Drugs For Cough

Question 1

Prolonged wheezy coughing

Answer 1

• Severe asthma

* COPD

Question 2

Feeble non explosive bovine cough with hoarseness

Answer 2

• Lung cancer

* Neuromuscular disorders

Question 3

Harsh, barking, painful cough with hoarseness and stridor

Answer 3

• Laryngeal inflammation
• Infection
• Tumour

Question 4

Moist cough with secretions

Answer 4

• Bronchial infection

* Bronchiectasis

Question 5

Persistent moist smoker cough 1st thing in morning

Answer 5

• Chronic bronchitis

Question 6

Dry, centrally painful, non-productive cough

Answer 6

• Tracheitis

* Pneumonia

Question 7

Chronic dry cough

Answer 7

Interstitial lung disease eg. Idiopathic pulmonary fibrosis

Question 8

Nocturnal cough disrupting sleep

Answer 8

Asthma

Question 9

Drug categories

Answer 9

• Peripherally acting agents
• Expectorants
• Centrally acting agents (anti tussives)
• Miscellaneous agents

Question 10

Peripherally acting agents type

Answer 10

Pharyngeal demulcents

Question 11

Expectorants types

Answer 11

• Bronchial secretion enhancers

* Mucolytics

Question 12

Centrally acting agents types

Answer 12

• Opioides

* Non-Opioides

Question 13

Miscellaneous agents types

Answer 13

• Decongestants
• Antihistamines
• Bronchodilators

Question 14

Pharyngeal demulcents examples

Answer 14

• Syrups
• Lozenges
• Linctus

Question 15

Pharyngeal demulcents MOA

Answer 15

• Glutinously coat the pharynx - reduces afferent stimuli

Question 16

Cough arising below larynx remedy

Answer 16

• Steam inhalation with compound benzoin tincture, menthol or eucalyptus

Question 17

Expectorants MOA

Answer 17

• Increases bronchial gland secretion (which can be easily removed)

Question 18

Bronchial secretion enhancers examples

Answer 18

• Sodium or potassium citrate

* Potassium iodide

Question 19

Expectorants ADR

Answer 19

• Abdominal pain
• Nausea
• Vomiting

Question 20

Expectorants contraindications

Answer 20

• Children: iodism, goitre (iodides)

* Nursing/pregnant mothers: hyperthyroidism, hyperkalemia

Question 21

Mucolytics examples

Answer 21

• Bromhexine
• Ambroxol
• Acetyl cysteine

Question 22

Bromhexine MOA

Answer 22

• Depolymerises mucopolysaccharide and liberates lysosomal enzymes
• Induces thin copious bronchial secretion

Question 23

Bromhexine side effects

Answer 23

• Rhinorrhea
• Lacrimation
• Gastric irritation

Question 24

Acetyl cysteine MOA

Answer 24

Opens disulfide bonds in mucoproteins

Question 25

Acetyl cysteine indication

Answer 25

``` Respiratory disease with excessive/viscous mucoid secretion • Bronchitis • Bronchiectasis • Asthmatic bronchitis • Emphysema ```

Question 26

Antitussives MOA

Answer 26

Inhibits cough centre in medulla

Question 27

Opioids examples

Answer 27

* Codeine * Pholcodeine * Methadone * Noscapine

Question 28

Non opioids example

Answer 28

Dextromethorphan

Question 29

Antitussives indication

Answer 29

Used for dry/hazardous cough

Question 30

Codeine MOA

Answer 30

* More selective for cough centre * Suppresses cough for 6 hours * Naloxone (opioid antagonist) blocks action

Question 31

Codeine ADR

Answer 31

* Abuse liability * Constipation * Respiratory depression/drowsiness

Question 32

Codeine CI

Answer 32

asthmatics

Question 33

Dextromethorphan properties

Answer 33

* Synthetic opioid derivative * Does not depress mucociliary function * Action not blocked by Naloxone

Question 34

Dextromethorphan indication

Answer 34

* Irritating/hacking cough | * Cough due to bronchitis, common cold, pharyngitis, laryngitis, tonsillitis, URTI

Question 35

Dextromethorphan advantages

Answer 35

* No respiratory depression * No analgesic action * No addictive property * No narcosis * Less constipation * Less GI irritation

Question 36

Decongestants examples

Answer 36

Topical: oxymetazoline, xylometazoline, Phenylephrine Oral: Pseudoephedrine

Question 37

Antihistamines examples

Answer 37

* Chlorpheniramine * Diphenhydramine * Promethazine

Question 38

Bronchodilators examples

Answer 38

* Salbutamol | * Terbutaline

Question 39

Management of acute cough

Answer 39

• Treat cause • Antibiotics - pencillins, erythromycin, doxycycline • Choice of drugs: Dextromethorphan and cough suppressants Antihistamines and decongestants

Question 40

Management of persistent cough

Answer 40

* Codeine/Pholcodeine for dry cough disturbing sleep * Morphine: dry cough in patients with terminal illness * Expectorants: reduce viscosity of sputum * Inhalation of steam