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D. Respiratory Drugs > 1. Medicines for Cough and Cold > Flashcards

1. Medicines for Cough and Cold Flashcards

1
Q

Classifications of drugs for common cold

A

Rhinorrhoea/Nasal congestion/Post-nasal drip:

  1. Antihistamines
  2. Decongestants
  3. Mucoregulators (more severe)
  4. Mast cell stabilisers (more severe)

Cough

  1. Non-productive cough: Antitussive
  2. Productive cough: Expectorant and Mucoactive
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2
Q

Nasal congestion is associated with

A
  1. decrease sympathetic vasoconstriction of submucosal blood vessels
  2. increase parasympathetic stimulation of mucus secretion
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3
Q

Example of mucoregulators

A

Ipratropium

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4
Q

Uses of ipratropium

A
  1. Controls severe cold symptoms

2. Decrease mucus hypersecretions from globet cells and submucosal glands

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5
Q

MOA of ipratropium

A
  1. SAMA
  2. Blocks inflammation-induced parasympathetic cholinergic receptor (M3) activation of submucosal glands/globet cells
  3. Decrease stimulated mucus output and sputum volume

Do not dry basal secretions
Do not increase normal viscosity

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6
Q

Side effects of ipratropium

A
  1. Few side effects as little enters systemic circulation via intranasal route
  2. Unpleasant taste
  3. Dry mouth
  4. Urinary retention in the elderly
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7
Q

Example of mast cell stabiliser

A

Cromoglicic acid

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8
Q

Uses for cromoglicic acid

A

Intranasal or inhaled for severe cold symptoms

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9
Q

MOA of cromoglicic acid

A
  1. Mast cell stabiliser
  2. Controls chloride channels to inhibit cellular activation
  3. Decrease mast cell degranulation by IgE-mediated FcεRI cross linking
  4. Decrease secretion of inflammatory mediators from eosinophils, neutrophils, and macrophages
  5. Increase secretion of annexin A1
    - annexin A1 inhibits prostaglandins and leukotriene production
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10
Q

Side effects of cromoglicic acid

A
  1. Throat and nasal irritation, mouth dryness, cough

2. Unpleasant / bitter taste

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11
Q

Examples of decongestants

A

phenylephrine, oxymetazoline, naphazoline, pseudoephedrine, ephedrine

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12
Q

MOA of decongestants

A
  1. Direct alpha adrenoceptor agonists
    - Alpha-1 selective → phenlyephrine (oral or intranasal)
    - Non-selective → oxymetazoline (intranasal) / naphazoline (intranasal)
  2. Indirect increase in release of adrenaline/noradrenaline
    - Pseudoephedrine (oral) / Ephedrine (intranasal)
  3. Vasoconstriction of nasal blood vessels
  4. Reduce inflammation and secretion of mucus
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13
Q

Examples of nasal glucocorticoids

A

fluticasone, mometasone

intranasal

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14
Q

MOA of nasal glucocorticoids

A
  1. Anti-inflammatory

2. Decrease inflammation → decrease congestion & mucus secretions

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15
Q

Adverse effect of fluticasone

A

Some people report that intranasal fluticasone has a “rose water” odour that they cannot tolerate

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16
Q

Adverse effects of sympathomimetic agents

A
  1. Rebound congestion → occurs with prolonged (> few days) topical intranasal use
  2. CNS stimulation
    - More likely with oral decongestants
    - Restlessness, tremors, irritability, anxiety and insomnia
  3. Cardiovascular
    - More likely with oral decongestants
    - Hypertension due to vasoconstriction
    - Tachycardia (indirect sympathomimetics e.g. pseudoephedrine)
  4. Dry mouth
    - Alpha-2 agonist effect on salivary gland
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17
Q

Adverse effects of nasal glucocorticoids

A
  1. Systemic side effects limited by intranasal delivery

2. Local mucosal dryness and irritation

18
Q

Types of antitussives

A
  1. Opioid antitussives
    - Codeine
  2. Nonopioid antitussives
    - Dextromethorphan
    - Diphenhydramine
19
Q

Uses for codeine

A

Most effective cough suppressant

20
Q

MOA of codeine

A

Acts in the CNS to suppress cough

21
Q

Adverse effects of codeine

A
  1. CNS → sedation
  2. Weak opioid but still has abuse potential at high dose
  3. Respiratory depression
    - should not occur with normal clinical dose
    - risk on overdose
    - risk in patients with severe respiratory insufficiency
  4. Do not combine with other CNS depressants
  5. Caution in CYP2D6 ultra-rapid metabolisers → convert more codeine to morphine
22
Q

Age group in which codeine is not recommended

A

< 18 years old

23
Q

Uses of dextromethorphan

A
  1. Most effective non-opioid antitussive

2. Used for non-productive cough

24
Q

MOA of dextromethorphan

A

Acts in CNS to suppress cough

25
Q

Adverse effects of dextromethorphan

A
  1. CNS → drowsiness, dizziness, confusion, insomnia, excitement, nervousness
  2. GIT → nausea, vomiting, stomach pain
  3. Abuse potential at higher dose (dissociative anaesthetic-like effect)
26
Q

Age group in which dextromethorphan is not recommended

A

< 4 years old

27
Q

MOA of diphenhydramine

A

Antihistamine, MOA of antitussive action unknown

28
Q

Adverse effects of diphenhydramine

A

Sedative, anticholinergic

29
Q

Example of expectorants

A

Guaifenesin

30
Q

MOA of guaifenesin

A

Increase production of respiratory tract fluids to help liquefy and reduce the viscosity of tenacious secretions

31
Q

Adverse effects of guaifenesin

A

GI disturbances, nausea

32
Q

Age group in which guaifenesin is not recommended

A

Caution < 6 years old

Not indicated < 2 years old

33
Q

Advice that should be given to patients with the usage of guaifenesin

A
  1. Not for persistent cough associated with asthma or smoking
  2. Take adequate fluid to make secretions less viscous and protect renal function (nephrolithiasis reported on overdose)
34
Q

Examples of mucolytics

A

acetylcysteine, carbocisteine

35
Q

MOA of mucolytics

A
  1. Free sulfhydryl group opens disulphide bonds in mucoproteins
  2. Lowers mucous viscosity
36
Q

Adverse effects of mucolytics

A
  1. Bronchospasm
  2. Anaphylactoid reactions - rash, hypotension, dyspnea, wheezing
  3. GI disturbances (carbocisteine contraindicated in patients with active peptic ulcer)
37
Q

Cautions with the usage of mucolytics

A
  1. Elderly or debilitated patients with severe respiratory insufficiency
  2. Patients with asthma
38
Q

Examples of mucokinetics

A

Bromhexine and its active metabolite ambroxol

39
Q

MOA of mucokinetics

A
  1. Mucokinetic → promotes ciliary clearance
    - Increase ciliary beat frequency
    - Decrease adherence of mucus to cilia
  2. Stimulate surfactant production → surfactant is an anti-glue factor to prevent mucus from sticking to alveolar and bronchial walls
  3. Antioxidant as free radical scavenger
  4. Anti-inflammatory by decreasing cytokines
  5. Suppresses influenza virus multiplication
  6. Local anaesthetic by blocking voltage-gated Na+ channel
40
Q

Potential side effects of mucokinetics

A
  1. Allergic reactions
  2. Cutaneous adverse effects
  3. Avoid in patients with history of asthma and peptic ulcer disease
  4. Caution < 6 years old
  5. Not indicated < 2 years old
41
Q

Is cough and cold medication safe for paediatric use?

A

Generally unsafe, wait and see instead of giving meds

42
Q

Is cough and cold medication safe for geriatric use?

A

Generally unsafe

D. Respiratory Drugs (2 decks)

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