Anti-tussive, Mucolytic and Expectorant agents

Question 1

What are mucolytic agents?

Answer 1

Drugs used to clear thick pulmonary secretions, INDICATION: COPD

Question 2

Give an example of a mucolytic agent

Answer 2

Acetylceisteine

Question 3

What are the mechanisms of action for mucolytics like acetylcysteine？

Answer 3

Mucolytics work by breaking down the chemical bonds in mucus, reducing its viscosity.

This action makes it easier for individuals to clear the mucus from the airways, relieving congestion and facilitating better breathing.

Question 4

What are the contraindications for using mucolytics in patients with respiratory conditions?

Answer 4

①Asthma or a history of
bronchospasm.
②Respiratory insufficiency,
inadequate cough mechanism, or
gag reflex depression.

Question 5

What are the mechanisms of action for expectorants like guaifenesin?

Answer 5

Expectorant therapy increases the volume and decrease the viscosity of bronchial secretions, making coughing more effective. Provided one is adequately hydrated

Question 6

What are the contraindications for using expectorants in patients with respiratory conditions?

Answer 6

①Persistent or chronic cough

②Some asthmatics are prone to bronchospasm

③Cardiovascular disease and hypertension

④Diabetes, glaucoma, hyperthyroidism

⑤Prostatic hypertrophy, especially with combination
products

⑥Pregnancy or lactation

Question 7

Side Effects of Guaifenesin

Answer 7

GIT: Nausea, vomiting and diarrhea.
CNS: Drowsiness, dizziness, and headache.

Question 8

Clinical Indications of Guaifenesin

Answer 8

①Combined in cough
syrups for the symptomatic
management of productive
(“wet”) coughs. (upper respiratory tract infection)

②Combination with the cough suppressant,
dextromethorphan to reduce dry cough, while loosening mucus in the respiratory tract to allow for productive cough.

③Expectorants should not be used
for self-medication for persistent
or chronic coughs such as those
associated with smoking or
COPD.

Question 9

Antitussives

Answer 9

Cough suppressants like dextromethorphan and hydrocodone act on the cough center in the medulla, indicated for persistent non-productive coughs, with precautions for asthma, COPD, and children

Question 10

What are the two groups of cough suppressants?

Answer 10

Narcotic preparations and non-narcotic preparations

Question 11

Narcotic antitussives

Answer 11

Codeine(Less side effects) and Hydrocodone (More potent)

Question 12

Non-narcotic antitussives

Answer 12

①Dextromethophan (Benylin, Triphen)
②Benzonatate
③Diphenhydramine

Question 13

Dextromethorphan has similar antitussive effect as codeine at the same dose. Why is it more recommended than codeine?

Answer 13

*Does not depress respirations
* Does not cause dependence
*Less side effects at recommended doses.

Question 14

MoA of Benzonatate

Answer 14

• Acts centrally like the other antitussives.
• Suppresses cough peripherally by anesthetizing receptors in the alveoli of the lungs, bronchi, and pleura.

Question 15

Indication of Diphenhydramine
(Benadryl)

Answer 15

Patients experiencing a cough associated with the common cold or postnasal drip use a first-generation antihistamine and a decongestant to treat cough.

Question 16

Side Effects of Antitussives

Answer 16

①RESPIRATORY
DEPRESSION
(LARGE DOSES OR
EXCESSIVE USE)

②③CONSTIPATION SEDATION AND
DIZZINESS

④NAUSEA AND
VOMITING

⑤URINARY
RETENTION WITH
NARCOTIC
ANTITUSSIVES

Question 17

Precautions or
contraindications
of antitussives

Answer 17

①Addiction-prone patients (narcotic antitussives).

②Chronic obstructive airway disease (COPD).

③Concurrent use with other CNS depressants.

④Use of cough suppressants in coughs associated with
upper respiratory infection (URI) are not recommend, due
to limited efficacy.

⑤Caution for antitussives in children.

Question 18

What oral gel capsule is used for
cough suppression? What is the mode
of action?

Answer 18

Benzonatate (Tessalon)
①Central Action: It acts centrally like other antitussives to suppress the cough reflex.
②Peripheral Action: It anesthetizes receptors in the alveoli, bronchi, and pleura, thereby suppressing the cough peripherally.