120 Questions
What is the main purpose of a productive cough?
To expel secretions from the lower respiratory tract
Which of the following is NOT a classification of cough?
Recurrent
What is a common symptom of anaerobic bacterial infections?
Malodor
Which of the following is a complication of chronic cough?
Economic burden
What is the term for cough that is initiated by stimulation of vagally mediated sensory pathways?
Defensive cough
Which of the following is a cause of subacute cough?
Post infectious cough
What is the term for the cough that is characterized by the presence of secretions that are difficult to expel?
Ineffective cough
Which of the following is a risk factor for chronic cough?
All of the above
What is the primary goal of self-treatment of cough?
To reduce the number and severity of cough episodes
What type of cough is associated with viral and atypical bacterial infections?
Nonproductive cough
What is a common complication of cough?
Excessive perspiration
What is the purpose of protussives in treatment of cough?
To change the consistency of mucus and increase the volume of expectorated sputum
What should be treated to stop the cough?
The underlying disorder
Why should antitussives not be used to treat productive coughs?
Because they may lead to retention of lower respiratory tract secretions
What is a consequence of prolonged coughing?
Prolonged absence from work or school
What is the mechanism of action of antitussives?
They control or eliminate cough
What is the primary mechanism of codeine in reducing cough?
By acting centrally on the medulla to increase the cough threshold
What is a potential complication of using humidifiers in nonpharmacologic therapy?
Increased environmental mold and dust mites
Why are coolmist humidifiers and vaporizers preferred in nonpharmacologic therapy?
Fewer bacteria grow at the cooler temperatures and there is less risk of scalding
What is a common side effect of codeine?
Nausea
What is the purpose of propping infants upright when they sleep and raising the head of the bed at night?
To promote drainage of nasal secretions
What is a contraindication for the use of codeine?
In patients with known codeine hypersensitivity
What is the maximum amount of codeine allowed per 100 milliliters in codeine-containing products?
200 mg
What is the purpose of using a rubber bulb nasal syringe in nonpharmacologic therapy?
To clear the nasal passages and reduce cough
Combining antitussives and protussives may be beneficial in treating cough.
False
Codeine acts peripherally to decrease the cough threshold.
False
Codeine is contraindicated in infants under 6 months old.
True
Dextromethorphan is a non-opioid antitussive that can cause respiratory depression.
False
Concomitant use of codeine and central nervous system depressants causes subtractive CNS depression.
False
Diphenhydramine can cause CNS depression and exacerbate respiratory depression.
True
Humidifiers can increase environmental mold, dust mites, minerals, and microorganisms.
True
Codeine is contraindicated in patients with known codeine hypersensitivity only during labor.
False
The combination of opioids and non-opioid antitussives can increase the risk of respiratory depression.
True
Respiratory tract irritation can be caused by inhaled medications.
True
Coolmist humidifiers and vaporizers are preferred because they promote bacterial growth.
False
Cough medications can exacerbate underlying respiratory conditions like asthma.
True
Non-medicated lozenges can increase cough by stimulating throat irritation.
False
Cough is a symptoms of GERD.
True
Codeine-containing products can contain more than 200 mg of codeine per 100 milliliters.
False
Anaerobic bacterial infections are associated with a distinct malodor.
True
Dextromethorphan is a type of opioid with analgesic properties.
False
Patients with impaired respiratory reserve should use codeine with caution.
True
Diphenhydramine is a second-generation antihistamine with antitussive activity.
False
Dextromethorphan has a narrow margin of safety.
False
The combination of monoamine oxidase inhibitors (MAOIs) and dextromethorphan may cause serotonin syndrome.
True
Codeine is approximately equipotent with dextromethorphan.
False
Dextromethorphan is indicated for the treatment of productive coughs.
False
Additive CNS depression occurs with the combination of dextromethorphan and psychotropic medications.
True
What is a concern when combining codeine with central nervous system depressants?
additive CNS depression
What is a potential complication of using dextromethorphan in combination with monoamine oxidase inhibitors (MAOIs)?
serotonin syndrome
What is a side effect of diphenhydramine that can exacerbate respiratory depression?
CNS depression
What is a risk associated with using humidifiers and vaporizers in non-pharmacologic therapy?
increased environmental mold, dust mites, minerals, and microorganisms
What is a contraindication for the use of codeine?
infants under 6 months old, known codeine hypersensitivity during labor
What is a characteristic of dextromethorphan?
narrow margin of safety
What is a concern when using opioids and non-opioid antitussives together?
increased risk of respiratory depression
What is a potential complication of respiratory tract irritation caused by inhaled medications?
exacerbation of underlying respiratory conditions
What is the primary mechanism of action of codeine in reducing cough?
Codeine acts centrally on the medulla to increase the cough threshold.
What is a potential complication of using humidifiers in nonpharmacologic therapy?
High humidity may increase environmental mold, dust mites, minerals, and microorganisms.
What is the purpose of using a rubber bulb nasal syringe in nonpharmacologic therapy?
To clear the nasal passages and reduce cough if postnasal drip causes cough.
What is a common side effect of codeine?
Nausea, vomiting, sedation, dizziness, and constipation.
What is the maximum amount of codeine allowed per 100 milliliters in codeine-containing products?
200 mg.
What is the purpose of propping infants upright when they sleep and raising the head of the bed at night?
To promote drainage of nasal secretions.
What is a contraindication for the use of codeine?
Patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.
Why are coolmist humidifiers and vaporizers preferred in nonpharmacologic therapy?
Fewer bacteria grow at the cooler temperatures and there is less risk of scalding if they are tipped over.
What is the primary concern for patients with impaired respiratory reserve when taking codeine?
Respiratory depression
What is the main difference between codeine and dextromethorphan?
Dextromethorphan has no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses
What is the potential interaction between diphenhydramine and other medications?
Additive CNS depression
Why should monoamine oxidase inhibitors (MAOIs) and dextromethorphan not be used together?
Serotonin syndrome
What is the primary mechanism of action of dextromethorphan in reducing cough?
Acts centrally in the medulla to increase the cough threshold
What is the primary indication for dextromethorphan?
Suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
What is the potential complication of combining opioids and non-opioid antitussives?
Increased risk of respiratory depression
What is the primary mechanism of action of diphenhydramine in reducing cough?
Acts centrally in the medulla to increase the cough threshold
Diphenhydramine may cause _______________, especially in children.
excitability
Diphenhydramine potentiates the depressant effects of _______________ on the CNS.
narcotics
Chlophedianol is an alkylamine _______________ derivative with antitussive, moderate local anesthetic, and mild anticholinergic effects.
antihistamine
Diphenhydramine should be used with caution in patients with diseases potentially exacerbated by drugs with _______________ activity.
anticholinergic
Diphenhydramine can cause _______________ depression and exacerbate respiratory depression.
CNS
Chlophedianol is indicated for the suppression of nonproductive cough caused by _______________ or mechanical respiratory tract irritation.
chemical
Diphenhydramine containing antitussives should not be used with any other _______________ containing product, including topical products.
diphenhydramine
Large doses of chlophedianol are associated with _______________, vertigo, visual disturbances, nausea, vomiting, and drowsiness.
dry mouth
Patients with impaired respiratory reserve (e.g., asthma or COPD) or preexisting respiratory depression, ______ addicts, and individuals who take other respiratory depressants or sedatives, including alcohol, should use codeine with caution.
drug
Dextromethorphan is considered approximately ______ with codeine.
equipotent
Dextromethorphan is a nonopioid with no ______, sedative, respiratory depressant, or addictive properties at usual antitussive doses.
analgesic
Dextromethorphan has a ______ margin of safety.
wide
The combination of ______ oxidase inhibitors (MAOIs) and dextromethorphan may cause serotonergic syndrome.
monoamine
Diphenhydramine is a nonselective (first-generation) ______ with significant sedating and anticholinergic properties.
antihistamine
Diphenhydramine acts centrally in the ______ to increase the cough threshold.
medulla
Additive CNS depression occurs with the combination of ______ and psychotropic medications.
dextromethorphan
Codeine acts centrally on the ______ to increase the cough threshold.
medulla
The concomitant use of codeine and ______ depressants causes additive CNS depression.
central nervous system
Non-medicated lozenges may reduce cough by decreasing ______ irritation.
throat
Diphenhydramine can cause ______ depression and exacerbate respiratory depression.
CNS
Humidifiers can increase environmental ______, dust mites, minerals, and microorganisms.
mold
Codeine is contraindicated in patients with known ______ hypersensitivity.
codeine
Codeine-containing products must contain one or more non-codeine active ingredients and no more than ______ mg of codeine per 100 milliliters.
200
The most common side effects of codeine are ______, vomiting, sedation, dizziness, and constipation.
nausea
Match the following medications with their effects:
Codeine = Increases the cough threshold Diphenhydramine = Causes CNS depression Dextromethorphan = Is a non-opioid antitussive Humidifiers = Increases environmental mold, dust mites, minerals, and microorganisms
Match the following medication interactions with their effects:
Codeine and CNS depressants = Additive CNS depression Dextromethorphan and MAOIs = Serotonin syndrome Opioids and non-opioid antitussives = Increases the risk of respiratory depression Antitussives and protussives = Potentially counterproductive
Match the following medication contraindications with their reasons:
Codeine = Known codeine hypersensitivity and during labor Dextromethorphan = Impaired respiratory reserve Diphenhydramine = History of respiratory depression Humidifiers = Inhalation of bacteria and mold
Match the following respiratory effects with their causes:
Respiratory depression = Combination of opioids and non-opioid antitussives Respiratory tract irritation = Inhaled medications Cough exacerbation = Underlying respiratory conditions like asthma GERD symptoms = Cough
Match the following non-pharmacologic therapies with their effects:
Non-medicated lozenges = Reduces cough by decreasing throat irritation Humidifiers = Soothes irritated airways Vaporizers = Produces medicated vapor Propping infants upright = Promotes drainage of nasal secretions
Match the following antitussives with their characteristics:
Codeine = Acts centrally to increase the cough threshold Dextromethorphan = Is a non-opioid antitussive with a narrow margin of safety Diphenhydramine = Has antitussive activity and causes CNS depression Antitussives = Combining with protussives may be counterproductive
Match the following medication effects with their consequences:
Codeine = May cause nausea, vomiting, sedation, dizziness, and constipation Dextromethorphan = May cause respiratory depression Diphenhydramine = May exacerbate respiratory depression Humidifiers = May increase environmental mold, dust mites, minerals, and microorganisms
Match the following medication interactions with their risks:
Codeine and CNS depressants = Additive CNS depression Dextromethorphan and MAOIs = Serotonin syndrome Opioids and non-opioid antitussives = Increased risk of respiratory depression Antitussives and protussives = Counterproductive effects
Match the following antitussives with their properties:
Dextromethorphan = Non-opioid with no analgesic, sedative, or addictive properties Codeine = Opioid with analgesic properties Diphenhydramine = Antihistamine with sedating and anticholinergic properties Levorphanol = Codeine analogue
Match the following medications with their effects on the central nervous system:
Dextromethorphan = No CNS depression at usual doses Codeine = Additive CNS depression with other CNS depressants Diphenhydramine = Significant sedating and anticholinergic properties Antihistamines = Additive CNS depression with dextromethorphan
Match the following patient populations with their precautions for using codeine:
Patients with impaired respiratory reserve = Use codeine with caution Drug addicts = Use codeine with caution Individuals taking other respiratory depressants = Use codeine with caution Pregnant women = No specific precautions mentioned
Match the following medications with their interactions with other drugs:
Dextromethorphan = May cause serotonin syndrome with MAOIs Codeine = Additive CNS depression with antihistamines Diphenhydramine = Additive CNS depression with psychotropic medications MAOIs = Contraindicated with dextromethorphan for at least 14 days
Match the following medications with their indications:
Dextromethorphan = Suppression of nonproductive cough Codeine = Pain relief and cough suppression Diphenhydramine = Suppression of nonproductive cough and allergic reactions Loratadine = Allergic reactions, but no antitussive activity
Match the following side effects with the medications:
Drowsiness, nausea, vomiting, stomach discomfort, or constipation = Dextromethorphan Respiratory depression = Codeine CNS depression and anticholinergic effects = Diphenhydramine No common side effects mentioned = Loratadine
Match the following medications with their mechanisms of action:
Dextromethorphan = Acts centrally in the medulla to increase the cough threshold Codeine = Acts peripherally to decrease the cough threshold Diphenhydramine = Acts centrally in the medulla to increase the cough threshold Levorphanol = Codeine analogue with unknown mechanism of action
Match the following medications with their safety profiles:
Dextromethorphan = Wide margin of safety Codeine = Narrow margin of safety due to respiratory depression risk Diphenhydramine = Significant sedating and anticholinergic properties MAOIs = Contraindicated with dextromethorphan due to serotonin syndrome risk
Match the following medications with their potential side effects:
Diphenhydramine = CNS depression, hypotension, and CNS stimulation Chlophedianol = Excitation, hyperirritability, nightmares, hallucinations Codeine = Respiratory depression, nausea, vomiting, and drowsiness Dextromethorphan = Not mentioned in the text
Match the following medications with their antitussive mechanisms:
Codeine = Acts peripherally to decrease the cough threshold Dextromethorphan = Non-opioid antitussive mechanism not specified in the text Diphenhydramine = Anticholinergic effect Chlophedianol = Moderate local anesthetic and mild anticholinergic effects
Match the following medications with their indications:
Diphenhydramine = Not specified in the text Chlophedianol = Suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation Codeine = Not specified in the text Dextromethorphan = Not specified in the text
Match the following medication interactions with their effects:
Codeine and central nervous system depressants = Additive CNS depression Dextromethorphan and monoamine oxidase inhibitors (MAOIs) = Serotonin syndrome Diphenhydramine and MAOIs = Increased anticholinergic effect Codeine and non-opioid antitussives = Not mentioned in the text
Match the following medications with their cautions:
Diphenhydramine = Should be used with caution in patients with diseases potentially exacerbated by drugs with anticholinergic activity Codeine = Should be used with caution in patients with known codeine hypersensitivity and impaired respiratory reserve Chlophedianol = No specific cautions mentioned in the text Dextromethorphan = Should be used with caution when combining with opioids and psychotropic medications
Match the following medications with their properties:
Codeine = Opioid with analgesic properties Dextromethorphan = Non-opioid antitussive with a narrow margin of safety Diphenhydramine = Antihistamine derivative with antitussive and anticholinergic effects Chlophedianol = Centrally acting oral antitussive with moderate local anesthetic and mild anticholinergic effects
Match the following medications with their interactions:
Diphenhydramine and opioids = Potentiates the depressant effects of opioids on the CNS Codeine and non-opioid antitussives = May be beneficial in treating cough Dextromethorphan and opioids = Increases the risk of respiratory depression Chlophedianol and MAOIs = Not mentioned in the text
Match the following medications with their formulations:
Chlophedianol = Oral liquids, solutions, and syrups Codeine = Not specified in the text Diphenhydramine = Topical products and oral formulations Dextromethorphan = Not specified in the text
Study Notes
Cough
- Cough is a vital defensive respiratory reflex that can have significant physical, psychological, and economic consequences.
- It is the most common symptom for which patients seek medical care.
Etiology of Cough
- Acute cough causes: viral URTI, pneumonia, acute left ventricular failure, asthma, and foreign body aspiration.
- Subacute cough causes: post-infectious cough, bacterial sinusitis, and asthma.
- Chronic cough causes: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis, autoimmune disease, left ventricular failure, and aspiration secondary to pharyngeal dysfunction.
Clinical Presentation of Cough
- Coughs can be productive (wet or "chesty" cough) or nonproductive (dry or "hacking" cough).
- Productive coughs may be effective or ineffective, and the appearance of secretions is not always a reliable diagnostic indicator.
- Nonproductive coughs serve no useful physiologic purpose and are associated with viral and atypical bacterial infections, GERD, cardiac disease, and some medications.
- Common complications of cough include exhaustion, insomnia, musculoskeletal pain, hoarseness, excessive perspiration, and urinary incontinence.
Treatment of Cough
- The primary goal of self-treatment of cough is to reduce the number and severity of cough episodes, and the second goal is to prevent complications.
- The underlying disorder must be treated to stop the cough.
- Antitussives (cough suppressants) are used to control or eliminate cough and are the drugs of choice for nonproductive coughs.
- Protussives (expectorants) change the consistency of mucus and increase the volume of expectorated sputum and may provide relief for coughs that expel thick, tenacious secretions.
Nonpharmacologic Therapy
- Nonpharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.
- Non-medicated lozenges may reduce cough by decreasing throat irritation.
- Humidifiers increase the amount of moisture in inspired air, which may soothe irritated airways.
Pharmacologic Therapy
- Codeine is a medication used to treat cough, acting centrally on the medulla to increase the cough threshold.
- Codeine-containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters.
- Common side effects of codeine include nausea, vomiting, sedation, dizziness, and constipation.
Cough Therapy
- FDA allows various combinations of antitussives, protussives, analgesics, decongestants, and antihistamines, but combinations of antitussives and protussives are potentially counterproductive.
- Non-pharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.
Non-Pharmacologic Therapy
- Non-medicated lozenges reduce cough by decreasing throat irritation.
- Humidifiers (ultrasonic, impeller, and evaporative) increase moisture in inspired air, soothing irritated airways, but high humidity may increase environmental mold, dust mites, minerals, and microorganisms.
- Vaporizers produce a medicated vapor, with cool-mist humidifiers and vaporizers preferred due to fewer bacteria growth and less risk of scalding.
- Babies and young children (up to 2 years) can't blow their noses, so a rubber bulb nasal syringe may be used to clear nasal passages and reduce cough.
- Propping infants upright when sleeping and raising the head of the bed promotes drainage of nasal secretions.
Pharmacologic Therapy
- Codeine acts centrally on the medulla to increase the cough threshold, but has side effects like nausea, vomiting, sedation, dizziness, and constipation.
- Concomitant use of codeine and CNS depressants causes additive CNS depression.
- Codeine is contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.
Cough
- Cough is an important defensive respiratory reflex with potential physical, psychological, and economic consequences.
- Cough is the most common symptom for which patients seek medical care.
- Cough is initiated by stimulation of chemically and mechanically sensitive vagally mediated sensory pathways in laryngeal, esophageal, and tracheobronchial airway epithelium.
Etiology of Cough
- Acute cough: viral URTI, pneumonia, acute left ventricular failure, asthma, foreign body aspiration.
- Subacute cough: post-infectious cough, bacterial sinusitis, asthma.
- Chronic cough: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis.
Clinical Presentation of Cough
- Coughs are described as productive or nonproductive.
- Productive cough expels secretions from the lower respiratory tract.
- The appearance of secretions is not always a reliable diagnostic indicator.
Dextromethorphan
- Considered approximately equipotent with codeine, dextromethorphan is a nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties.
- Dextromethorphan acts centrally in the medulla to increase the cough threshold.
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
- Has a wide margin of safety, with uncommon side effects including drowsiness, nausea, vomiting, stomach discomfort, or constipation.
Diphenhydramine
- Diphenhydramine is a nonselective antihistamine with significant sedating and anticholinergic properties, acting centrally in the medulla to increase the cough threshold.
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
- Second-generation antihistamines (e.g., loratadine and fexofenadine) lack antitussive activity.
Cough Therapy
- FDA allows various combinations of antitussives, protussives, analgesics, decongestants, and antihistamines, but combinations of antitussives and protussives are potentially counterproductive.
- Non-pharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.
Non-Pharmacologic Therapy
- Non-medicated lozenges reduce cough by decreasing throat irritation.
- Humidifiers (ultrasonic, impeller, and evaporative) increase moisture in inspired air, soothing irritated airways, but high humidity may increase environmental mold, dust mites, minerals, and microorganisms.
- Vaporizers produce a medicated vapor, with cool-mist humidifiers and vaporizers preferred due to fewer bacteria growth and less risk of scalding.
- Babies and young children (up to 2 years) can't blow their noses, so a rubber bulb nasal syringe may be used to clear nasal passages and reduce cough.
- Propping infants upright when sleeping and raising the head of the bed promotes drainage of nasal secretions.
Pharmacologic Therapy
- Codeine acts centrally on the medulla to increase the cough threshold, but has side effects like nausea, vomiting, sedation, dizziness, and constipation.
- Concomitant use of codeine and CNS depressants causes additive CNS depression.
- Codeine is contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.
Cough
- Cough is an important defensive respiratory reflex with potential physical, psychological, and economic consequences.
- Cough is the most common symptom for which patients seek medical care.
- Cough is initiated by stimulation of chemically and mechanically sensitive vagally mediated sensory pathways in laryngeal, esophageal, and tracheobronchial airway epithelium.
Etiology of Cough
- Acute cough: viral URTI, pneumonia, acute left ventricular failure, asthma, foreign body aspiration.
- Subacute cough: post-infectious cough, bacterial sinusitis, asthma.
- Chronic cough: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis.
Clinical Presentation of Cough
- Coughs are described as productive or nonproductive.
- Productive cough expels secretions from the lower respiratory tract.
- The appearance of secretions is not always a reliable diagnostic indicator.
Dextromethorphan
- Considered approximately equipotent with codeine, dextromethorphan is a nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties.
- Dextromethorphan acts centrally in the medulla to increase the cough threshold.
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
- Has a wide margin of safety, with uncommon side effects including drowsiness, nausea, vomiting, stomach discomfort, or constipation.
Diphenhydramine
- Diphenhydramine is a nonselective antihistamine with significant sedating and anticholinergic properties, acting centrally in the medulla to increase the cough threshold.
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
- Second-generation antihistamines (e.g., loratadine and fexofenadine) lack antitussive activity.
Diphenhydramine
- Symptoms of diphenhydramine overdose include mild to severe CNS depression, hypotension, and CNS stimulation
- Causes excitability, especially in children
- Potentiates the depressant effects of narcotics, nonnarcotic analgesics, benzodiazepines, tranquilizers, and alcohol on the CNS
- Intensifies the anticholinergic effect of MAOIs and other anticholinergics
- Should be used with caution in patients with diseases potentially exacerbated by drugs with anticholinergic activity
Chlophedianol
- Centrally acting oral antitussive
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
- Has antitussive, moderate local anesthetic, and mild anticholinergic effects
- Side effects include excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria
- Patients with impaired respiratory reserve or preexisting respiratory depression should use with caution
Dextromethorphan
- Nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses
- Acts centrally in the medulla to increase the cough threshold
- Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
- Has a wide margin of safety
- Side effects with usual doses are uncommon, but may include drowsiness, nausea or vomiting, stomach discomfort, or constipation
- Additive CNS depression occurs with alcohol, antihistamines, and psychotropic medications
Nonpharmacologic Therapy
- Includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration
- Non-medicated lozenges may reduce cough by decreasing throat irritation
- Humidifiers increase the amount of moisture in inspired air, which may soothe irritated airways
- Vaporizers produce a medicated vapor
- Propping infants upright when they sleep and raising the head of the bed at night promotes drainage of nasal secretions
Pharmacologic Therapy
- Codeine containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters
- Codeine acts centrally on the medulla to increase the cough threshold
- The most common side effects are nausea, vomiting, sedation, dizziness, and constipation
- Concomitant use of codeine and CNS depressants causes additive CNS depression
- Contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated
Nonpharmacologic Therapy
- Non-medicated lozenges reduce cough by decreasing throat irritation
- Humidifiers (ultrasonic, impeller, and evaporative) soothe irritated airways by increasing moisture in inspired air
- Vaporizers produce a medicated vapor, with coolmist humidifiers and vaporizers preferred due to fewer bacteria growth and lower scalding risk
- Babies and young children up to 2 years old cannot blow their noses, so a rubber bulb nasal syringe is used to clear nasal passages and reduce cough
- Propping infants upright when sleeping and raising the head of the bed promotes nasal secretion drainage
Pharmacologic Therapy
Codeine
- Codeine-containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters
- Codeine acts centrally on the medulla to increase the cough threshold
- Side effects include nausea, vomiting, sedation, dizziness, and constipation
- Contraindications: known codeine hypersensitivity, labor when premature birth is anticipated, impaired respiratory reserve, preexisting respiratory depression, drug addicts, and individuals taking other respiratory depressants or sedatives
Dextromethorphan
- Equipotent with codeine, but nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses
- Acts centrally in the medulla to increase the cough threshold
- Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
- Wide margin of safety, but side effects include drowsiness, nausea or vomiting, stomach discomfort, or constipation
- Additive CNS depression occurs with alcohol, antihistamines, and psychotropic medications
Diphenhydramine
- Nonselective (first-generation) antihistamine with sedating and anticholinergic properties
- Acts centrally in the medulla to increase the cough threshold
- Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
- Side effects include excitability, especially in children, and potentiates CNS depressant effects of other drugs
- Contraindications: diseases exacerbated by anticholinergic activity, such as narrow angle glaucoma, stenosing peptic ulcer, and cardiovascular disease
Chlophedianol
- Centrally acting oral antitussive with antitussive, moderate local anesthetic, and mild anticholinergic effects
- Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
- Side effects include excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria
Learn about the symptoms, causes, and consequences of cough, a common defensive respiratory reflex. Explore the physical, psychological, and economic impacts of cough.
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