Medicines for Cough And Cold

Question 1

What are the 4 classes of drugs for treatment of rhinorrhoea?

Answer 1

1. Antihistamines
2. Mucoregulators*
3. Mast cell stabilisers*
4. Nasal congestants

*Are only for more severe cases

Question 2

When do we give meds for cough?

Answer 2

If the cough is not beneficial (ie deprving sleep and comfort)

Beneficial -> clear foreign matter/mucus

Question 3

What is used to treat dry cough?

Answer 3

Antitussives

Question 4

What is used to treat wet cough?

Answer 4

Expectorant and mucoactive agents

Question 5

Name a mucoregulator and its MOA

Answer 5

Ipratropium: SAMA, act on M3 muscarinic receptors

Reduce mucus or sputum output

Question 6

Name a mast cell stabiliser and its MOA

Answer 6

Cromoglicic acid

Prevent mast cell degranulation and reduce secretion of inflammatory mediators.

Invrease secretion of annexin A1 (anti inflammatory)

Question 7

List 3 first gen antihistamines

Answer 7

*Diphenhydramine
Chlorpheniramine
*Promethazine
Ketotifen

Question 8

List ALL the 2nd gen antihustamines and which has a little sedative effect

Answer 8

Little sedative: cetirizine

Non sedative:
Loratadine
Fexofenadine

Question 9

List 2 sympathomimetic nasal decongestants

Answer 9

Oxymetazoline
Phenylephrine
Pseudoephedrine
Ephedrine

Question 10

Name an alpha 1 selective sympathomimetic nasal decongestant

Answer 10

Phenylephrine

Question 11

Name a non selective sympathomimetic nasal decongestant

Answer 11

Oxymetazoline
Naphazoline

Question 12

List 2 nasal glucocorticoid (also used in asthma and COPD)

Answer 12

Fluticasone
Budesonide

Question 13

What is the unique property of intranasal fluticasone?

Answer 13

Rose water odour

Question 14

What is the most common adverse effect of sympathomimetic nasal decongestants?

Answer 14

Rebound congestion.

Sustained administration results in compensatory upregulation of the endogenous parasympathetic system.

When stopped, the excess parasympathetic activity continues = increased mucus secretion

Question 15

What is the correct form of putting nasal spray or drip?

Answer 15

Head down or lying down with head tilted over the bed

Question 16

Name an opiod antitussive

Answer 16

Codeine

Question 17

Name 2 non opioid antitussive

Answer 17

Dextromethorphan
Diphenhydramine

Question 18

Which antitussive is prescribed the most?

Answer 18

Dextromethorphan

Question 19

What are the side effects of dextromethorphan?

Answer 19

CNS: drowsiness, dizziness
GIT adverse effects

Question 20

What is the most severe adverse effect of opioid antitussives?

Answer 20

Abuse

Question 21

Name the most commonly prescribed expectorant and its MOA

Answer 21

Guaifenesin

Increase production of respiratory tract fluid to promote more coughing

Question 22

When is guaifenesin not advised to be taken?

Answer 22

NOT for persistent cough associated with asthma or smoking.

Take adequate fluid to make secretions less viscous and protect renal function

Question 23

Name 2 mucoactive agents and what is the brand name?

Answer 23

Acetylcysteine - Flumucil
Carbocisteine

Question 24

What is the MOA of mucolytic agents?

Answer 24

Opens the disulfide bond which lowers mucous viscosity

Question 25

In which group of patients is carbocisteine contraindicated in?

Answer 25

Patients with active peptic ulcers

Question 26

When can mucolytic agents NOT be used?

Answer 26

1. Elderly or debilitated patients with severe respiratory insufficiency
2. Asthmatic patients

Question 27

In which group of patients is cough/cold medications usually not prescribed and why?

Answer 27

Paediatric

For eg, 1st gen antihistamine has risk of respiratory depression in children (promethazine)

Question 28

Which 2 cough medications are okay for geriatric use?

Answer 28

Expectorants - guaifenesin
Mucolytic agents - flumucil/acetylcysteine