Cough Flashcards
What is a cough?
A protective reflex that clears the respiratory tract of accumulated
secretions, exudates or foreign substances/bodies. It involves an
initial bronchospasm and the closing of the glottis, after which air is
forced out with tremendous power
List the underlying causes of cough
Tuberculosis
* Foreign bodies in the airway
* Cystic fibrosis
* Immune deficiencies should be ruled out.
* Nocturnal cough = asthma or early congestive heart failure
* Smoking
* Side effects of drugs such as ACE inhibitors
Describe dry cough and its treatment
No mucus, persistent.
Tx: Antitussive = cough suppressant
Describe wet cough and its Tx
Mucus – white (viral)
Yellow-green (bacterial)
Tx:
-Expectorant or
Mucolytic + adequate
hydration to reduce
viscosity of mucus
- Antibiotic
Describe mild cough and Tx
Irritating, no bacterial
infection, no bronchospasm
Tx
Simple linctus
Honey &lemon
____________________ preparations reduce frequency of exacerbations of COPD
Cysteine-based mucolytic preparations reduce frequency of
exacerbations of COPD
What may be the cause of acute cough in children?
Cause
Viral respiratory tract infection
Tx of allergic cough with allergic rhinitis
Treatment
Antihistamines + topical nasal steroids
Chronic cough in children
Exclude asthma and other underlying conditions
Indication for antitussives
Treatment for
unproductive persistent
cough, which exhausts
the patient.
* NOT for productive
cough, withholds the
mucus, NOT for bacterial
infections
Examples of antitussive agents
Codeine phosphate
Dihydrocodeine**
Methadone**
Noscapine**
Pholcodine (Pholtex®)xxxxxx
(+ Antihistamine)
Dextromethorphan
Why was pholcodine discontinued in SA?
Increased risk of sudden, severe, and life-threatening
allergic reactions occurring during surgery. (ANAPHYLAXIS INPTs RECEIVES NMBAs)
Opiod-related side effects:
Suppress cough centre (medulla)
Side-effect & Abuse potential – limit use
C/I: Not < 2yr
No-opiod-related side effects:
Suppress cough centre
BUT
No analgesic, euphoric or constipating effects
List side effects of antitussives (cough suppressants)
Dizziness, drowsiness, sedation: Avoid alcohol, CNS depressants
* Headaches
* Confusion, excitement (children ++)
* Epigastric discomfort, N, V
* Constipation + biliary colic (opioids)
What happens with antitussive OD?
Respiratory depression
Abuse and addiction is most common with ________________ and _____________________
Codeine & Antihistamine
CI of cough suppressants:
Asthmatic patients, chronic bronchitis
Indications of Expectorants
Facilitate coughing up of mucous and other material from the lungs
* Used for patients with thick, tenacious respiratory secretions, dry
non-productive coughing, sinusitis to increase airway hydration
MOA of expectorants
Stimulates bronchial secretions, thinning mucus for easy removal
Example of an expectorant
Guaifenesin
Mucolytics MOA
Dissolves thick mucus & usually used to relieve respiratory difficulties
* MOA: Liquifies mucus by dissolving the mucopolysaccharides (long chain
sugar molecules found in mucus & fluid in joints), reducing its viscosity,
thereby enabling pt. to cough up mucus more easily.
Examples of mucolytics:
Bromhexine (Bisolvon®) (+ bronchodilator), Carbocisteine
(Mucospect®) , N-acetylcysteine (Salmucol®)
Adverse effects of mucolytics
Epigastric discomfort, N, V
* Tinnitus, headache
* Fever, skin rash, urticaria
* Bronchospasm
What is another use of N-acetylcysteine?
Antidote for paracetamol poisoning
Precautions for cough medicine:
Cough suppressants C/I: Asthma patients & Chronic bronchitis
* Diabetic patients: Pholcodine, Noscapine, Bromhexine +
bronchodilator
* Combining Cough suppressant + Expectorant = No justification!
* Dryness & irritation of throat:
* Gargle with salt water i.e.
* 2.5g salt in 250ml water
