and MOA Class: protussive/expectorant (thins mucus) MOA ineffective/minimally productive in coughs: thins mucus and increases the volume of expectorated sputum MOA nasal congestion: thins nasal secretions Expectorated sputum Material from the lower respiratory tract produced by a deep cough Guaifenesin (Mucinex, Robitussin) symptoms that will be treated Cough: ineffective productive cough or minimally productive cough nasal congestion
Guaifenesin (Mucinex, Robitussin) side effects -thins mucus throughout body (i.e. mucus in vaginal, nasal and chest areas) (systemic) no major side effects - some pts may have GI side effects (nausea, diarrhea, stomach pain) which can be alleviated by taking with food Guaifenesin (Mucinex, Robitussin) pros -available in various formulations and in combination with other drugs; IR and ER -can be used in pregnancy and lactation -no drug-drug interactions and can be used by almost all pts (healthy or with comorbid conditions) Guaifenesin (Mucinex, Robitussin) cons not much data to support use Guaifenesin (Mucinex, Robitussin) other -always use max dose (to be effective) -want them to cough it out (but if they are coughing it out, they do not need anything) *cough can be good! (unless dry)
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Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine 2+ per FDA 4+ per manufacturer Codeine > 18 yo Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine drug class/MOA Class: antitussive (e.g. cough suppressant) (prevents cough) MOA Dextromethorphan: nonopiod that acts centrally in the medulla to increase the cough threshold MOA codeine: opioid that acts centrally on the cough control center (medulla) to increase the cough threshold Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine symptoms that will be treated dry cough Dextromethorphan (Robitussin, Delsym, Robitussin AC)
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Codeine side effects DM: -stomach discomfort (from sugar content) -drowsiness/CNS depression -abuse (robotripping): euphoria, hallucinations Codeine: -euphoria, risk of addiction -N/V -sedation -dizziness -constipation -respiratory depression (overdose) Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine pros -DM is safe in pregnancy, likely safe in lactation at recommended doses Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine cons -CI: DM has a DDI with MAO-I (rarely used antidepressants)
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-caution: both Dm and codeine can be abused and should not be used with alcohol. caution: with CNS depressants -not for productive coughs unless pt cannot sleep or interfering with ADLs -codeine is NOT to be used in kids, pregnancy or breastfeeding -codeine is a CS-V and is OTC in certain states Dextromethorphan (Robitussin, Delsym, Robitussin AC) Codeine other -stop cough at night -dry cough that interferes with activities -dry cough - not removing anything, can lead to pneumonia Honey Nonpharm: if from kitchen Pharm: if in box labeled for cough adults, children 1+ Honey drug class/MOA Class: antitussive MOA: acts as a cough suppressant by coating the throat decreasing irritation and reducing frequency; also has antimicrobial properties
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Honey symptoms that will be treated dry cough Honey side effects upset stomach or diarrhea from sugar content Honey pros -data to support honey as more effective than placebo; buckwheat honey was formulation in studies; may be more effective than DM -may be a good alternative for children under age of 6 as data supports effectiveness in children 1-5 to treat nocturnal cough -safe in pregnancy and lactation Honey cons contraindication: avoid use in children < 1 yr due to risk of botulism infection Zinc all ages, but we would not recommend for infants *Must start w/in 24 hours of symptoms (sometimes we say 24-48 hrs) Zinc drug class/MOA Class: supplement
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MOA: prevents the adhesion (binding) of human rhinovirus to the nasal epithelium MOA: inhibits viral replication by disrupting viral capsid formation Zinc symptoms that will be treated cold symptoms Zinc side effects -upset stomach/N/V (GI) -altered/bitter taste -anosmia with nasal zinc - do not recommend this formulation (should not be on the market) Zinc pros -available in various different formulations -can reduce cold symptoms or duration of cold if taken w/in 24 hrs of symptom onset -safe in pregnancy and lactation if doses are less than 40 mg/day Zinc cons oral lozenges should be administered every 2 hrs Vitamin C all ages, but we would not recommend for infants Vitamin C drug class/MOA
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Class: supplement prevention and treatment of cold MOA: possibly affects rhinovirus and boosts immune system (increased levels of vit V in WBCs) antioxidant effects Vitamin C symptoms that will be treated cold symptoms Vitamin C side effects upset stomach and diarrhea Vitamin C pros -usually well tolerated at recommended doses -safe to use in pregnancy and lactation at recommended doses -many formulations including chewable and powders Vitamin C cons -data are not strong/likely to provide no benefit in preventing colds in most people with the exception of elite athletes -caution: may increase risk of kidney stones and GI SE especially with high doses over 2g/day
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Echinacea > 12 yo Echinacea drug class/MOA Class: supplement Complementary medicine MOA: may exhibit antiviral activity and boost immune function Echinacea symptoms that will be treated cold symptoms Echinacea side effects -GI discomfort -rash (children) -worsening of asthma, allergies and eczema Echinacea cons -most likely to be adulterated of all cough/cold products on matrix -must be taken at the first sign of illness (for most benefit) -caution: pts with severe asthma or allergy to Asteraceae/compositae (ragweed and chrysanthemum) should avoid this product -caution: avoid in children under 12 b/c allergy risk -caution: avoid in use in pts who are immunocompromised
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-caution: lack of data to address safety in pregnancy or lactation - avoid use Other about cough/cold/flu -ineffective cough = use drug therapy (for the most part) Non-pharm (more for kids) -congestion: fluids (will thin mucus), kleenex -cough: honey About us About Quizlet How Quizlet works Careers Advertise with us Get the app For students Flashcards Test Learn Solutions Q-Chat For teachers Live Checkpoint Blog Be the Change Resources
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