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Respiratory System > Drugs for Cough and Cold > Flashcards

Drugs for Cough and Cold Flashcards

1
Q

What are the drugs for a beneficial cough?

A

None, do not medicate

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2
Q

What are the drugs for a non-beneficial dry cough?

A

Antitussives:
1) Codeine
2) Dextromethorphan
3) Diphenhydramine

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3
Q

What are the drugs for a productive non-beneficial cough?

A

1) Expectorants:
- Guanifesin

2) Mucolytics:
- Acetylcysteine
- Carbocisteine

3) Mucokinetic
- Bromhexine/ambroxol

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4
Q

What are the drugs for rhinorrhoea/nasal congestion/post-nasal drip?

A

1) Mucoregulator
- Ipratropium

2) Mast cell stabiliser
- cromoglicic acid

3) Antihistamine

4) Decongestants
- sympathomimetics
- nasal glutocorticoids

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5
Q

What is the moa of ipratropium?

A

Mucoregulator:
- SAMA → blocks M3 activation of submucosal/goblet cells mucus secretion
- ↓mucus and sputum

(does not dry basal secretion/↑ viscosity)

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6
Q

What are 2 AEs of ipratropium?

A

Few as little enters systemic circulation via intranasal route:
- unpleasant taste
- dry mouth
- urinary retention in elderly

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7
Q

Why is compliance in px Rx Ipratropium and Cromoglicic acid a concern?

A

Both have unpleasant/bitter taste

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8
Q

What is the moa of Cromoglicic acid?

A

Mast cell stabiliser:
Controls Cl- channels → inhibit cellular activation
1) ↓mast cell granulation by IgE FcεRI crosslinking

2) ↓secretion of inflammatory mediators from eosinophils, neutrophils, macrophages

3) ↑secretion of annexin A1 → inhibit prostaglandin and leukotriene production

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9
Q

What are 2 AEs of cromoglicic acid?

A

1) Unpleasant/bitter taste
2) Throat/nasal irritation
3) Mouth dryness
4) Cough

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10
Q

What are 2 nasal glucocorticoids used as nasal decongestants?

A

1) Fluticasone (rose water odor)
2) Mometasone

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11
Q

What is the moa of nasal glucocorticoids (eg. fluticasone, mometasone)?

A

Anti-inflammatory (COX inhibition → ↓PGI2 and PGE2) → ↓congestion and mucus secretions

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12
Q

What is the main AE of nasal glucocorticoids (eg. fluticasone, mometasone)?

A

Local mucosal dryness and irritation
(Systemic side effects limited by intranasal delivery)

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13
Q

How is ipratropium administered?

A

Intranasal/oral inhalation

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14
Q

How is Cromoglicic acid administered?

A

Intranasal/inhaled

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15
Q

How are nasal glucocorticoids (eg. fluticasone, mometasone) administered?

A

Intranasal

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16
Q

How are sympathomimetics used ass decongestants administered?

A

Oral or intranasal

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17
Q

What are 3 examples of sympathomimetic agents used as nasal decongestants?

A

1) Direct α adrenoceptor agonists
a) α-1 selective: Phenylephrine (oral or intranasal)
b) Non-selective: Oxymetazoline (intranasal) / naphazoline (intranasal)

2) Indirect ↑ NE/E release
a) Pseudoephedrine (oral) / Ephedrine (intransal)

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18
Q

What is the moa of sympathomimetics used as nasal decongestants?

A

α-agonism / Indirect → ↑NE/E
→ Vasoconstriction of nasal blood vessels → ↓ inflammation and mucus secretion

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19
Q

What are 3 AEs of sympathomimetic agents used as nasal decongestants (eg. phenylephrine, pseudoephedrine)?

A

1) Rebound congestion
- prolonged (>days) use of topical intranasal decongestants

2) CNS stimulation
- more likely with oral decongestants
- restlessness, tremors, irritability, anxiety, insomnia

3) CVS
- more likely with oral decongestants
- HTN (2° to vasoconstriction)
- Tachycardia (indirect sympathomimetics eg. pseudoephedrine)

20
Q

When are nasal glucocorticoids (eg. fluticasone, mometasone) contraindicated?

A

<4 y/o

21
Q

When are sympathomimetic agents used as nasal decongestants (eg. phenylephrine, pseudoephedrine) contraindicated?

A

Caution in elderly and <12 y/o

22
Q

What are 3 antitussives?

A

In order of potency, decreasing order of addictiveness

Opioid:
1) Codeine

Non-opioid:
2) Dextromethorphan
3) Diphenhydramine

23
Q

What are 2 AEs of using codeine as an antitussive?

A

1) CNS sedation
2) Abuse @ high dose (weak opioid)
3) Respiratory depress (only at @ dose)
- risk in px with severe respiratory insufficiency
4) Do not combine with other CNS depressants
5) Do not combine with CYP2D6 ultra-rapid metabolisers

24
Q

What are 2 AEs of using dextromethorphan as an antitussive?

A

1) CNS:
- drowsiness, dizziness, confusion, insomnia, excitement, nervousness

2) GIT
- nausea, vomiting, stomach pain

3) Abuse at high dose
- dissociative anaesthetic-like effect

4) Others:
- nonselective serotonin reuptake inhibitor
- sigma-1 receptor agonist
- (at high-dose) NMDA receptor block

25
Q

What are 2 AEs of using Diphenhydramine as an antitussive?

A

1) Sedative
2) Anticholinergic

26
Q

How antitussives (eg. codeine, diphenhydramine, dextromethorphan) administered?

A

Oral

27
Q

How are expectorants (eg. guaifenesin) administered?

A

Oral

28
Q

When is codeine contraindicated?

A

1) <18
2) With other CNS depressants
3) With other CYP2D6 ultra-rapid metabolisers

29
Q

When is dextromethorphan not recommended?

A

<4 years old

30
Q

What is the moa of guaifenesin?

A

↑ production of respiratory tract fluids → liquefy + ↓ viscosity of tenacious secretions

31
Q

What are 2 AEs of guaifenesin?

A

1) GI disturbances
2) Nausea

32
Q

What should px taking guaifenesin be advised?

A

Take adequate fluid to make secretions less viscous and protect renal function (nephrolithiasis reported on overdose)

33
Q

When is guaifenesin contraindicated?

A

1) <2 y/o (caution <6)
2) persistent cough associated with asthma or smoking

34
Q

When are mucolytics (eg. acetylcysteine, carbocisteine) contraindicated?

A

1) Elderly or debilitated px with severe respiratory insufficiency
2) px with asthma
3) Carbocisteine for px with active PUD

35
Q

How are mucolytics (eg. acetylcysteine, carbocisteine) administered?

A

1) Inhalation
2) Effervescent tablets
3) Oral granule/syrups

36
Q

What is the moa of mucolytics (eg. acetylcysteine, carbocisteine)?

A

Free sulfhydryl group opens disulphide bonds in mucoproteins → ↓ mucous viscosity

37
Q

What are 2 AEs of mucolytics (eg. acetylcysteine, carbocisteine)?

A

1) Bronchospasm
2) Anaphylactoid rxns (rash, hypotension, dyspnea, wheezing)
3) GI disturbances

38
Q

What are 2 examples of mucolytics?

A

1) Acetylcysteine
2) Carbocisteine

39
Q

What is an example of an expectorant?

A

Guaifenesin

40
Q

What is an example of a mucokinetic?

A

Bromhexine
and its active metabolite ambroxol

41
Q

What is the moa of mucokinetics (eg. bromhexine, ambroxol)

A

Mucokinetic: promotes mucus clearance
1) ↑ ciliary beat frequency
2) ↑ adherence of mucus to cilia
3) Stimulate surfactant production (prevent mucus sticking to walls)
4) Antioxidant as free radical scavenger
5) Anti-inflammatory by ↓ cytokines
6) Suppresses influenza virus multiplication
7) Local anesthetic by blocking voltage-gated Na+ channel

42
Q

What are 2 AEs of mucokinetics (eg. bromhexine, ambroxol)?

A

1) Allergic rxn
2) Cutaneous AEs

43
Q

When should mucokinetics (eg. bromhexine, ambroxol) be avoided?

A

1) px with Hx of asthma and PUD
2) caution <6 y/o
3) contraindicated <2y/o

44
Q

What is the best medication for cough and cold in pediatric px?

A

None, just observe, mostly self-limiting.

45
Q

Which of the cough and cold medications are safe for pediatric use?

A

None <2y/o

46
Q

Which of the cough and cold medications are safe for geriatric use?

A

1) expectorants (Guaifenesin)
2) Mast cell stabilisers (Cromoglicic acid)
3) Mucoregulators (Ipratropium)
4) Nasal glucocorticoids (fluticasone, mometasone)

Respiratory System (10 decks)

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