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Respi > Meds for cough and cold > Flashcards

Meds for cough and cold Flashcards

1
Q

Classes of drugs to treat runny nose/sneezing

A

Intranasal ipratropium (mucoregulator)
Intranasal/inhaled cromoglicic acid
H1 antihistamines
Intranasal corticosteroid

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2
Q

Class of drugs to treat sore throat and headache

A

Analgesics

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3
Q

Class of drugs to treat fever

A

Antipyretic

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4
Q

Class of drugs to treat blocked nose

A

Nasal decongestant

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5
Q

Class of drugs to treat dry cough

A

Cough suppressants/antitussive

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6
Q

Class of drugs to treat wet cough

A

Expectorants and mucoactive agents

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7
Q

What is a common cold?

A

Viral infection of URT
- cough and cold meds for symptomatic relief only
- usually resolve within 3-7 days

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8
Q

Pathophysio of common cold that causes nasal congestion

A

Viral infection -> trigger mast cell degranulation -> release histamine and inflammatory mediators -> inflammation -> vasodilation and excess mucus production -> nasal congestion/rhinorrhea

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9
Q

What is post-nasal drip?

A

When mucus drip and irritate back of throat

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10
Q

Associations of nasal congestion

A

Decreased sympathetic vasoconstriction of submucosal blood vessels

Increased parasympathetic stimulation of mucus secretion

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11
Q

Eg of mucoregulator

A

Ipratropium -> M3 antagonist

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12
Q

Uses of mucoregulators

A

Used to control sever cold symptoms

Decrease mucus hypersecretion from goblet cells and submucosal glands

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13
Q

MOA of ipratropium

A

Short acting muscarinic receptor antagonist (SAMA)

Blocks inflammation-induced parasympathetic cholinergic receptor (M3) activation of submucosal glands/goblet cells

Decrease stimulated mucus output and sputum vol

DOES NOT dry basal secretion/increase normal viscosity

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14
Q

Side effect of ipratropium

A

Few as little enters systemic circulation via intranasal route

Unpleasant taste -> non-compliance

Dry mouth

Urinary retention in elderly -> indicates that a lot of the drug is entering systemic circulation

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15
Q

What kind of drug is cromoglicic acid?

A

Mast cell stabiliser

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16
Q

MOA of cromoglicic acid

A

Controls Cl- channels to inhibit cellular activation

Decrease mast cell degranulation induced by IgE-mediated Fc epsilon RI crosslinking

Decrease secretion of inflammatory mediators from eosinophils, neutrophils and macrophages

Increase secretion of annexin A1
- annexin A1 inhibits prostaglandin and leukotriene pdtn

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17
Q

Side effects of cromoglicic acid

A

Throat and nasal irritation, mouth dryness, cough

Unpleasant/bitter taste -> non-compliance

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18
Q

Uses of antihistamine

A

Treat rhinorrhea

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19
Q

Eg of decongestants

A

Sympathomimetic agents
- phenylephrine, oxymetazoline, naphazoline, pseudoephedrine, ephedrine

Nasal glucocorticoid
- fluticasone, mometasone

NOTE: intranasal more effective than oral

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20
Q

MOA of sympathomimetic agents

A

Direct alpha adrenoceptor agonist
- alpha-1 selective: phenylephrine
- non-selective: oxymetazoline/naphazoline

Indirect increase in release of adrenaline/noradrenaline
- pseudoephedrine/ephedrine

Vasoconstriction of nasal blood vessels

Reduce inflammation and secretion of mucus

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21
Q

Administration of nasal glucocorticoid

A

Intranasal

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22
Q

MOA of nasal glucocorticoid

A

Anti-inflammatory -> decrease inflammation -> decrease congestion and mucus secretions

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23
Q

Notable feature of fluticasone

A

Rose water odour -> pt can’t tolerate -> non-compliance

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24
Q

Adverse effects of sympathomimetics

A

Rebound congestion
- occurs w/ prolonged use of topical intranasal decongestants -> compensatory upregulation of endogenous parasympathetic sys

CNS stimulation
- more likely w/ oral decongestants
- restlessness, tremors, irritability, anxiety and insomnia

CVS
- via activation of alpha adrenoceptors
- more likely oral decongestants
- hypertension due vasoconstriction
- tachycardia

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25
Q

Adverse effects of glucocorticoids

A

Systemic side effects limited by intranasal delivery

Local mucosal dryness and irritation

26
Q

Proper way to deliver nasal drops and sprays

A

Lie down and tilt head back before applying drops/bend body forward all the way down and apply drops
- as long as body is not put in a position that can allow medication to be easily ingested (i.e: standing)

27
Q

Why should you know over-the-counter cough and cold formulations?

A

To avoid prescribing drugs in the same class to pts

28
Q

What is cough?

A

Defense reflex mechanism to clear upper airways

29
Q

Eg of protussive stimuli

A

Cigarette smoke

Bradykinin

PGE2

Histamine

TNF-alpha

30
Q

Management of cough

A

Elimination of precipitating factor and treatment of underlying cause

31
Q

Pathophysio of cough

A

Sensory input to brainstem nuclei regulating cough generation -> antitussive and cough suppressants work in CNS to suppress cough

32
Q

How are antitussives classified? Which one is more potent?

A

Opioid antitussives
- more potent

Nonopioid antitussives

33
Q

Eg of opioid antitussives

A

Codeine

34
Q

Pros and cons of codeine

A

Pros
- most effective/potent antitussive

Cons
- potential for abuse
- sedation
- respi depression on overdose
- risk in pts w/ severe respi insufficiency

35
Q

Eg of nonopioid antitussives

A

Dextromethorphan
- most potent antitussive among nonopioid class

Diphenhydramine
- 1st gen antihistamine

36
Q

Pros and cons of dextromethorphan

A

Pros
- less risk of addiction
- most effective non-opioid antitussive

Cons
- drowsiness, dizziness
- GIT adverse effects
- potential for abuse at high doses

37
Q

Pros and cons of diphenhydramine

A

Pros
- no risk of addiction

Cons
- sedation
- anticholinergic adverse effects

38
Q

MOA of codeine

A

Acts in CNS to suppress cough

39
Q

Cautions to take when prescribing codeine

A

CYP2D6 ultra-rapid metabolisers -> more codeine rapidly converted to morphine -> greater risk of opioid adverse effect if dose is not adjusted

Children more sensitive to opioid-induced respi depression as respi centres and livers are not fully developed -> not recommended for those <18 yrs old

40
Q

Uses of dextromethorphan

A

Non-productive cough

41
Q

MOA of dextromethorphan

A

Acts in CNS to suppress cough

42
Q

Adverse effects of dextromethorphan

A

CNS -> drowsiness, dizziness, confusion, insomnia, excitement, nervousness
- last 3 exp at higher doses

GIT -> nausea, vomiting, stomach pain

Abuse potential at high dose -> dissociative anaesthetic-like effect

43
Q

Opiate vs opioid

A

Opiate
- chemical derived from components of opium

Opioid
- agonist at opioid receptor

44
Q

Actions of opiate

A

Nonselective serotonin reuptake inhibitor

Sigma-1 receptor agonist

NMDA receptor blocker at high dose

45
Q

MOA of diphenhydramine

A

Antihistamine

MOA of antitussive action unknown

46
Q

Adverse effects of diphenhydramine

A

Sedative

Anticholinergic

47
Q

What kind of drug is guaifenesin?

A

Expectorants
- promote coughing -> increased fluid in airways stimulates more coughing

48
Q

Uses of guaifenesin

A

Wet cough

49
Q

Dosage forms of guaifenesin

A

Oral soln

Tablet

50
Q

MOA of guaifenesin

A

Increases pdtn of respi tract fluids to help liquefy and reduce viscosity of tenacious secretions

51
Q

Adverse effects of guaifenesin

A

GIT disturbance

Nausea

52
Q

Advise to pts when prescribing guaifenesin

A

Not for persistent cough associated w/ asthma/smoking

Take w/ adequate fluid to make secretions less viscous and protect renal fn
- kidney stones reported on overdose

53
Q

Is guaifenesin suitable for children?

A

Caution <6 yrs old

Not indicated < 2 yrs old

54
Q

Eg of mucolytics and their dosage forms

A

Acetylcysteine, carbocisteine

Inhalation, effervescent tablets, oral granules, syrups

55
Q

Disadvantage of mucolytic agents

A

Smells and tastes strongly of sulphur -> non-compliance

56
Q

MOA of mucolytics

A

Free sulfhydryl grp opens disulphide bonds in mucoproteins -> lowers mucus viscosity

57
Q

Adverse effects of mucolytics

A

Bronchospasm -> used w/ caution for pts w/ asthma

Anaphylactoid rxns -> rash, hypotension, dyspnea, wheezing

GIT disturbance -> carbocisteine contraindicated in pts w/ active peptic ulcer

58
Q

What grp of pts req caution when administering mucolytics?

A

Elderly/debilitated pts w/ severe respi insufficiency

Pts w/ asthma

59
Q

Eg of mucokinetics

A

Bromhexine

Ambroxol
- active metabolite of bromhexine

60
Q

MOA of mucokinetics

A

Promote mucus clearance
- increase ciliary beat freq
- decrease adherence of mucus to cilia

Stimulate surfactant pdtn
- surfactant is an anti-glue factor to prevent mucus from sticking to alveolar and bronchial walls

Antioxidant as free radical scavenger

Anti-inflammatory by decreasing cytokines

Suppresses influenza virus multiplication

Local anesthetic by blocking voltage-gated Na+ channel

61
Q

Potential side effects of mucokinetics

A

Allergic rxns

Cutaneous adverse effects

Avoid in pts w/ hist of asthma and peptic ulcer disease

Caution < 6yrs old

Not indicated < 2 yrs old

62
Q

Is cough and cold medication safe for paediatric use?

A

Usually don’t medicate, only observe closely as infection takes its normal course
- under 2 yrs usually not recommended
- 2 yrs and above use w/ caution

Respi (16 decks)

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