Cough and Cold Flashcards
Name 2 type of medications that are used for severe rhinorrhoea/nasal congestion/post-nasal drip?
Mucoregulators
Mast Cell Stabilisers
____ is used to control severe cold symptoms by decreasing mucus hypersecretion from goblet cells and submucosal glands
Ipratropium
Name a SAMA that is used for severe cold symptoms
Ipratropium
Route of administration of Ipratropium?
Intranasal
(MOA) Ipratropium ____ inflammation-induced ____ cholinergic receptor _____ which blocks the activation of ______. This leads to a ____ in stimulated mucus output and _____ volume.
Ipratropium blocks inflammation-induced parasympathetic cholinergic receptor M3 which blocks the activation of submucosal glands/ goblet cells. This leads to a decrease in stimulated mucus output and sputum volume.
Name 3 side effects of Ipratropium
Unpleasant taste
Dry Mouth
Urinary retention in elderly
Name a mast cell stabiliser
Cromoglicic acid
Name a medication for severe cold symptom that can be inhaled
Cromoglicic acid
(MOA) Cromoglicic acid controls _____ channels to inhibit cellular activation
____ mast cell degranulation induced by ____ mediated FC epsilon receptor crosslinking
Decrease secretion of inflammatory mediators from _____, neutrophils and _____
____ secretion of Annexin A1
Cromoglicic acid controls chloride channels to inhibit cellular activation
Decrease mast cell degranulation induced by IgE mediated FC epsilon receptor crosslinking
Decrease secretion of inflammatory mediators from eosinophils, neutrophils and macrophages
Increase secretion of Annexin A1
What are 3 side effects of Cromoglicic acid
Dry mouth
Unpleasant taste
Throat and nasal irritation
Cough
What is the duration of action for 1st gen antihistamines?
4 to 6 hours
What is the duration of action for 2nd gen antihistamines?
12 to 24 hours
Name 3 antihistamines which are frequently used in oral cough and cold formulations
Chlorpheniramine
Triprolidine
Promethazine
What is one 2nd gen antihistamine that still has a little sedation effect?
Cetirizine
What are some examples of sympathomimetic decongestants
“PON PE”P: PhenylephrineO: OxymetazolineN: NaphazolineP: PseudoepedrineE: Epedrine
(MOA) Sympathomimetic decongestants are direct _____ adrenoceptor ____ thus having the effect of ____ of nasal blood vessels. It also reduces _____ and secretion of ____.
Sympathomimetic decongestants are direct alpha-adrenoceptor agonist, thus having the effect of vasoconstriction of nasal blood vessels. It also reduces inflammation and secretion of mucus.
Route of administration of nasal glucocorticoid?
Intranasal
Name 2 sympathomimetic decongestant that can be taken orally
Phenylephrine
Pseudoephedrine (think of the Ps)
Fluticasone and mometasone are examples of nasal _____
Glucocorticoid
Which sympathomimetic decongestant is alpha 1 selective?
Phenylephrine
List 2 examples of non-selective sympathomimetic decongestant
Oxymetazoline
Naphazoline
Pseudoepedrine and ephedrine are examples of _____ sympathomimetic decongestants
Indirect
Name a side effect which occurs with prolonged use of topical intranasal decongestants
Rebound congestion
In a patient with hypertension or other CVS history, ___ sympathomimetic agent should be avoided as it can cause the side effects of palpitations and hypertension.
Indirect
due to B1 effects(Alpha adrenoceptor agonist would be preferred)
Antitussives are used for dry or wet cough?
Dry Cough
What is the most effective non-opioid antitusive?
Dextromethorphan
What is the most potent antitusive but has the potential for abuse
Codeine
(MOA) Codeine acts in ___ to suppress cough
CNS
List 3 adverse effects of Codeine
Sedation
Respiratory depression
Potential for abuse at high dose
Codeine needs to be used with caution as it is a CYP___ ultra-rapid metabolizer which means that codeine will be more rapidly converted to the more potent opioid morphine, hence increasing the risk of opioid adverse effect.
CYP2D6
Can a 10 year old patient be prescribed codeine?
Not recommended for <18 years old
What is the typical adult dose for dextromethorphan?
10 to 30mg every 4 to 8 hours
List any 3 adverse effects of Dextromethorphan
Drowsiness
Dizziness
Confusion
Nausea
Vomitting
Dextromethorphan is an opioid. True or False?
False. Opiate but not opioid
Which receptor does Dextromethorphan at high dose block?
NMDA receptor blocker
Expectorants are used for dry or wet cough?
Wet cough
Name one example of an expectorant
Guaifenesin
(MOA) Guaifenesin increase/decrease production of respiratory tract fluids to help liquefy and increase/decrease viscosity of tenacious secretions
Guaifenesin increase production of respiratory tract fluids to help liquefy and decrease viscosity of tenacious secretions
Can guaifenesin be used for a 1 year old patient?
Not indicated < 2 years oldCaution < 6 years old
List 2 adverse effect of guaifenesin
GI disturbances
Nausea
Name 2 examples of mucolytics
Acetylcysteine
Carbocisteine
Name a medication that smells and taste strongly of sulfur (rotten egg smell)
Acetylcysteine
Can asthmatics be prescribed Acetylcysteine?
Avoided or use with caution as Acetylcysteine has the side effect of bronchospasm
Carbocisteine is contraindicated in patients with _____
Active peptic ulcer
What medication is safe for use for patients under 6 months old
Usually not to mediate and observe closely while infection recovers within 3 to 7 days
Name a cough and cold medication that is safe for geriatric use
Expectorant (Guaifenesin)
Mucolytic (Acetylcysteine)
Decongestants (Pseudoephedrine, phenylephrine)
Can a elderly patient be prescribed dextromethorphan?
Not recommended as elderly are more susceptible to sedation and confusion
60 year old Mr Lim presents to your clinic with cough and cold, has a history of hypertension and narrow angled glaucoma. P1. What medications are contraindicated for him? P2. What medication would you prescribe?
P1. Antihistamines, Diphenhydramine, Pseudoepedrine, PhenylephrineP2. Guaifenesin / Acetylcysteine
