Drugs for Allergic Rhinitis, Cough & Cough Flashcards
what is the indication of cromigrilic acid
for control of severe cold symptoms
why should patient lean forward when taking nasal drop/spray
to prevent accidental digestion of medication
what is 1 drug from the expectorant class, explain the MOA
guaifenesin
increase production of respiratory tract fluid to liquefy and lower viscosity of tenacious secretion
which of the following is an opioid drug
A) dextromethorphan
B) diphenhydramine
C) guaifenesin
D) none of the above
D
- ans should be codeine
2nd/3rd generation antihistamine cause less ANS block & less sedation (true/false)
true
what is the route & MOA of ipratropium bromide
- intranasal
- block the activation of m3 receptor in submucosal gland & goblet cells to reduce mucus secretion
which class of medication should you give for dry (non-productive) cough
antitussive
below which age is dextromethorphan not recommended
<4 y/o
why are some patient not compliant to fluticasone
drug give off a rose water odour
which age is contraindicated for patient taking expectorant
1. <20
2. <18
3. <6
4. <2
<2 y/o
which age should be caution & contraindicated when giving guaifenesin
<6 y/o
contraindicated in <2 y/o
how do you prevent the a/e of dry mouth?
recommend patient to sip water or suck hard on sugarless candy
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
D
diphenhydramine is both an antihistamine (gen 1) & anittussive (non-opioid)
which age should be caution and contraindicated when giving mucokinetic
- caution in pt <6 y/o
- contraindicated in pt <2 y/o
which of the following is mast cell stabiliser drug
1. acetylcysteine
2. cromogrilic acid
3. promethazine
4. fluticasone
cromogrilic acid
list 1 drug of opioid antitussive, what are the advantages & disadvantage?
codeine
advantage
- most effective antitussive
disadvantages
- sedation
- potential for abuse
- respiratory depression at high dose
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
C
give 2 drug example of 3rd gen antihistamine
- levocetirizine
- desloratadine
which age is opioid antitussive not recommended, why?
<18 y/o, as their respiratory centres and liver are not yet fully developed = high risk of respiratory depression
list 4 a/e of cromigrilic acid
- unpleasant taste
- throat/nasal irritation
- cough
- dry mouth
what is 1 a/e of nasal corticosteroid
local mucosal dryness & irritation
which age is contraindicated for guaifenesin
<2 y/o
what is the 2 patient advice when giving guaifenesin
- 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
list 5 drug of sympathomimetic agent
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)
what is 1 a/e of guaifenesin
GI disturbance eg. nausea/vomiting
list 2 drug of non-opioid antitussive + advantages & disadvantages of each
- dextromethorphan
advantage
- most effective non-opioid antitussive
- less risk of addiction
disadvantages
- GI disturbance
- dizziness, drowsiness
- potential for abuse
- diphenhydramine
advantage
- no risk of addiction
disadvantages
- anticholinergic a/e
- sedation
1st generation antihistamine cause less ANS block & less sedation (true/false)
false, 1st gen antihistamine cause more sedation & more ANS block
briefly explain the difference between 1st & 2nd gen antihistamine + what is the duration of action
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
what is the MOA of antitussive
act on CNS to suppress cough
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
which of the following is a pro-drug
A) levocetirizine
B) loradatine
C) desloradatine
D) cetirizine
E) diphenhydramine
B
- loradatine require CYP3A4 & CYP2D6 to metabolise into desloratadine
what is the MOA of sympathomimetic agent drugs
cause vasoconstriction of nasal blood vessels, resulting in reduce inflammation, reduce congestion & reduce mucus secretion
give 3 drug example of 2nd gen antihistamine
- cetirizine (weak sedation)
- fexofenadine (non-sedating)
- loratadine (non-sedating)
give 3 drug example of 1st gen antihistamine
- chlorpheniramine
- diphenhydramine
- promethazine
all 3 medication have marked sedation, while diphenhydramine can be use to treat motion sickness
what is the MOA of mucolytic
free sulfhydryl group open bisulphide bond in mucoprotein, reducing mucus viscosity
which age is not recommended for sympathomimetic agent
< 12 y/o
is dextromethorpan recommended in elderly pt
no, as drug can increase risk of sedation & confusion in elderly pt
what is the 2 a/e of mucolytic
- bronchospasm
- not to give pt w asthma
- not to give elderly or weak pt with severe respiratory insufficiency - GI disturbance
list 2 drug of mucoactive agent - mucolytic
- acetylcysteine
- carbocisteine
what is the 2 type of antitussive
- opioid
- non-opioid
list 2 drug from mucokinetic
- bromhexine
- ambroxol (active metabolite)
which pharmacological class does cromogrilic acid belongs to
mast cell stabiliser
give 1 drug example of a mucoregulator
ipratropium bromide
what is the indication of ipratropium bromide & how does it work
for control of severe cold symptoms by decreasing mucus hypersecretion in submucosal gland & goblet cells
what is the class of drug for sore throat, headache & fever
analgesic & antipyretic: NSAIDS eg. ibuprofen/paracetamol
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
C
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
C
*acetylcysteine (mucolytic) should be caution when giving to pt with hx of asthma
which of the following is the most potent antitussive
A) codeine
B) dextromethorphan
C) diphenhydramine
D) acetylcysteine
A
what is 1 contraindication for carbocisteine
contraindicated in patient w PUD
what are the a/e of sympathomimetic agent
- hypertension (due to vasoconstriction)
- tachycardia (for indirect release drug eg. pseudoephedrine & ephedrine)
- rebound congestion (for intranasal)
- CNS: anxiety, insomnia, tremors, irritability
list 2 common a/e of antihistamine
- dry mouth
- sedation
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
- 2nd gen, non sedating drug
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
B
list 2 drugs from nasal corticosteroid & explain the MOA
- fluticasone
- mometasone
- drug reduce inflammation, resulting in reduce congestion & mucus secretion
list 3 adverse effect of ipratropium bromide
- unpleasant taste
- dry mouth
- urinary retention (esp in elderly)
which class of drug should you give for wet (productive) cough
- expectorants
- mucoactive agent (mucolytic, mucokinetic)
what is the route of cromogrilic acid, and explain the MOA
inhalation & intranasal
- decrease mast cell degranulation induced by IgE mediated FcεRI crosslinking
- decrease inflammatory cell mediators secretion by eosinophils, neutrophils & macrophages
- control cl- channel to inhibit cellular activation
- increase annexin A1 secretion, which inhibit PG & leukotriene production
what is the 3 disadvantages of diphenhydramine when use in elderly pt
- increase risk of sedation & confusion
- anticholinergic a/e can cause dementia
- contraindicated in elderly pt w narrow angle glaucoma
why are some patient not compliant to mucolytic
drug give off a strong sulphur taste & smell
which CYP convert codeine to morphine
CYP2D6
list 2 other contraindications (other than age) for mucokinetic drugs
- pt w asthma/hx of asthma
- hx of PUD
what is the MOA of mucokinetic
- increase ciliary beat frequency
- reduce adherence of mucus to cilia
