Pharm--Decongestants, Cough Suppressants, & Expectorants

Question 1

Explain the cough sensors and signals

Answer 1

Cough receptors in airway and distal esophagus send vagus signals to cough center in cerebral cortex; efferents coordinate muscle responses

Question 2

Acute cough definition

Answer 2

less than 3 wks

Question 3

Subacute cough definition

Answer 3

3-8 wks

Question 4

Chronic cough def

Answer 4

> 8 wks

Question 5

Dextromethorphan MOA

Answer 5

Direct suppression of medulla cough center in brain

Question 6

Dex Metabolism notable for

Answer 6

Prodrug metabolized by CYP2D6 to active metabolite

Question 7

Dextromethorphan vs codeine?

Answer 7

Equipotent but dex isn’t opioid!

Question 8

Dex side effects

Answer 8

Dizziness/lightheadedness, drowsiness, N/V/D, irritability, excitability, insomnia

So, CNS and GI

Question 9

Dex C/I

Answer 9

MAOIs, anti-depressants, hepatic disease

Question 10

Diphenhydramine MOA

Answer 10

H1 receptor antagonist that suppresses cough center directly in medulla (anticholinergic properties)

Question 11

Benadryl side effects

Answer 11

Sleepiness, respiratory depression, blurry vision, dry mouth, urinary retention, constipation

Question 12

Benadryl C/I

Answer 12

Prostatic hyperplasia, urinary obstruction, ASTHMA, COPD, MAOIs

Question 13

Codeine MOA

Answer 13

Acts on mu receptors and depresses cough center in CNS directly

Question 14

Codeine side effects

Answer 14

Constipation, sedation, histamine release, vasodilation, orthostatic hypotension, dizziness

Question 15

Codeine C/I

Answer 15

Pregnancy, prostatic hypertrophy, sedatives, ARD, ASTHMA, COPD

Question 16

Guaifenesin MOA

Answer 16

Increases mucosal volume and reduces viscosity

Question 17

Guaifenesin AEs

Answer 17

dizziness, dry mouth, rash, N/V/D, stomach pain, hyperuricemia

Question 18

Most nasal decongestants act in this way

Answer 18

Vasoconstriction to reduce congestion without affecting histamine release or other mediator levels

Question 19

Nasal decongestants MOA

Answer 19

Alpha agonist (sympathomimetic) but constricts blood vessels throughout the body

Reduces blood supply to nose, decreasing amount in sinusoid vessels and dec edema

Question 20

Pseudoephedrine MOA

Answer 20

Release of NE from adrenergic nerves

Question 21

Phenylephrine (PE) MOA

Answer 21

Direct stimulation of adrenergic receptors on postsynaptic sites

Question 22

PE metabolism

Answer 22

Rapidly metabolized in GI mucosa, liver, …

Question 23

Compare metabolism of PseudoD and PE

Answer 23

Pseudo is only minimally metabolized, 88% excreted unchanged in 36 hrs; PE is metabolized quickly

Question 24

Side effects of systemic decongestants

Answer 24

CV stimulation, CNS stimulation, and rebound congestion (ischemia from local vasoconstriction)

Question 25

Sudafed and Suda PE C/I

Answer 25

Children, elderly, bradycardia, HyperT, heart block, HTN, v Tach

Question 26

Oxymetazoline trade name

Answer 26

Afrin

Question 27

Guaifenesin as expectorant MOA

Answer 27

At high doses, stimulates bronchial gland secretion

Question 28

N-Acetyl cysteine MOA

Answer 28

Breaks mucus S-S bond

Question 29

N-acetyl cysteine alternative indication

Answer 29

reverse tylenol overdose (or prevent)

Question 30

Mucolytics that interrupt sulfide bridges - AEs with asthma

Answer 30

Bronchospasm - esp prob with ASTHMA

If used with asthma, use bronchodilator

Question 31

Mucolytics that interrupt sulfide bridges - AEs

Answer 31

N/V, bad odor (sulfur), can’t use with antibiotics at once, inc mucus production so use SUCTION

Question 32

Amiloride MOA

Answer 32

Na channel blocker diuretic; blocks Na reabsorption in CF and keeps mucus hydrated

Question 33

Use these for dry coughs

Answer 33

Antitussives

Question 34

Use these for productive coughs

Answer 34

Expectorants