What does the Qu in QuEST stand for?

Quickly and accurately assess the patient.

What does the E in QuEST stand for?

Establish candidacy for self-care.

What does the S in QuEST stand for?

Suggest appropriate self-care strategies.

What does the T in QuEST stand for?

Talk with the patient.

What does the S in SCHOLAR-MAC stand for?

Symptoms

What does the C in SCHOLAR-MAC stand for?

Characteristics

What does the H in SCHOLAR-MAC stand for?

History

What does the O in SCHOLAR-MAC stand for?

Onset

What does the L in SCHOLAR-MAC stand for?

Location

What does the A in SCHOLAR-MAC stand for?

Aggravating factors

What does the R in SCHOLAR-MAC stand for?

Remitting factors

What are the exclusions for self-care for a cough?

• A fever above 103
• It has lasted longer than 7 days
• Worsening conditions even after the cold/flu has ended
• The cough is due to an underlying condition
• Suspected drug-associated cough

What are the goals of treating a cough?

Reduce the number and severity of episodes, minimize consequences of uncontrollable episodes, suppress unproductive ones but improve productivity of under-productive ones.

Antitussive

Interrupts cough impulse transmission.

What type of medications does Dextromethorphan, or Delsym, interact with?

Serotonin modulating medications, such as antidepressants and pain medication.

Dextromethorphan

Delsym

Expectorant

Stimulates respiratory tract secretions, increases respiratory fluid volumes, decreases viscosity of respiratory fluid.

Guaifenesin tablets

Mucinex

Guaifenesin liquid

Robitussin

What is added to cough medicine brand names to say that they are combination products?

DM

Fever for common colds is _____, and for allergic rhinitis is _____.

Rare, absent.

Nasal discharge for common colds is _____, and for allergic rhinitis is _____.

Mucopurulent (contains mucus), watery.

Pruritus, or itching, for common colds is _____, and for allergic rhinitis is _____.

Uncommon, common.

Sneezing for common colds is uncommon, and for allergic rhinitis is _____.

Uncommon, common.

Exclusions for self-care of a common cold:

• Fever above 101.5
• Chest pain
• Shortness of breath
• Frail patients
• Suspected drug-associated
• Infants less than 9 months
• AIDs or on immunosuppressive therapy

Exclusions for self-care of allergies:

Symptoms of uncontrolled asthma, COPD, or other respiratory disorders; children less than 12 years with signs of infection; pregnant or lactating women.

First Generation Antihistamines include:

Benadryl, Lodrane, and Chlor-Trimeton.

Benadryl

Diphenhydramine

Lodrane

Brompheniramine

Chlor-Trimeton

Chlorpheniramine

Anticholinergics have what effects?

Sedation, dizziness, dry mouth/eyes. constipation.

MOA of 1st Generation Antihistamines?

Block histamine 1 receptors at central and peripheral sites.

Which are generally stronger and more effective: 1st or 2nd generation antihistamines?

1st Generation

Patient considerations when prescribing antihistamines:

Uncontrolled asthma or COPD, glaucoma, prostrate or bladder issues, elderly who are at risk of falling.

MOA of 2nd Generation Antihistamines?

Block H1 receptors at peripheral sites.

Second Generation Antihistamines include:

Claritin, Zyrtec, and Allegra.

Claritin

Loratadine

Zyrtec

Cetirizine

Allegra

Fexofenadine

Fexofenadine's peak of action is _____, and it lasts about _____.

2-3 hours, 24 hours.

Cetirizine's peak of action is _____, and it lasts about _____.

About 1 hour, >24 hours.

Loratadine's peak of action is _____, and it lasts about _____.

8-12 hours, >24 hours.

Pseudoephedrine is used as a what?

Decongestant

Sudafed

Pseudoephedrine

How is pseudoephedrine signified?

"D"

Why is pseudoephedrine behind-the-counter?

It can be used to make methamphetamine.

Pseudoephedrine is limited to ___ grams per day and ___ grams per 30 days.

3.6, 9.

What is phenylephrine used as?

A decongestant.

What signifies phenylphrine?

"PE"

What side-effect do oral decongestants have?

Raise blood pressure.

What agents are in topical decongestants?

Oxymetazoline (Afrin) and Naphazoline

How long can you use topical decongestants before they begin to worsen the congestion?

3 days

Oxymetazoline dosing:

Older than 6 y.o., 2-3 sprays in each nostril.

Naphazoline dosing:

Older than 12 y.o., 1-2 drops/sprays as needed every 6 hours.

Exclusions for self-care of pain:

• Severe pain
• Lasts more than 10 days
• Worsening
• Signs of infection
• Signs of nerve involvement

Exclusions for self-care of fever:

• Severe symptoms of infection
• Cardiovascular or pulmonary disease
• Child who may be dehydrated
• Child with spots or rash

Tylenol

Acetaminophen

What is acetaminophen used for?

Fever and pain

Does acetaminophen have anti-inflammatory properties?

No.

What is the max dosing for acetaminophen?

3-4 grams per day.

What should be watched for when suggesting acetaminophen?

If combination products you are suggesting on the side also contain acetaminophen.

What does NSAID stand for?

Non-Steroidal Anti-Inflammatory meDications

Which drugs are NSAIDs?

Ibuprofen and naproxen sodium

Motrin

Ibuprofen

Advil

Ibuprofen

Aleve

Naproxen sodium

Always take NSAIDs with food or milk.

Always take NSAIDs with food or milk.

How does Dr. Huston feel about Aspirin?

BAD. Not the best choice for pain or fever.

What can Aspirin cause?

Reye's Syndrome

What age group can Aspirin cause Reye's Syndrome in?

<12 years