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Pharmacology > Management Of Cough > Flashcards

Management Of Cough Flashcards

1
Q

What is cough?

A

Useful physiological mechanism that serves to clear the respiratory passages of foreign material and excess secretions

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2
Q

What underlying causes can you look for when treating a cough

A
  • GERD
  • Infection
  • Worms
    -Drugs
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3
Q

List the 5 classes of anticough agents

A
  • Antitussive
  • Antihistamines
  • Pharyngeal demulcents
  • Expectorants
  • Mucolytics
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4
Q

What is the MOA of antitussives

A

Inhibits cough reflex by suppressing cough center in medulla or peripheral receptors

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5
Q

Drugs classified as antitussives

A
  • Codeine central acting
  • Pholcodine and Noscapine
  • Dextromethorphan
  • Benzonatate
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6
Q

Disadvantages of antitussives

A

-Addiction
-Drowsiness
- Constipation
- Respiratory depression

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7
Q

Difference between codeine-central acting drugs and pholcodine

A

-Pholcodine is longer acting than codeine
- Do not have analgesic nor addictive properties
- Do not cause constipation
- Does not interfere with mucociliary movement

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8
Q

Which anticough agent should be avoided in children and asthmatics

A

Codeine and Pholcodine

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9
Q

What is the most widely used cough suppressant

A

Dextromethorphan

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10
Q

What form of administration is available for Dextromethorphan

A

Tablets
Syrup
Spray forms

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11
Q

What receptors are targeted by Dextromethorphan

A

NMDA receptors

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12
Q

What is the therapeutic use of Dextromethorphan

A

Temporary relief of cough caused by minor throat and bronchial irritation

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13
Q

What cough suppressant removes sensation

A

Benzonatate

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14
Q

Which is the drug of choice to suppress cough in patients undergoing bronchoscopy

A

Benzoate

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15
Q

What is the MOA of antihistamines

A

They are H1 receptor antagonists
They target histamine receptors of the smooth muscle.

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16
Q

List first generation H1 receptor antagonists

A

Diphenhydramine
Chlorpheniramine
Cyclizine
Promethazine
Cyproheptadine
Ketorifen

17
Q

List second generation H1 receptor antagonists

A

Cetirizine
Fexofenadine
Loratadine
Desloratadine
Olopatadine
Azelastine

18
Q

What are the major differences between first and second generation antihistamines

A

First generation Antihistamines block both histaminic and muscarinic receptors as well as passing the BBB

Second generation Antihistamines mainly block histaminic receptors and do not pass the BBB

19
Q

Why are second generation antihistamines preferred over first generation

A

Due to their favourable efficacy/safety ratio and lack of cholinergic and sedative side effects

20
Q

Half life of first generation antihistamines

A

4 to 12 hrs

21
Q

Half life of second generation antihistamines

A

12 to 24 hrs

22
Q

What are other therapeutic uses of antihistamines

A
  • H1 blockers have major application in allergies of the immediate type
  • Used as anti motion sickness drugs
  • Morning sickness in pregnancy (Doxylamine and pyridoxine)
  • Appetite stimulants
23
Q

List pharyngeal demulcents

A

Lozenges
Linctus
Honey
Cough drops
Liquorice

24
Q

What is the MOA of pharyngeal demulcents

A

Used when cough arises due to irritation above larynx by protecting irritant receptors in mucosa or respiratory tract

Produce soothing effect on inflamed mucosa

May contain mild local anesthetics

25
Q

What is the MOA of expectorants

A

Increase volume of bronchial secretion

Reduce the thickness, adhesiveness, and surface tension of mucus so cough becomes less tiring and productive

26
Q

What are the two classifications of expectorants

A
  • Directly acting on RT cells ( Guaifenesin)
  • Reflex acting: stimulate the RT secretions by secreting gastric mucosa
    (Ammonium salt, iodides, some bitter herbs like ipecac)
27
Q

What is the MOA of mucolytics

A

Breakdown mucus

28
Q

Examples of mucolytics

A

Bromohexine
Acetyl cysteine

29
Q

What are bland aerosols

A

Drugs that dilute mucus molecules and are known as wetting agents

30
Q

Types of bland aerosols

A
  • Sterile and distilled water (humectant, dense aerosols and asthmatics)
  • Normal (isotonic saline)
  • Hypertonic saline
  • Hypotonic saline
31
Q

MOA of bland aerosols

A

Disruption of disulfide bonds
-Acetyl cysteine breaks the bonds by substituting a sulfhydryl radical

32
Q

Hazards of acetylcysteine

A
  • Bronchospasm
  • Increase mucus secretion
  • Do not mix with antibiotics in the same nebuliser
  • Nausea and vomiting (smells like rotten eggs)
  • Alteration of pH
  • Proteolysis
33
Q

Common side effects of pulmozyne

A
  • Voice alteration
  • Pharyngitis/ laryngitis
  • Rash
34
Q

MOA and side effects of bromohexine

A

Liberates lysosomal enzymes which digest mucopolysaccharides, hence decrease viscosity of sputum

Side effects: rhinorrhea and lacrimation

35
Q

MOA of amiloride

A

It is a sodium channel blocker. In cystic fibrosis, Na+ is absorbed in the epithelium along with H2O, leaving the mucus thick and dehydrated.
By blocking sodium absorption, dehydration of the mucus is prevented.

36
Q

MOA of denusfosol tetrasodium

A

Enhances mucosal hydration and mucus clearance by activating Cl- secretion and inhibiting epithelial Na+ transport

Pharmacology (3 decks)

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