Cough: Understanding Causes and Management

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Questions and Answers

What is the primary purpose of a cough?

To produce sputum for laboratory testing

To stimulate the immune response

To indicate the presence of a cold

To clear the airway for normal breathing (correct)

Which type of cough lasts longer than 8 weeks?

Chronic cough (correct)

Non-productive cough

Productive cough

Acute cough

What is a common viral infection that often causes coughing?

Pneumonia

Gastroesophageal reflux disease (GERD)

Upper respiratory tract infection (correct)

Chronic bronchitis

Which of the following is classified as a non-productive cough?

A dry cough without sputum Signup and view all the answers

When should a cough be referred to a medical practitioner?

If it lasts longer than 3 weeks Signup and view all the answers

What is the most likely cause of a cough in a patient presenting to a community pharmacy?

Viral infection Signup and view all the answers

Which condition is considered unlikely to cause a cough?

Heartburn Signup and view all the answers

What indicates a need for referral for cough management?

Cough that recurs regularly Signup and view all the answers

Which of the following symptoms would not typically indicate a need to consult a community pharmacist for a cough?

Cold and sore throat Signup and view all the answers

Which medication is specifically indicated for a nonproductive cough?

Antitussives Signup and view all the answers

What is a common side effect of narcotic antitussives such as codeine?

Constipation Signup and view all the answers

How long should patients consult their doctor if a cough has not improved?

3 weeks Signup and view all the answers

Which previous history is least likely to be considered relevant for assessing the cause of a cough?

Diabetes Signup and view all the answers

What is the primary mechanism of action of mucolytics like acetylcysteine?

Loosen thick bronchial secretions Signup and view all the answers

Which medication is contraindicated to be taken with MAOIs?

Dextromethorphan Signup and view all the answers

What type of headache is most commonly associated with stress and dehydration?

Tension headache Signup and view all the answers

Which of the following is an adverse effect associated with acetylcysteine?

Bronchospasm Signup and view all the answers

Which of the following describes a primary headache?

Includes tension, migraines, and cluster headaches Signup and view all the answers

In comparing carbocysteine and acetylcysteine, what advantage does carbocysteine have?

Causes less gastrointestinal irritation Signup and view all the answers

What is the typical treatment for chronic tension headaches?

Amitriptyline or tricyclic antidepressants Signup and view all the answers

What effect do topical antitussives like menthol and camphor have?

Provide cooling and local anesthetic effects Signup and view all the answers

What is a common trigger for migraines?

Consuming specific foods Signup and view all the answers

What type of pain is typically associated with a cluster headache?

Excruciating, stabbing pain Signup and view all the answers

What symptom might occur during a migraine aura?

Visual disturbances Signup and view all the answers

Which medication is used for treating severe migraines?

Sumatriptan Signup and view all the answers

What is a characteristic feature of cluster headaches?

Occurs at the same time every day Signup and view all the answers

Which of the following statements about migraines is incorrect?

They are typically bilateral in nature. Signup and view all the answers

What is the primary treatment modality for cluster headaches?

100% oxygen Signup and view all the answers

Which of the following is NOT a common symptom associated with cluster headaches?

Visual distortions Signup and view all the answers

Study Notes

Cough

Coughing is a defense mechanism to clear the airway.
It occurs when the airway is obstructed or irritated.
Viral upper respiratory tract infections (URTIs) are the most common cause of cough.
Cough can signal various conditions like bronchitis, laryngitis, pneumonia, and GERD.
Acute cough lasts less than 3 weeks, and chronic cough persists beyond 8 weeks.
Refer any cough lasting longer than 3 weeks to a doctor.
Important information to collect from the patient includes:
- Age
- Duration of cough
- Nature of cough (dry or productive)
- Associated symptoms (cold, sore throat, fever, chest pain, shortness of breath, wheezing)
- Previous history (COPD, asthma, diabetes, heart disease, GERD, smoking habit)
- Current medication
Possible causes of cough based on their likelihood in community pharmacy:
- Most Likely: Viral infection
- Likely: Upper airways cough syndrome, acute bronchitis
- Unlikely: Croup, chronic bronchitis, asthma, pneumonia, ACE inhibitor induced cough
- Very Unlikely: Heart failure, tuberculosis, cancer, pneumothorax
Trigger points for referral:
- Chest pain, hemoptysis (coughing up blood), pain on inspiration, wheezing, or shortness of breath
- Cough lasting longer than 3 weeks
- Cough that recurs regularly
- Debilitating symptoms in the elderly
- Persistent nocturnal cough in children
Treatment timescales:
- Patients should consult their doctor 3 weeks after the cough onset if it hasn't improved.
- Antitussives are used for non-productive coughs.
- Mucolytics and expectorants are indicated for productive coughs.
- Antitussives suppress cough:
  - Narcotics: Codeine, dihydrocodeine, pholcodine (can be addictive, cause constipation, dysphoria, and fatigue)
  - Non-narcotic: Dextromethorphan (no analgesia, low addictive potential, better side effect profile)
  - Topical Antiussives: Menthol and camphor (provide cooling and local anesthetic effects, available as ointments, lozenges, and steam inhaler)
- Mucolytics break down mucus:
  - Acetylcysteine (can cause bronchospasm, GI irritation and high liability for drug-drug interactions)
  - Carbocysteine (safer in asthmatic patients as it doesn't cause bronchospasm, more effective in chronic conditions due to decrease in mucus hyperplasia)
- Expectorants stimulate respiratory secretions:
  - Guaifenesin
  - Side effects of expectorants include nausea, vomiting, and diarrhea

Headaches

Headaches occur due to stimulation of pain-sensitive structures in the head and neck.
These include meninges, blood vessels, nerves, and muscles.
Primary Headaches are more common and recurrent. These are:
- Tension headaches:
  - Most common type, more frequent in females.
  - Slow, gradual, bilateral, tight, "band-like" with no other symptoms.
  - Lasts between 30 minutes and a week.
  - Triggered by stress and dehydration.
  - Treatment: NSAIDs for pain relief, Amitriptyline or other tricyclic antidepressants for chronic pain.
- Migraine Headaches:
  - Also more common in females.
  - Usually have specific triggers (foods, weather, lights, noises, exertion, sleep deprivation).
  - Typically severe, unilateral, throbbing, worsening with movement.
  - Lasts 4-72 hours.
  - Accompanied by nausea, vomiting, photophobia, phonophobia.
  - Treatment: NSAIDs, analgesics, Sumatriptan for severe migraines.
  - Prevention: Lifestyle changes, beta-blockers like propranolol, amitriptyline.
  - Aura: Precedes or occurs during headache, includes visual symptoms (bright lights, zig-zag lines) or neurological symptoms like tinnitus, aphasia, confusion.
  - Hemiplegic Migraine is a type of migraine with temporary paralysis of one side of the body, which can be mistaken for a stroke.
- Cluster Headaches:
  - Rarest type, mainly affecting males.
  - Excruciating, stabbing pain located behind the eye, occurring unilaterally.
  - Occur daily for 8-10 weeks in a year, followed by periods of absence.
  - Happen at similar time every day.
  - Last 15 minutes to 3 hours.
  - Linked to smoking and alcohol.
  - Symptoms: Individuals pace around, seeking relief, experience autonomic symptoms on the affected side (ptosis, miosis, lacrimation, nasal congestion).
  - Treatment: 100% oxygen, Sumatriptan.
  - Prophylaxis: Verapamil, valproic acid, lithium.
Secondary Headaches are caused by specific underlying medical conditions:
- Subarachnoid hemorrhage
- Meningitis
- Sinusitis
- Brain abscess
- Brain tumor

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Description

Explore the nuances of cough, a vital defense mechanism for clearing airways. Learn about acute versus chronic cough, common causes, and essential patient information to gather. This quiz will enhance your understanding of coughs related to various respiratory conditions.