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PHRM 5001 > 5. Cough and Cold Agents > Flashcards

5. Cough and Cold Agents Flashcards

1
Q
  1. the common cold describes what?
  2. what type of etiology? what does the common cold usually present as?
  3. what are the 4 classic signs and symptoms of the common cold?
A
  1. non-bacterial upper respiratory tract infections (URTI)
  2. viral etiology –> usually rhinovirus
  3. General malaise, Nasal congestion, +/- cough and sore throat
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2
Q

Compare the following S+S between the cold and infleunza.. are they present and how may they present?

  1. fever?
  2. chills?
  3. cough?
  4. headache?
  5. fatigue?
  6. myalgia?
  7. nasal congestion?
  8. sneezing?
  9. sore throat?
A
  1. cold = rare, flu = high
  2. cold = none, flu = typical
  3. cold = hacking (with/without mucus), flu = non-productive and severe
  4. cold = rare, flu = severe
  5. cold = mild, flu = early, severe
  6. cold = mild if present, flu = can be severe
  7. cold = common, flu = occasional
  8. cold = common, flu = occasional
  9. cold = common (may irritate receptors), flu = occasional
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3
Q

what are the 4 drug classifications of cough and cold agents?

A
  • Sympathomimetic decongestants
  • H1-histamine receptor antagonists
  • Mucoactive Drugs (e.g. expectorants)
  • Anti-tussives
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4
Q
  1. what do sympathomimetic decongestants promote? what effect does this produce?
  2. what do these decongestants do to the nasal mucosa?
  3. what are the 2 common alpha 1 adrenergic agonists?
A
  1. Promote a1-adrenergic effects, producing vasoconstriction/vasopressor effects
  2. Constrict blood vessels in nasal mucosa thereby relieving congestion
  3. Ephedrine, Phenylephrine
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5
Q
  1. is Ephedrine direct or indirect acting? what does this drug promote?
  2. what does this drug inhibit? what does this drug resist?
  3. is this drug specific or non-specific?
  4. what is special about Pseudoephedrine?
A
  1. indirect acting - promotes the release of endogenous NE to stimulate alpha receptors
  2. inhibits MAO and resists COMT
  3. non-specific sympathomimetic drug
  4. Pseudoephedrine = less potent stereoisomer
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6
Q
  1. how is Ephedrine usually given?
  2. what are the indicators for using this drug as a treatment?
  3. why is the drug helpful for treating these indicators?
A
  1. oral formulation
  2. Mild bronchospasm, Sinus congestion,
    Nasal congestion
  3. due to its vasoconstrictive properties
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7
Q
  1. what are the contraindications to using Ephedrine?

2. where is this drug closely monitored? why?

A
  1. Pre-existing cardiac disease, Hypertension
    Can worsen insomnia, nervousness and/or agitation
  2. retail pharmacies because this drug is one of the ingredients used to make methamphetamine
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8
Q
  1. what is Phenylephrine also known as?
  2. specific or non specific? what type of drug is this?
  3. this drug is a potent what? what is there less of due to this?
  4. how can this drug be given?
  5. what can this drug be mixed with? what does this do? when can this be helpful?
A
  1. (Neo-Synephrine ®)
  2. specific, alpha 1 adrenoreceptor sympathomimetic
  3. Potent peripheral vasoconstrictor, less cardiac and CNS effects
  4. Oral, parenteral, nasal and ophthalmic formulations
  5. Can be mixed with local anesthetics to limit distribution, helpful in case a patients BP drops
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9
Q
  1. what is the contraindication to using Phenylephrine (Neo-Synephrine)? why?
  2. what are the 2 precautions to using this drug?
A
  1. Pre-existing HTN***, If already have high BP, we are further increasing the BP which is BAD
  2. Rebound nasal congestion and Slight risk of bronchoconstriction
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10
Q

what are the 4 types of histamine receptors? where are they found?

A
  • H1-histamine receptors: found on intestinal, airway and vascular smooth muscle
  • H2-histamine receptors: found on gastric parietal cells
  • H3-histamine receptors: found on CNS neurons and pre-synaptic neurons of the PNS
  • H4-histamine receptors: found on mast cells
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11
Q
  1. how do Anti-histamines block histaminic effects?
  2. what 3 histaminic effects are blocked?
  3. what are Anti-histamines unable to do?
A
  1. Compete with histamine for H1-histamine receptors
  2. Capillary leakage, Edema, Vasodilation
  3. Unable to repair tissue damage already inflicted
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12
Q
  1. are first generation anti-histamines able to produce weak or strong anti-histaminic effects?
  2. what type of side effects do these drugs produce? (3)
  3. what are the 2 types of first gen anti-histamines?
  4. can these drugs penetrate the BBB?
A
  1. Weak anti-histaminic effects
  2. Anti-cholinergic side effects, Some anti-emetic effects and sedation (some)
  3. Dimenhydrinate (Gravol ®) and Diphenhydramine (Benadryl ®)
  4. yes!
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13
Q
  1. do second gen anti-histamines cross the BBB?
  2. what type of side effects are minimized with this gen?
  3. which generation (first or second) of anti-histamines is the most potent? what does this mean?
  4. what type of symptoms are these drugs able to suppress?
  5. what are the 2 types of second gen anti-histamines?
A
  1. do not penetrate the BBB
  2. fewer sedative effects
  3. second gen is more potent –> near complete H1-histamine receptor blockade
  4. Able to suppress symptoms of atopic (allergic) asthma
  5. Cetirizine (Reactine ®/Zyrtec ®) and Loratidine (Claritin)
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14
Q
  1. what is Loratidine (Claritin) commonly used to treat? what type of drug is this?
  2. rapid or slow acting? onset of action? long or short acting?
  3. how is this drug typically administered?
  4. which other histamine receptors are affected? what does this cause?
A
  1. Used to treat allergic rhinitis (H1 receptor antagonist)
  2. Rapid onset (~ 1 hour), long acting
  3. Oral administration
  4. also target H4 receptors causing some mast cell stabilization
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15
Q
  1. what type of drug is Cetirizine (reactine/Zyrtec)?
  2. what does this drug inhibit? what does this cause?
  3. why does this drug have non-sedating effects?
  4. what are 2 other second generation anti-histamines?
A
  1. H1 receptor antagonist
  2. Inhibits histamine release and eosinophil chemotaxis, less WBC’s coming to the area therefore, decreasing strength of immune rxn
  3. this drug does not readily pass the BBB
  4. Fexofenadine (Allegra ® ) and Desloratadine (Aerius ®)
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16
Q
  1. what type of condition can GERD contribute to?
  2. when are the symptoms the worst with GERD? why?
  3. what reflex does GERD stimulate?
A
  1. GERD can contribute to non-allergic asthma
  2. Symptoms worse at night when stomach contents ascend the esophagus
  3. Stimulates the gastropulmonary vagal reflex
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17
Q
  1. what can H2 histamine receptor blockers help to improve? how do they do this?
  2. which patient population would benefit most from H2 histamine receptor antagonists?
  3. what other problem can these drugs help to treat?
  4. what are the 2 H2 histamine receptor antagonists?
  5. why did 2019 Health Canada direct companies to stop distributing ranitidine?
  6. when were sales allowed to resume? why?
A
  1. H2-histamine receptor blockers can improve respiratory symptoms and pulmonary function, by ↓ stomach acidity
  2. patients suffering from GERD and asthma
  3. may help to relieve stomach ulcers
  4. Cimetidine (Tagamet ®) and Ranitidine (Zantac ®)
  5. precautionary measure while NDMA levels were tested.
  6. 2020 some companies resumed sales, made sure levels of NDMA were safe
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18
Q

airway secretions serve important functions, what are they? (6)

A
  • Nonspecific defense (Capturing inhaled pathogens)
  • Warming and humidification
  • Mucociliary transport (mucociliary escalator)
  • Prevent desiccation (state of being very dry)
  • Antibacterial activity (certain enzymes)
  • Inactivation of inhaled noxious stimuli
19
Q

what are the 3 secretory cells distributed in the airways?

A
  • goblet cells
  • clara cells
  • submucosal glands
20
Q
  1. what are goblet cells stimulated by?
  2. what do these cells release?
  3. what does this release do to the airway lumen?
A
  1. stimulated by irritants
  2. Release a ↑ viscosity gel-forming protein
  3. Protein absorbs water from airway lumen –> protective layer of mucus that lines epithelial cells
21
Q
  1. where are clara cells found?
  2. what do these cells have a high degree of? what do these cells contain a lot of?
  3. what are these cells responsible for? what do these cells prevent?
A
  1. Found in terminal bronchioles
  2. High degree of metabolic activity and contains many enzymes
  3. Protein synthesis –> coats airways to prevent desiccation
22
Q
  1. how are submucosal glands stimulated? what type of glands are these?
  2. what is the difference in mucus production between goblet cells and submucosal glands?
  3. what are the 2 secretory cells that make up the submucosal glands?
A
  1. Vagally stimulated exocrine glands
  2. Mucus production exceeds that of goblet cells
  3. Serous cells and Mucous cells
23
Q
  1. how does mixed secretions reach the airway lumen?
  2. what do these secretions separate into?
  3. where does the particulate matter become embedded?
  4. what is the role of the cilia?
A
  1. via ciliated duct
  2. Separates into sol phase and gel phase
  3. Particulate matter becomes embedded in gel phase
  4. Cilia carry material upwards to be swallowed or expectorated (moving gel layer)
24
Q

what factors affect mucociliary clearance? (7)

A
  • COPD
  • Airway drying
  • Narcotics
  • Suctioning/airway trauma
  • Cigarette smoke
  • Atmospheric pollutants
  • Hyperoxia /hypoxia
25
Q
  1. what are the 5 drug categories for mucoactive drugs?

2. out of the 5, which 2 do we commonly use/see as RT’s?

A
  1. Expectorants, Mucolytic agents, Mucokinetic agents, Mucoregulatory agents and Mucospissics
  2. Expectorants and Mucolytic agents
26
Q
  1. what does an expectorant do? what does this help to stimulate?
  2. what does a Mucolytic drug do?
  3. what do Mucokinetic agents do?
A
  1. Medication that ↑ the volume or hydration of airway secretions, helps to stimulate a cough to clear them
  2. Medications that break up secretions making them more thin and less sticky
  3. Medication that ↑ cough or ciliary clearance of respiratory secretions
27
Q
  1. what do Mucoregulatory agents do? what is this effective in?
  2. what do Mucospissic agents do? what is this effective in treating?
  3. what is Bronchorrhea? why do we want to thicken the secretions in this case?
A
  1. Drug that ↓ the volume of airway secretions, Effective in hyper-secretory states
  2. Drug that ↑ viscosity of secretions, May be effective in treating bronchorrhea
  3. patients that produce more watery secretions leading to constant irritation, easier to move them up the respiratory tract to expel or swallow
28
Q
  1. what is the major reason Expectorants are used?
  2. what do these drugs promote?
  3. what do these drugs help to trigger? why?
  4. what are the 2 formulations this drug can be given?
A
  1. Used to thin secretions thereby improving mucokinesis
  2. Promote transfer of fluid into bronchial lumen
  3. Mild irritants –> trigger cough reflex (To help move mucus out of the airways to cough or swallow)
  4. Aerosol and oral formulations available
29
Q
  1. what type of drug is Guaifenesin (Robitussin ®/Mucinex ®)
  2. how does this drug stimulate bronchial gland secretion?
  3. does this drug have to be prescribed?
A
  1. A stimulant expectorant
  2. Stimulates bronchial gland secretion via gastropulmonary vagal reflex or by absorption into the respiratory glands to directly stimulate mucus production
  3. no, can be a prescription or a non-prescription med
30
Q
  1. what is the goal with bland aerosol solutions? what does this lead to?
  2. what are the 4 examples of bland aerosol solutions?
A
  1. Goal to ↑ the osmotic gradient between the inhaled solution and mucosal cells, Leads to > fluid transfer and tissue irritation
  2. Hypertonic saline (3 to 7% NaCl)** (expectorant), Normal saline (0.9% NaCl), Sterile distilled water, Hypotonic solution (0.45% NaCl)
31
Q
  1. what do mucolytic agents alter? what do they decrease?
  2. what do these agents disrupt?
  3. what are the 3 subtypes of mucolytic agents?
A
  1. physical properties of bronchial mucus, ↓ elasticity = easier to clear
  2. Disrupt chemical bonds in protein chain
  3. Cysteine derivatives, Proteases (act on DNA), Depolymerizing agents
32
Q
  1. what type of agent is N-acetylcysteine (Mucomyst ®)?
  2. what is this drug derived from?
  3. what type of bonds does this drug interrupt? what are they replaced with?
  4. which chains become weakened as a result? what is decreased as a result? (2)
A
  1. mucolytic agent
  2. Derivative of amino acid L-cysteine
  3. Interrupts protein disulfide (S-S) bonds in our sputum, replacing with sulfhydryl groups (-SH)
  4. Adjacent glycoprotein chains weakened (easier to clear): ↓ viscosity and ↓ elasticity
33
Q
  1. how is N-acetylcysteine (Mucomyst ®) administered?
  2. what localized airway effects are produced? (2)
  3. what about this drug was thought to decrease efficacy? why?
A
  1. Administered via the inhalational route
  2. Rapid onset of action and Minimizes adverse effects
  3. Retained secretions thought to ↓ efficacy because if too much of a build up of secretions, drug may not effectively break them up
34
Q
  1. N-acetylcysteine (Mucomyst ®) experiences something called NAC, what does this do to COPD patients?
  2. what 2 things lead to the formation of ROS?
  3. what does NAC increase the production of? what is this molecule?
A
  1. NAC ↓ cellular oxidative stress and inflammation associated with COPD
  2. Chemicals in cigarettes or when we administer oxygen lead to the formation of reactive oxygen species (ROS)
  3. NAC ↑ production of glutathione, an antioxidant/free-radical scavenger produced naturally from our cells
35
Q

what are the indications to using N-acetylcysteine (Mucomyst ®)?

A

Bronchitis, Emphysema, Pneumonia, CF, Bronchial asthma, Acetaminophen toxicities (IV NAC to reduce liver damage), Inhalational burns (decrease inflammation)

36
Q

what are the adverse effects/precautions when using N-acetylcysteine (Mucomyst ®)?

A
  • Bronchospasm due to NAC acidity
  • Tracheal suction may be required to manage secretions
  • “Rotten egg” breath, unpleasant taste lead to Nausea & Vomiting (due to release of hydrogen sulfide)
  • Can inactivate some inhaled antimicrobials
  • Can react with oxidizing agents
37
Q
  1. what type of drug is Dornase Alpha (Pulmozyme ®)?
  2. what type of enzymes does this drug contain?
  3. how is this drug usually administered?
  4. what does this drug help to decrease? how does it do this? (2)
A
  1. mucolytic agent
  2. Protease/proteolytic enzyme
  3. Administered via inhalation
  4. ↓ mucus viscosity by disrupting glycoprotein molecules rather than breaking bonds
    and attack DNA bonds in purulent sputum (derived from bacteria and WBCs)
38
Q

what are the indications to using Dornase Alpha (Pulmozyme ®) for treatment? (3)

A
  • Cystic fibrosis associated with thick tenacious secretions and impaired mucociliary clearance
  • ↓ frequency and severity of respiratory infections
  • Helps to clear necrotic cellular debris
39
Q
  1. is coughing a specific or non-specific defense?
  2. what is the major role of antitussives?
  3. this drug combined with what helps to clear secretions?
  4. what conditions limit secretion clearance? (2)
A
  1. non-specific defense
  2. to suppress cough reflex
  3. Combined with mucociliary escalator to clear secretions
  4. ↑ secretion production and Damage to mucociliary escalator
40
Q
  1. what do antitussives specifically do?
  2. what type of cough is this drug used to treat?
  3. specifically, what symptoms can antitussives help with?
A
  1. Agents provide symptomatic relief from cough without improving the underlying cause
  2. Used for non-productive coughs
  3. ↑ mucosal inflammation with repeated coughing bouts/irritation and Patient unable to rest
41
Q
  1. why do some antitussives contain local anesthetics? (2)
  2. where else can local anesthetics be found? why?
  3. what are the 2 examples of local anesthetics found in antitussive meds?
A
  1. Used for cough suppression and ↓ action of peripheral irritant receptors in airways
  2. OTC lozenges to numb the area suppressing the cough reflex
  3. benzocaine and phenol
42
Q
  1. what is codeine?
  2. how does this drug produce a central effect?
  3. how does this drug produce a peripheral effect?
  4. high or low potency? high or low dose given? large or minimal CNS effects?
A
  1. Opiate analgesic (narcotic)
  2. by suppressing medullary cough control centre (at the medulla oblongata)
  3. Binding at mu-opioid receptors in airways
  4. Low potency and low dose ∴ minimal CNS effects
43
Q
  1. what is Dextromethorphan (Delsym ®) a common component of? what type of drug is this?
  2. how is this drug commonly administered?
  3. is this drug a narcotic?
  4. what type of isomer? from what type of drug?
  5. are there analgesia effects? are there additive effects?
A
  1. Component of many cough suppressants, an anti-tussive drug
  2. Oral administration
  3. Timed released non-narcotic product
  4. d-isomer of narcotic levorphanol
  5. no and no
44
Q
  1. what are mucoactive drugs commonly used in conjunction with?
  2. what other airway clearance techniques can this drug be used with? (6)
A
  1. chest physiotherapy (CPT) and other airway clearance techniques/devices
  2. Postural drainage, Insufflation-exsufflation, Exercise, Positive airway pressure, Deep breathing techniques, High frequency techniques (Chest wall compression and Airway oscillation – PEP devices to shake secretions loose)

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