Antitussives

Question 1

steps for treating cough?

Answer 1

Step 1 - identify the cause

Step 2 - choose appropriate therapy

Step 3 - follow-up

Question 2

what are drug classes that can treat cough?

Answer 2

o	Antihistamines
o	Glucocorticoids
o	Antitussives (cough suppressants)
o	Expectorants
o	Leukotriene Receptor Antagonists
o	Beta-2 Adrenergic Agonists
o	Anticholinergic

Question 3

what are the 2 Major Categories of Antitussives?

Answer 3

o Centrally-acting

o Peripherally-acting

Question 4

where do Peripherally-acting antitussives work?

Answer 4

in the lungs

Question 5

how do Centrally-acting antitussives work?

Answer 5

decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center

(Work in CNS, brain. Inhibit impulse that comes into brain that tells your body to cough. Part of the medulla oblongata controls cough. )

Question 6

Most common antitussive that we use?

Answer 6

Dextromethorphan

Question 7

what drug is a Centrally-acting, non-opioid antitussive agent

Answer 7

Dextromethorphan

Question 8

is Dextromethorphan structurally related to codeine?

Answer 8

yes, it is Structurally related to codeine

Question 9

Dextromethorphan is Labelled for OTC use in pt >_ years of age

Answer 9

less than 4 years of age

Question 10

what is a contraindication for Dextromethorphan?

Answer 10

concurrent MAOI (monoamine oxidase inhibitor) use +/- 2 weeks

Question 11

what are warnings of Dextromethorphan?

Answer 11

o Serotonin syndrome
To much serotonin in the brain can cause this and can be fatal

o Abuse/misuse
It is abused and misused often by teenagers
Some people get euphoric from it because it is structurally related to codeine. Some people get really sleepy from it, and some get euphoric and it alters mood.

Question 12

what are ADRs of Dextromethorphan?

Answer 12

CNS: confusion, excitement (why it might be abused), irritability, nervousness, drowsiness/sedation

Question 13

DDI of Dextromethorphan?

Answer 13

substrate of several CYP isozymes (2D6, 3A4, 2C9, etc.)

Question 14

Opioid Derivative agents for antitussives?

Answer 14

o	Hydrocodone (CII)
o	Codeine - off-label

Question 15

what is a warning when prescribing Opioid Derivative antitussive medications?

Answer 15

High risk for dependence and abuse/misuse

Question 16

what is a warning when prescribing Opioid Derivative antitussive medications?

Answer 16

High risk for dependence and abuse/misuse

Question 17

when should you use caution when prescribing Opioid Derivative antitussive medications?

Answer 17

o	Any other CNS drug
o	CNS diseases
o	Respiratory disease
o	Renal/liver impairment
o	Debilitated patients
o	Elderly
o	Bowel, thyroid, prostate, eye diseases

Question 18

what are ADRs of Opioid Derivative antitussive medications?

Answer 18

o	CNS: sedation, confusion, dysphoria, euphoria, fear, mood swings, mental impairment
o	Derm: pruritus, rash
o	GI: constipation, n/v
o	Resp: respiratory depression
o	GU: urinary retention, bladder spasms

Question 19

Suggested Uses for Opioid Derivative antitussive medications?

Answer 19

o Cough is severe (e.g. significant impact on QOL)
Impacting ability to sleep

o Mainly/only for bedtime dosing

o If DM or other drug fails and cough is severe

Question 20

is benzonatate OTC?

Answer 20

NO

Question 21

PO soft gel form of benzonatate is referred to as a ___.

Answer 21

perle

Question 22

how does benzonatate work? (MOA)

Answer 22

Presumably acts by anesthetizing stretch receptors in the lungs and pleura

Question 23

what are the ADRs for benzonatate?

Answer 23

o ADRs are almost non existent
o Rare isolated CNS disturbances causing abnormal behavior
o Rare but severe hypersensitivity reactions have been reported

Question 24

Antitussives can be used for symptomatic control of ______ cough

Answer 24

acute (<3 week)

Question 25

If cough present ≥3 weeks, what is next step?

Answer 25

thorough workup needed

Question 26

If etiology of cough cannot be identified, no specific therapy exists, or specific therapy has failed, what agent should you start with?

Answer 26

dextromethorphan

Question 27

what antitussive can be used if the cough persists and/or there is concern for drowsiness

Answer 27

benzonatate