meds for cough and cold

Question 1

Name 2 type of medications that are used for severe rhinorrhoea/nasal congestion/post-nasal drip?

Answer 1

MucoregulatorsMast Cell Stabilisers

Question 2

____ is used to control severe cold symptoms by decreasing mucus hypersecretion from goblet cells and submucosal glands

Answer 2

Ipratropium

Question 3

Name a SAMA that is used for severe cold symptoms

Answer 3

Ipratropium

Question 4

Route of administration of Ipratropium?

Answer 4

Intranasal

Question 5

(MOA) Ipratropium ____ inflammation-induced ____ cholinergic receptor _____ which blocks the activation of ______. This leads to a ____ in stimulated mucus output and _____ volume.

Answer 5

Ipratropium blocks inflammation-induced parasympathetic cholinergic receptor M3 which blocks the activation of submucosal glands/ goblet cells. This leads to a decrease in stimulated mucus output and sputum volume.

Question 6

Name 3 side effects of Ipratropium

Answer 6

Unpleasant tasteDry MouthUrinary retention in elderly

Question 7

Name a mast cell stabiliser

Answer 7

Cromoglicic acid

Question 8

Name a medication for severe cold symptom that can be inhaled

Answer 8

Cromoglicic acid

Question 9

(MOA) Cromoglicic acid controls _____ channels to inhibit cellular activation ____ mast cell degranulation induced by ____ mediated FC epsilon receptor crosslinkingDecrease secretion of inflammatory mediators from _____, neutrophils and _________ secretion of Annexin A1

Answer 9

Cromoglicic acid controls chloride channels to inhibit cellular activation Decrease mast cell degranulation induced by IgE mediated FC epsilon receptor crosslinkingDecrease secretion of inflammatory mediators from eosinophils, neutrophils and macrophagesIncrease secretion of Annexin A1

Question 10

What are 3 side effects of Cromoglicic acid

Answer 10

Dry mouthUnpleasant tasteThroat and nasal irritationCough

Question 11

What is the duration of action for 1st gen antihistamines?

Answer 11

4 to 6 hours

Question 12

What is the duration of action for 2nd gen antihistamines?

Answer 12

12 to 24 hours

Question 13

Name 3 antihistamines which are frequently used in oral cough and cold formulations

Answer 13

ChlorpheniramineTriprolidinePromethazine

Question 14

What is one 2nd gen antihistamine that still has a little sedation effect?

Answer 14

Cetirizine

Question 15

What are some examples of sympathomimetic decongestants

Answer 15

“PON PE”P: PhenylephrineO: OxymetazolineN: NaphazolineP: PseudoepedrineE: Epedrine

Question 16

(MOA) Sympathomimetic decongestants are direct _____ adrenoceptor ____ thus having the effect of ____ of nasal blood vessels. It also reduces _____ and secretion of ____.

Answer 16

Sympathomimetic decongestants are direct alpha-adrenoceptor agonist, thus having the effect of vasoconstriction of nasal blood vessels. It also reduces inflammation and secretion of mucus.

Question 17

Route of administration of nasal glucocorticoid?

Answer 17

Intranasal

Question 18

Name 2 sympathomimetic decongestant that can be taken orally

Answer 18

PhenylephrinePseudoephedrine (think of the Ps)

Question 19

Fluticasone and mometasone are examples of nasal _____

Answer 19

Glucocorticoid

Question 20

Which sympathomimetic decongestant is alpha 1 selective?

Answer 20

Phenylephrine

Question 21

List 2 examples of non-selective sympathomimetic decongestant

Answer 21

OxymetazolineNaphazoline

Question 22

Pseudoepedrine and ephedrine are examples of _____ sympathomimetic decongestants

Answer 22

Indirect

Question 23

Name a side effect which occurs with prolonged use of topical intranasal decongestants

Answer 23

Rebound congestion

Question 24

In a patient with hypertension or other CVS history, ___ sympathomimetic agent should be avoided as it can cause the side effects of palpitations and hypertension.

Answer 24

Indirect due to B1 effects(Alpha adrenoceptor agonist would be preferred)

Question 25

Antitussives are used for dry or wet cough?

Answer 25

Dry Cough

Question 26

What is the most effective non-opioid antitusive?

Answer 26

Dextromethorphan

Question 27

What is the most potent antitusive but has the potential for abuse

Answer 27

Codeine

Question 28

(MOA) Codeine acts in ___ to suppress cough

Answer 28

CNS

Question 29

List 3 adverse effects of Codeine

Answer 29

SedationRespiratory depressionPotential for abuse at high dose

Question 30

Codeine needs to be used with caution as it is a CYP___ ultra-rapid metabolizer which means that codeine will be more rapidly converted to the more potent opioid morphine, hence increasing the risk of opioid adverse effect.

Answer 30

CYP2D6

Question 31

Can a 10 year old patient be prescribed codeine?

Answer 31

Not recommended for <18 years old

Question 32

What is the typical adult dose for dextromethorphan?

Answer 32

10 to 30mg every 4 to 8 hours

Question 33

List any 3 adverse effects of Dextromethorphan

Answer 33

DrowsinessDizzinessConfusionNausea Vomitting

Question 34

Dextromethorphan is an opioid. True or False?

Answer 34

False. Opiate but not opioid

Question 35

Which receptor does Dextromethorphan at high dose block?

Answer 35

NMDA receptor blocker

Question 36

Expectorants are used for dry or wet cough?

Answer 36

Wet cough

Question 37

Name one example of an expectorant

Answer 37

Guaifenesin

Question 38

(MOA) Guaifenesin **increase/decrease** production of respiratory tract fluids to help liquefy and **increase/decrease** viscosity of tenacious secretions

Answer 38

Guaifenesin **increase** production of respiratory tract fluids to help liquefy and **decrease** viscosity of tenacious secretions

Question 39

Can guaifenesin be used for a 1 year old patient?

Answer 39

Not indicated < 2 years oldCaution < 6 years old

Question 40

List 2 adverse effect of guaifenesin

Answer 40

GI disturbancesNausea

Question 41

Name 2 examples of mucolytics

Answer 41

AcetylcysteineCarbocisteine

Question 42

Name a medication that smells and taste strongly of sulfur (rotten egg smell)

Answer 42

Acetylcysteine

Question 43

Can asthmatics be prescribed Acetylcysteine?

Answer 43

Avoided or use with caution as Acetylcysteine has the side effect of bronchospasm

Question 44

Carbocisteine is contraindicated in patients with _____

Answer 44

Active peptic ulcer

Question 45

What medication is safe for use for patients under 6 months old

Answer 45

Usually not to mediate and observe closely while infection recovers within 3 to 7 days

Question 46

Name a cough and cold medication that is safe for geriatric use

Answer 46

Expectorant (Guaifenesin)Mucolytic (Acetylcysteine)Decongestants (Pseudoephedrine, phenylephrine)

Question 47

Can a elderly patient be prescribed dextromethorphan?

Answer 47

Not recommended as elderly are more susceptible to sedation and confusion

Question 48

60 year old Mr Lim presents to your clinic with cough and cold, has a history of hypertension and narrow angled glaucoma. P1. What medications are contraindicated for him? P2. What medication would you prescribe?

Answer 48

P1. Antihistamines, Diphenhydramine, Pseudoepedrine, PhenylephrineP2. Guaifenesin / Acetylcysteine

Question 49

Name a Mucokinetic and its metabolite

Answer 49

Bromhexine and its active metabolite ambroxol

Question 50

how does a mucokinetic work

Answer 50

promotes mucus clearance - increases ciliary beat frequency - decreases adherence of mucus to cilia stimulate surfactant production antioxidant as free radical scavenger anti-inflammatory by decreasing cytokines suppresses influenza virus multiplication local anaesthetic by blocking voltage gated Na channels

Question 51

side effects of mucokinetic

Answer 51

allergic reaction cutaneous adverse effects avoid in patients with history of asthma and peptic ulcer disease caution<6 yrs old not indicated<2 yrs old