Antitussive and Mucolytics

Question 1

Nasal Decongestants

Answer 1

1. Phenylephrine- post synaptic alpha stimulant.
   Nasal spray
2. Pseudoephedrine- Similar to endoephrine both has alpha and beta agonist properties .

The alpha receptor mediated vasoconstriction in the respiratory mucosa shrinks swollen nasal mucosa. Relief the nasal congestion or eustachian tube congestion.

3. Xylometazoline- alpha 1 and alpha 2 adrenergic agonist
   Faster acting
4. Oxymetazoline - Lon acting topical nasal decongestant caused by fever, allergies, cold, sinus.
   Direct acting alpha against (1 and 2)

Question 2

Pseudoephedrine

Answer 2

Similar to endoephrine both has alpha and beta agonist properties .

The alpha receptor mediated vasoconstriction in the respiratory mucosa shrinks swollen nasal mucosa. Relief the nasal congestion or eustachian tube congestion.

Question 3

Xylometazoline

Answer 3

alpha 1 and alpha 2 adrenergic agonist
Faster acting

Question 4

Oxymetazoline

Answer 4

Lon acting topical nasal decongestant caused by fever, allergies, cold, sinus.
Direct acting alpha against (1 and 2)

Question 5

Side effects of Nasal decongestant

Answer 5

1. Rebound congestion from prolonged use. Symptoms return worse than before
2. Nasal perforation
3. Oral decongestants like pseudoephedrine can caused increased blood pressure, palpitations, CNS stimulation

Question 6

Dextromethorphan

Answer 6

Robbitusin

Synthetic codeine analog

Decreases the sensitivity of cough receptor- Antagonizes NMDA glutamate receptor.

Interrupts the transmission of cough impulses by depressing the medullary cough center.

Naloxone can be giving for overdose

May cause serotonin syndrome if combined with other agents

Produces constipation

Question 7

Benzonatate

Answer 7

Non-narcotic

(Numbs the throat) Anesthetizes the stretch receptor and thereby reducing the cough reflex at its source

Question 8

N-acetylcysteine

Answer 8

Mucolytics- Breaks/Dilution of thick mucus makes it easier to cough up.

Opens disulfide bonds, reducing the viscosity of mucous.

Reduce congestion related to sinusitis, chronic bronchitis and asthma

Used to ease congestion in pneumonia, chronic respiratory disease like COPD and Cystic fibrosis.

Antidote for acetaminophen overdose. - replenishes (increases) glutathione stores in the liver.

Question 9

Guaifenesin

Answer 9

Increases the volume and reduces the viscosity of secretions in the trachea and bronchi.

Makes the mucus more loose.

Question 10

Drugs for cystic fibrosis

Answer 10

1. Dornase alfa- Mucolytic agent. Recombinant human deoxyribonuclease 1

Cleaves The extracellular DNA from invading neutrophils to decrease mucus viscosity and facilitate mucus clearance.

2. Ivacaftor and Lumacaftor- There are effective only on people with certain mutations. Patients with Phe508 deletion.

Ivacaftor is CFTR potentiator: enhances the function of the receptor by increasing the chloride ion transport by increasing the channel open.

Lumacaftor is CFTR corrector: corrects the misfiled proteins and improve their transport to cell surface.

Pancreatic enzyme replacement therapy- contains mixture of amylase, lipase and proteases

Question 11

Drugs for Pulmonary Hypertension

Answer 11

Bosentan- Endothelin receptor antagonist

Epoprostenol- PG analogue

Sildenafil - PDE5 antagonist

Question 12

PDE5 inhibitor

Answer 12

Sildenafil and Tadalafil

Inhibits cGMP hydrolysis, elevates the cellular lever of cGMP

Contraindications-

Patients receiving nitrates and alpha adrenergic antagonist due to severe hypotension

he ache, flushing, insomnia, Transient blue green tinting of vision due to inhibition of retinal PDG6