Cough Medication

Question 0

Dextromethorphan ( MD) ( not know to be teratogenic for pregnancy& lactation ) elderly sedating effect

1) nonopioid = medulla increase cough threshold
2) onsite 30 min
3) duration 6 hrs
4) Polymorphic metabolism ( not good for pt with poor metabolism

Answer 0

1) N/ V
2) Drowsiness
3) Gi problem
4) constipation
5) overdose lead to confusion , excitability , nervousness, restless, respiratory depressant

Question 1

Codeine ( Antitussive)( more sedating effect for Elderly pt )
( not prefer for choric or close to delivery pregnancy & distributes in milk )
1- no more then 200mg/100ml
2- for non-productive cough
3- medulla to increase cough threshold
Cautions with other CNS depressant medication

Answer 1

1) onset 30 min
2) duration 6 hrs
3) methylated in liver form morphine
——
1) N/V
2) Dizziness / sedation
3) constipation
4) respiratory depressive if over does
Caution with other CNS depressant medication

Question 2

Dextromethorphan drug interaction

** metabolized via CYP2D6

Answer 2

1) CNS effect with antihistamine , alcohol
2) Serotonergic syndrome with MAOIs or SSRIs
3) potential for abuse due to phencyclidine euphoric effect

Question 3

Diphenhydramine ( 1st gen antihistamine ; antitussive properties)
Not good for pregnancy & lactation ( causes paradoxical effect for children and elderly)
- medulla to increase cough threshold
** onset 15 min
- duration 6 hrs
Adverses effect

Answer 3

Drowsiness 
Respiratory depression 
** Blurred Vision 
** urinary retention 
*** dry mouth 
*** may cause excitably esp in children

Question 4

• ***Guaifenesin
• expectorant
• *** For acute ineffective Productive Cough
• loosens and thins LRT

Not good as OTC dosage
Adverse effects

Answer 4

N/V , diarrhea , abdominal pain 
Dizziness, drowsiness 
Headache
** Rash 
** renal calculi ( large doses )

Question 5

ACCP ( American college of chest physician)
Guidelines for Cough management

–Guaifenesin bot recommend for anything

– Naproxen may reduce viral associated cough

Answer 5

1) acute cough associated with cold
Antitussive are ineffective
( combination of 1 gen antihistamine + decongestant )

2) acute and chronic cough associated with bronchitis: post infection subacute cough
( short term of Codeine or Dextrometgorphan )