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Pathophysiology > Antihistamines, Decongestants, Antitussives, Expectorants & Mucolytic > Flashcards

Antihistamines, Decongestants, Antitussives, Expectorants & Mucolytic Flashcards

1
Q

When cough is beneficial, do you need medicine ?

A

Do not medicate as the purpose is to clear foreign material from airway

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2
Q

When it is a productive cough, What medicine should be given ?

A

Expectorants
- Guaifenesin
Mucolytic
- Ambroxol
- Bromhexine
- Acetylcysteine (Cysteine derivatives)
- Carbocisteine (Cysteine derivatives)

Cysteine is an amino acid found naturally in the human body

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3
Q

When it is a non productive(dry) cough, What medicine should be given ?

A

Antitussives
Opioid
-Codeine
Non-Opioid
-Dextromethorphan
-Diphenhydramine

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4
Q

Is there is a nasal congestion due to allergic rhinitis. What medicine to use?

A

H1 Anti histamine
-1st Gen - Will sedate & dry mouth , cross into CNS,
Cholinergic antagonism: dry mouth, urinary retention, sinus tachycardia
α-adrenergic antagonism: hypotension, dizziness, reflex tachycardia
Serotonin receptor antagonism: increased appetite
-2nd and 3rd gen will not sedate

Intranasal Corticosteroids
- Fluticasone

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5
Q

What decongestants medication to use when nose block

A

Direct

  • Phenylophrine (Alpha 1 Agonist)
  • Oxymetazoline (dry mouth)

Indirect

  • Ephedrine
  • Pseudoephedrine
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6
Q

What happen during a common cold ?

A
  • Viral infection of upper respiratory tract
  • Resolve within 3-7 days
  • Cough and cold medication for symptomatic
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7
Q

What is Antihistamines ?

A

inverse agonists

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8
Q

Name the first Generation antihistamine drug

A

Chlorpheniramine
Diphenhydramine
Promethazine

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9
Q

Name the first Generation antihistamine drug use to treat motion sickness

A

Diphenhydramine
Dimenhydrinate
Cyclizine

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10
Q

How do H1 antihistamines work?

A

-Physically blocking the H1 receptors so histamine from reaching its target. decreases your body’s reaction to allergens

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11
Q

First generation Anti histamine also interact with ______?

A
  • Beside H1 , it also interact with muscarinic cholinergic, alpha-adrenergic and serotonin receptors
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12
Q

Second generation Anti histamine also interact with ______?

A

Reduced lipophilicity or greater p-glycoprotein efflux pump
affinity and so reduced CNS effects

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13
Q

Name all the 2nd Generation ANti histamine drug

A

Centrizine - Abit sedation
Fexofenadine
Loratadine

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14
Q

Name all the 3rd Generation ANti histamine drug

A

Levocetrizine
Desloratadine

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15
Q

What is the effective duration for 1st generation vs 2nd generation Anti histamine drug ?

A

1st Gen - 4-6H
2nd Gen - 12-24H

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16
Q

Which human organ is use to metabolise the 1st generation vs 2nd generation Anti histamine drug ?

A

1st Generation - Liver
2nd Generation - Liver P450 with active metabolites

17
Q

Discuss how 1st generation vs 2nd generation Anti histamine drug is excreted ?

A

1st Generation - Urine
2nd Generation - Urine , Feces

18
Q

Name all the Decongestants drugs use to clear congestion (Oral)

A

Oral / Intranasal

  • Phenylephrine
  • Pseudoephedrine
  • ephedrine
  • Oxymetazoline

Mechanism of action
- “Peseu & ephedrine”increase adrenaline
- “Phen & Oxy “ work on Alpha 1 adrenoceptor agonist
• Vasoconstriction of nasal blood vessels
• Reduce inflammation and secretion of mucus

19
Q

Name the adverse effect of Sympathomimetic Agents that help in decongestion

A

• Rebound congestion
• Occurs with prolonged (> few days) use of topical intranasal
decongestants
• CNS stimulation
• More likely with oral decongestants
• Restlessness, tremors, irritability, anxiety and insomnia
• Cardiovascular
• More likely with oral decongestants
• Hypertension due to vasoconstriction
• Palpitations (indirect sympathomimetics e.g. pseudoephedrine)

20
Q

Name all the Decongestants drugs use to clear congestion (Intranasal)

A

Intranasal
Fluticasone - Nasal Glucocorticoid

Mechanism of Action:
• Anti-inflammatory

21
Q

Name all the Glucocorticoids Decongestants adverse effect.

A
  • Systemic side effects limited by intranasal delivery
  • Local mucosal dryness and irritation
22
Q

Name a few Antihistamine-Decongestant Combinations

A

Chlopheniramine + Pseudephedrine
Diphenhydramine + Pseudephedrine

23
Q

Name the advantage and disadvantage og Opioid Antitussives

A
24
Q

Name the advantage and disadvantage of NON-Opioid Antitussives

A
25
Q

Names the action mechanism and adverse effect?

A

Mechanism of Action: Acts in CNS to suppress cough

  • CNS – sedation
  • Weak opioid but still has abuse potential at high dose
  • Respiratory depression
    • Should not occur at normal clinical doses
    • Risk on overdose
    • Risk in patients with severe respiratory insufficiency
  • Do not combine with other CNS depressants
26
Q

What is the recommended does of codeine for adult and children ?

A

Adult - 10 to 20 mg every 4 to 6 times a day

Children not recommended as liver and respiratory centre are not developed

27
Q

Name the working mechanism and adverse effect of Non Opioid Antitussives - Dextromethorphan

A

Mechanism of Action: • Acts in CNS to suppress cough

Adverse Effects:
• CNS – drowsiness, dizziness
• Gastrointestinal – nausea, vomiting, stomach pain
• Abuse potential at high dose (dissociative anaesthetic-like effect)

28
Q

Name the working mechanism and adverse effect of Non Opioid Antitussives - Diphenhydramine

A

Mechanism of Action:
• Antihistamine; Mechanism of antitussive action unknown
Adverse Effects:
• Sedative, anticholinergic

29
Q 
Name Guaifenesin (expectorants) mechanism of action and adverse effects
It is a component in many cough mixture formulations

Mechanism of action:
• Increases production of respiratory tract fluids to help liquefy and
reduce viscosity of tenacious secretions

Adverse Effects:
• Gastrointestinal disturbance, nausea

Cannot use for patient with persistence cough associated with asthma and smoking . Take more fluid

A
30
Q

Name the Mucolytics mechanism of action and adverse effect

A

Mechanism of action:
• Free sulfhydryl group opens disulphide bonds in mucoproteins
• Lowers mucous viscosity

Adverse Effects:
• Bronchospasm
• Anaphylactoid reactions – rash, hypotension, dyspnea, wheezing
• Gastrointestinal disturbance

Caution :
• Cannot use for Elderly or debilitated patients with severe respiratory insufficiency
• Patients with asthma

31
Q

List all Mucolytics drug

A

Acetylcysteine,
carbocisteine,
ambroxol,
bromhexine

32
Q

Can cought and cold medicine use for children? (e.g. Promethazine, Antihistamine, cough suppressants, cold and flu product)

A

Below 6 month - Not recommended for all

6mth- 2years old - Promethazine cannot use while all other use if benefits outweight risk

2 years above - Use with cayion for all

33
Q

Is cough and cold medication suotable for elderly use

A

Pathophysiology (4 decks)

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