Cough & Cold

Question 1

What are the drugs for cough & cold?

Answer 1

1. antitussives - opiates + dextromethorphan
2. mucolytics- aerosolised NAC + carbocisteine
3. expectorant - guaifenesin
4. mucoregulator- ipratropium + tiotropium
5. mucokinetics- beta agonist, ambroxol, bromhexine
6. nasal decongestants- phenylephrine, pseudoephedrine, oxymetazoline, xylometazoline, naphazoline

Question 2

Combination products for multisymptom for common cold relief

Answer 2

1. analgesic + h1 antihistamine + nasal decongestant
2. antitussive + h1 antihistamine + nasal decongestant
3. expectorant + nasal decongestant
4. expectorant + antitussive

Question 3

*Opiates

MOA
Use
Adverse effects
Contraindication

Answer 3

1. morphine/codeine/hydrocodone

MOA

1. codeine, prodrug converted by liver enzyme CYP2D6 to morphine
2. CYP2D6 poor metabolizer– ineffective but if rapid metabolizer- toxic
3. MOR mu opioid receptor agonists found in brain cough centre (centrally acting)
4. hydrocodone synthetic active opioid, more potent & high risk of SE

Use
1. codeine gold standard in cough suppression

AR

1. sedation & respiratory depression
2. itch
3. addiction
4. N/V/Diarrhea

Contraindication
1. pt under 18 years old (due to SE)

Question 4

*Dextromethorphan

MOA
Use
Adverse effects
Contraindication

Answer 4

non-narcotic codeine analogue, no analgesia, no addiction

MOA

1. blocks NMDA receptors
2. stimulates sigma-1 receptor
3. block Na+ & Ca2+ influx
4. & activates sig-1-r inside ER to channel Ca into mitochondria and modulate channel fn

Use
1. reducing cough severity

Adverse effect

1. CNS: confusion, excitement, irritability, nervousness
2. high dose: N/V, headche
3. extreme high dose: euphoria & dissociative effect

Contraindication
1. children <4 yr old

Question 5

*Aerosolised N-Acetylcysteine

MOA
Use
Adverse effects

Answer 5

MOA
1. free thiol group nucleophile severing disulfide bonds in mucus
2. depolymerise mucin polymers
3. decrease sputum viscosity 
thus effective mucus clearance

4. anti-inflamm: inhibit neutrophil infiltration
5. antioxidant: protect against free radicals

Use
1. mucus hypersecreting conditions like UTRI/COPD/asthma/cystic fibrosis

Alternative:
NAL (NAC lysine salt, Nacetelyn) neutral vs NAC acidic

Question 6

*Carbocisteine/SCMC/SCMC-Lys = capsule/solution

MOA
Use
Adverse effects

Answer 6

MOA

1. breaks disulfide bridges b/n macromlc in mucus reducing viscosity
2. increase sialomucin synthesis (via sialyl transferase) restoring viscoelastic properties of mucus
3. increase Cl- & GSH secretion w increased H2O transport
4. reduce IL-8 (neutrophil infil) + oxidative damage
5. reduce viral adhesion to ciliated epithelial cells

Question 7

*Guaifenesin = tablet/lq form

MOA
Use
Adverse effects

Answer 7

MOA

1. increase volume &hydration liqfy mucus
2. decrease viscoelasticity & adhesiveness of mucus
3. suppress mucin prdn & promotes mucociliary transport
4. promote productive cough & effective mucus expulsion

Adverse effect
1. Kidney stone (maintain good hydration, increase urinary pH)

Contraindication
1. children <2 yr old

Question 8

*Ipratropium & tiotropium

MOA
Use
Adverse effects

Answer 8

1.

Question 9

*salbutamol, bromhexidine, ambroxol

Answer 9

1.

Question 10

*Nasal decongestant
Phenylephrine, pseudoephedrine, oxymetazoline, xylometazoline, naphazoline

MOA
Use
Adverse effects

Answer 10

1.