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Pharmacology > Cough, Cold, and Allergy > Flashcards

Cough, Cold, and Allergy Flashcards

1
Q

Antitussives

A

Reason for Use: Cough suppression

Contraindications: Concurrent MAOI (Monoamine oxidase inhibitors) use

Mechanism: Block cough centrally or peripherally

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2
Q

Antitussives Mechanism of Action

A

Central Agents: Block cough center in the brain

Examples:
IMPORTANT EXAMPLES:
- Dextromethorphan [DM]
- Codeine & Hydrocodone [opiates]

Mechanism not clear

Peripheral Agents: Anesthetize local nerve endings or act as demulcents

Examples:
IMPORTANT EXAMPLES:
- Menthol [Vicks vapo rub]
- Benzonatate [Tesselon perles]

Other examples:
Camphor, eucalyptus oil, levodropropizine

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3
Q

Antitussives Onset and Duration

A

Dextromethorphan [DM]: Onset 15-30 minutes; Duration 3-6 hours

Camphor and Menthol: Topical/inhaled

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4
Q

Antitussives Side Effects

A

Dextromethorphan [DM]: Drowsiness, nausea, dizziness

Opiates (at lower doses): Sedation, constipation

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5
Q

Antitussives Considerations

A

DM vs. Codeine: DM has fewer CNS side effects, minimal euphoria; available OTC

Caution with DM: High doses can cause dissociative effects (similar to PCP) and toxicity
«HTN, Tachycardia, Respiratory Depression»

Codeine Dosing: Lower doses for antitussive effects than for analgesia
«So less Respiratory Depression at cough doses EXCEPT pediatrics who are more sensitive to this side effect»
High doses of Opioids through IV can induce cough

Older generation Antihistamines have been used as cough meds, with unclear MOA

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6
Q

Expectorants

A

Reason for Use: Loosens mucus from the respiratory tract

Contraindications: None of major significance

Mechanism: Increase fluid in the respiratory tract

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7
Q

Expectorants Mechanism of Action/Examples

A

Mechanism: Increases respiratory fluid, and clearance of irritants, and decreases mucus viscosity

Guaifenesin unclear MOA but increases respiratory fluid through local irritant effect

Examples:
IMPORTANT EXAMPLE:
- Guaifenesin [Duratuss, Robitussin]

Other examples:
Ammonium chloride, terpin hydrate, potassium iodide, iodinated glycerol

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8
Q

Expectorants Side Effects

A

Guaifenesin: Generally well tolerated; nausea, drowsiness, vomiting at higher doses

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9
Q

Expectorants Considerations for recommending

A

Limited data for efficacy in all ages

Overdose worry

Risk of duplication of ingredients in Multi Symptom Products

Guaifenesin is widely used

Other expectorants associated with several side effects like Acidosis (in renal failure patients), nausea, and vomiting

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10
Q

Decongestants

A

Reason for Use: Nasal congestion

Contraindications: MAOIs (Monoamine oxidase inhibitors) can lead to severe hypertension. Severe HTN and coronary disease can lead to vasoconstrictive response of decongestants

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11
Q

Decongestants Mechanism of Action

A

Mechanism: Vasoconstriction of precapillary blood vessels + reduce Hydrostatic Pressure, blood flow and volume

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12
Q

Decongestants Examples

A

Direct Agonists:
IMPORTANT:
- Phenylephrine [Sudafed PE, Dimetapp]

Other Direct Agonists: Oxymetazoline, xylometazoline, naphazoline

Indirect Agonists:
IMPORTANT:
- Pseudoephedrine [Sudafed]

Other Indirect Agonists Phenylpropanolamine

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13
Q

Decongestants Onset and Duration

A

Oral Pseudoephedrine: Onset 30 minutes; Duration 4-6 hours

Topical Agents: Faster onset, fewer systemic effects

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14
Q

Decongestants Side Effects

A

CNS Stimulation: Agitation, anxiety, insomnia, because similar structure to Amphetamines

Other: Rebound nasal congestion, increased blood pressure, urinary retention, dry mouth, sweating

Topical: Local irritation

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15
Q

Decongestants Considerations

A

Rhinitis Medicamentosa: Rebound nasal congestion from chronic use, can improve over time if stop using

Pseudoephedrine Restrictions: Behind the counter, monitored by NPLEX due to potential for methamphetamine production

Vasoconstrictive options are most effective but there are other options:
Camphor, Menthol, and Eucalyptus oils
But efficacy and MOA not well studied

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16
Q

Antihistamines (H1 Antagonists)

A

Reason for Use: Allergic rhinitis, urticaria, nasal symptoms from common cold, nausea (1st generation)

Contraindications: None of major significance

17
Q

Antihistamines Mechanism of Action

A

Mechanism: Block histamine receptors, mitigating (blocking) allergic response

18
Q

Antihistamines Examples

A

1st Generation:
Have Anticholinergic activity so treat nausea as well.
IMPORTANT 1st GEN:
- Diphenhydramine [Benadryl]
- Chlorpheniramine [Chlortrimeton]
- Hydroxzyine [Atarax]
- Cyproheptadine [Periactin]

Others 1st Gen:
Dimenhydrinate, brompheniramine, cyclizine, meclizine, promethazine, carbinoxamine, clemastine, pyrilamine, tripelennamine, phenendamine

2nd Generation:
IMPORTANT 2nd GEN:
- Loratadine [Claritin]
- Cetirizine [Zyrtec]
- Fexofenadine [Allegra]

Other 2nd Gen:
Desloratadine [clarinex], olopatadine, acrivastine, azelastine [Astelin], levocabastine, ebastine, mizolastine

3rd Generation:
Levocetirizine [Xyzal]

19
Q

Antihistamines Considerations

A

Sedation: Associated with some antihistamines, can cross BBB, can antagonize Serotonin (5-HT2) receptors

Use in Anaphylaxis: Not recommended due to slow onset and inability to address hypotension and bronchoconstriction

Many Antihistamines used for insomnia due to sedative effect

Doxepin, classified as a TCA (Tricyclic Antidepressant) has more potent antihistamine activity than most marketed antihistamines

20
Q

Mast Cell Stabilizers

A

Reason for Use: Allergy conditions (e.g., asthma, rhinitis, conjunctivitis) and systemic mastocytosis (rare disorder), adjunct therapy.

Not for acute therapy, but to prevent inflammatory mediators from getting released by Mast Cells before it happens.

Contraindications: None of major significance

21
Q

Mast Cell Stabilizers Mechanism of Action

A

Mechanism: Prevent degranulation of mast cells, suppress proinflammatory factors
(Eosinophils, neutrophils, and monocytes)
(reduce movement of Leukocytes in asthmatic airways)

22
Q

Mast Cell Stabilizers Examples

A

Examples:
IMPORTANT:
- Cromolyn sodium [Nasal Crom]

Other examples:
Nedocromil, lodoxamide

23
Q

Mast Cell Stabilizers Side Effects

A

Side Effects: Generally well tolerated; cough from throat irritation, nasal irritation

24
Q

Mast Cell Stabilizers Considerations

A

No bronchodilation, so NOT useful for acute asthma attack or allergy symptoms that already started

Topical, low oral bioavailability (1%), so minimal systemic effect if swallowed by accident

25
Q

Leukotriene Receptor Antagonists (LTRAs)

A

Indications for Use: Persistent asthma (but not 1st line, only for prevention), exercise-induced bronchospasm, allergic rhinitis

Contraindications: Acute liver disease or impaired liver function

26
Q

Leukotriene Receptor Antagonists (LTRAs) Mechanism of Action

A

Mechanism: Block leukotrienes to reduce bronchoconstriction and inflammation

Montekulast: selective competitive antagonist of cysteinyl-leukotriene receptor and another receptor D4

Xafirlukast: selective and competitive inhibitor of D4 and E4

27
Q

Leukotriene Receptor Antagonists Examples

A

IMPORTANT EXAMPLE:
- Montelukast [Singulair], Daily dosing

Other example:
Zafirlukast [Accolate], Twice daily dosing; monitor for liver metabolism issues, can result in 45% increase plasma level of zafirkulast if taken with other liver metabolized drugs

28
Q

Intranasal Steroids

A

Uses: Allergic rhinitis - to reduce nasal congestion, sneezing, nasal itching, rhinorrhea

Contraindications: Hypersensitivity to medication

29
Q

Intranasal Steroids Mechanism of Action

A

Mechanism: Inhibit inflammatory cells (mast cells, eosinophils, basophils, lymphocytes, macrophages)

30
Q

Intranasal Steroids Examples

A

IMPORTANT EXAMPLES:
- Fluticasone [Flonase/Veramyst]
- Mometasone [Nasonex]

Other examples:
Budesonide [rhinocort]
Ciclesonide [omnaris]
Triamcinolone [nasacort]

31
Q

Intranasal Steroids Side Effects

A

Minimal systemic absorption since Intranasal route (so much lower incidence than systemic steroids)

Slower than Antihistamines

Require continuous dosing for response

Pharmacology (5 decks)

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