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NUR1125 > Drugs for Allergic Rhinitis, Cough & Cough > Flashcards

Drugs for Allergic Rhinitis, Cough & Cough Flashcards

1
Q

what is the indication of cromigrilic acid

A

for control of severe cold symptoms

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2
Q

why should patient lean forward when taking nasal drop/spray

A

to prevent accidental digestion of medication

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3
Q

what is 1 drug from the expectorant class, explain the MOA

A

guaifenesin

increase production of respiratory tract fluid to liquefy and lower viscosity of tenacious secretion

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4
Q

which of the following is an opioid drug
A) dextromethorphan
B) diphenhydramine
C) guaifenesin
D) none of the above

A

D

  • ans should be codeine
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5
Q

2nd/3rd generation antihistamine cause less ANS block & less sedation (true/false)

A

true

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6
Q

what is the route & MOA of ipratropium bromide

A
  • intranasal
  • block the activation of m3 receptor in submucosal gland & goblet cells to reduce mucus secretion
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7
Q

which class of medication should you give for dry (non-productive) cough

A

antitussive

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8
Q

below which age is dextromethorphan not recommended

A

<4 y/o

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9
Q

why are some patient not compliant to fluticasone

A

drug give off a rose water odour

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10
Q

which age is contraindicated for patient taking expectorant
1. <20
2. <18
3. <6
4. <2

A

<2 y/o

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11
Q

which age should be caution & contraindicated when giving guaifenesin

A

<6 y/o

contraindicated in <2 y/o

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12
Q

how do you prevent the a/e of dry mouth?

A

recommend patient to sip water or suck hard on sugarless candy

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13
Q

which of the following antihistamine would be appropriate for a 24 year old woman with a non productive dry cough preventing her from sleeping
A) promethazine
B) cetirizine
C) fexofenadine
D) diphenhydramine
E) none of the above

A

D

diphenhydramine is both an antihistamine (gen 1) & anittussive (non-opioid)

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14
Q

which age should be caution and contraindicated when giving mucokinetic

A
  • caution in pt <6 y/o
  • contraindicated in pt <2 y/o
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15
Q

which of the following is mast cell stabiliser drug
1. acetylcysteine
2. cromogrilic acid
3. promethazine
4. fluticasone

A

cromogrilic acid

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16
Q

list 1 drug of opioid antitussive, what are the advantages & disadvantage?

A

codeine

advantage
- most effective antitussive

disadvantages
- sedation
- potential for abuse
- respiratory depression at high dose

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17
Q

patient with cough are given expectorants to…
A) break up mucus by opening disulphide bonds in mucoproteins
B) suppress cough
C) promote productive cough
D) reduce airway inflammation

A

C

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18
Q

give 2 drug example of 3rd gen antihistamine

A
  1. levocetirizine
  2. desloratadine
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19
Q

which age is opioid antitussive not recommended, why?

A

<18 y/o, as their respiratory centres and liver are not yet fully developed = high risk of respiratory depression

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20
Q

list 4 a/e of cromigrilic acid

A
  1. unpleasant taste
  2. throat/nasal irritation
  3. cough
  4. dry mouth
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21
Q

what is 1 a/e of nasal corticosteroid

A

local mucosal dryness & irritation

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22
Q

which age is contraindicated for guaifenesin

A

<2 y/o

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23
Q

what is the 2 patient advice when giving guaifenesin

A
  • drink plenty of fluid to decrease mucus viscosity & protect renal function (drug may cause kidney stones when overdose; nephrolithiasis)
  • drug should not be taken in persistent cough associated w smoking or asthma
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24
Q

list 5 drug of sympathomimetic agent

A

direct alpha-adrenoceptor agonist:
selective a1
- phenylephrine (oral or intranasal)
non-selective
- oxymetazoline (intranasal)
- naphazoline (intranasal)

indirect increase release of adrenaline/noradrenaline
- pseudoephedrine (oral)
- ephedrine (intranasal)

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25
Q

what is 1 a/e of guaifenesin

A

GI disturbance eg. nausea/vomiting

26
Q

list 2 drug of non-opioid antitussive + advantages & disadvantages of each

A
  1. dextromethorphan

advantage
- most effective non-opioid antitussive
- less risk of addiction

disadvantages
- GI disturbance
- dizziness, drowsiness
- potential for abuse

  1. diphenhydramine

advantage
- no risk of addiction

disadvantages
- anticholinergic a/e
- sedation

27
Q

1st generation antihistamine cause less ANS block & less sedation (true/false)

A

false, 1st gen antihistamine cause more sedation & more ANS block

28
Q

briefly explain the difference between 1st & 2nd gen antihistamine + what is the duration of action

A

1st gen antihistamine:
- less selective for h1 over other histamine receptor subtypes
- can cross BBB & affect muscarinic cholinergic, alpha adrenergic and serotonin receptors (therefore more CNS a/e)
- 4-6hrs action

2nd gen antihistamine:
- improve selectivity for h1 receptors
- reduce CNS a/e due to decrease lipophilicity or increase p-glycoprotein efflux pump affinity
- 12-24hrs action

29
Q

what is the MOA of antitussive

A

act on CNS to suppress cough

30
Q

for a patient with a cough given guaifenesin, which is the following is the most appropriate advice
A) take plenty water to increase fluid secretion into the lungs
B) reduce water intake to reduce amount of mucus produced
C) it is normal that the medication will have a rose water odour

A

A

31
Q

which of the following is a pro-drug
A) levocetirizine
B) loradatine
C) desloradatine
D) cetirizine
E) diphenhydramine

A

B

  • loradatine require CYP3A4 & CYP2D6 to metabolise into desloratadine
32
Q

what is the MOA of sympathomimetic agent drugs

A

cause vasoconstriction of nasal blood vessels, resulting in reduce inflammation, reduce congestion & reduce mucus secretion

33
Q

give 3 drug example of 2nd gen antihistamine

A
  1. cetirizine (weak sedation)
  2. fexofenadine (non-sedating)
  3. loratadine (non-sedating)
34
Q

give 3 drug example of 1st gen antihistamine

A
  1. chlorpheniramine
  2. diphenhydramine
  3. promethazine

all 3 medication have marked sedation, while diphenhydramine can be use to treat motion sickness

35
Q

what is the MOA of mucolytic

A

free sulfhydryl group open bisulphide bond in mucoprotein, reducing mucus viscosity

36
Q

which age is not recommended for sympathomimetic agent

A

< 12 y/o

37
Q

is dextromethorpan recommended in elderly pt

A

no, as drug can increase risk of sedation & confusion in elderly pt

38
Q

what is the 2 a/e of mucolytic

A
  1. bronchospasm
    - not to give pt w asthma
    - not to give elderly or weak pt with severe respiratory insufficiency
  2. GI disturbance
39
Q

list 2 drug of mucoactive agent - mucolytic

A
  1. acetylcysteine
  2. carbocisteine
40
Q

what is the 2 type of antitussive

A
  • opioid
  • non-opioid
41
Q

list 2 drug from mucokinetic

A
  1. bromhexine
  2. ambroxol (active metabolite)
42
Q

which pharmacological class does cromogrilic acid belongs to

A

mast cell stabiliser

43
Q

give 1 drug example of a mucoregulator

A

ipratropium bromide

44
Q

what is the indication of ipratropium bromide & how does it work

A

for control of severe cold symptoms by decreasing mucus hypersecretion in submucosal gland & goblet cells

45
Q

what is the class of drug for sore throat, headache & fever

A

analgesic & antipyretic: NSAIDS eg. ibuprofen/paracetamol

46
Q

antagonist activate receptors, antagonist block agonist from binding but on their own have no effect on receptor activity. on their own in the absence of histamine, antihistamine drugs…
A) do nothing
B) produce histamine-like effects
C) produce the opposite effects to histamine
D) none of the above

A

C

47
Q

which of the following drugs is least dangerous for a 73 y/o woman with a hx of mild cognitive impairment & asthma presenting with a productive cough
A) acetylcysteine
B) promethazine
C) guaifenesin
D) codeine

A

C

*acetylcysteine (mucolytic) should be caution when giving to pt with hx of asthma

48
Q

which of the following is the most potent antitussive
A) codeine
B) dextromethorphan
C) diphenhydramine
D) acetylcysteine

A

A

49
Q

what is 1 contraindication for carbocisteine

A

contraindicated in patient w PUD

50
Q

what are the a/e of sympathomimetic agent

A
  1. hypertension (due to vasoconstriction)
  2. tachycardia (for indirect release drug eg. pseudoephedrine & ephedrine)
  3. rebound congestion (for intranasal)
  4. CNS: anxiety, insomnia, tremors, irritability
51
Q

list 2 common a/e of antihistamine

A
  1. dry mouth
  2. sedation
52
Q

which of the following antihistamine would be appropriate for a taxi driver with a cough due to post nasal drip
A) fexofenadine
B) cetirizine
C) promethazine
D) chlorpheniramine

A

A

  • 2nd gen, non sedating drug
53
Q

which is the best way to ensure recovery from cough & cold
A) treat with antibiotic, antihistamines, antitussives, and expectorants
B) wait for 3-7 days
C) do sputum & blood test to identify the causal agent & treat with antibiotic

A

B

54
Q

list 2 drugs from nasal corticosteroid & explain the MOA

A
  1. fluticasone
  2. mometasone
  • drug reduce inflammation, resulting in reduce congestion & mucus secretion
55
Q

list 3 adverse effect of ipratropium bromide

A
  1. unpleasant taste
  2. dry mouth
  3. urinary retention (esp in elderly)
56
Q

which class of drug should you give for wet (productive) cough

A
  • expectorants
  • mucoactive agent (mucolytic, mucokinetic)
57
Q

what is the route of cromogrilic acid, and explain the MOA

A

inhalation & intranasal

  1. decrease mast cell degranulation induced by IgE mediated FcεRI crosslinking
  2. decrease inflammatory cell mediators secretion by eosinophils, neutrophils & macrophages
  3. control cl- channel to inhibit cellular activation
  4. increase annexin A1 secretion, which inhibit PG & leukotriene production
58
Q

what is the 3 disadvantages of diphenhydramine when use in elderly pt

A
  1. increase risk of sedation & confusion
  2. anticholinergic a/e can cause dementia
  3. contraindicated in elderly pt w narrow angle glaucoma
59
Q

why are some patient not compliant to mucolytic

A

drug give off a strong sulphur taste & smell

60
Q

which CYP convert codeine to morphine

A

CYP2D6

61
Q

list 2 other contraindications (other than age) for mucokinetic drugs

A
  1. pt w asthma/hx of asthma
  2. hx of PUD
62
Q

what is the MOA of mucokinetic

A
  • increase ciliary beat frequency
  • reduce adherence of mucus to cilia

NUR1125 (10 decks)

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