Antitussives, Expectorants and mucolytics

Question 1

List the antitussives

Answer 1

Dextromethorphan
Codeine and Dihydrocodeine
Butamirate
Pentoxyverine
Lidocaine

Dextromethorphan - the best, unknown mechanism

Codeine - antitussive at lower doses than analgesia/tolerance
Dihydrocodeine - twice as potent as codeine, still used at doses lower than analgesia or abusive doses.

Butamirate - also unknown mechanism, may act through the same dextromethorphan receptors.

Pentoxyverine - M1 inhibition

Lidocaine - topical spray for suppression during bronchoscopy/gastroscopy.

Question 2

Mechanism of pentoxyverine

Answer 2

M1 inhibition

Question 3

Oral expectorants

Answer 3

Ipecac
Guaifenesin

Iodine salts
Amonium Chloride

They are given at low doses and irritate the gastric mucosa,
causing vagal reflex activation and increased bronchial secretions.
Stimulates productive coughing.

Question 4

Inhaled expectorants

Answer 4

Peppermint and Eucalyptus oils

Bronchial irritation and vagal activation with mild mucolytic action

Question 5

Mucolytics

Answer 5

• Acetylcystein
• Carbocysteine
• Erdostein
  Cleave glycoprotein disulfide bridges

-Dornase alpha
clears leukocyte DNA debris

-Bromohexine and Ambroxol
clear degrade mucopolysaccarides

Question 6

Cilliary secretomotor agents

Answer 6

beta 2 agonists, SABAs and LABAs
Theophylline
Bromohexine
Acetylcysteine