Pharmacology cough Flashcards by Katya Angoua

Cough

Protective reflex that removes foreign material and secretions from the bronchi and bronchioles

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What trigger cough

Inflammation in the respiratory tract

Undiagnosed asthma
Chronic reflex with aspiration
neoplasia
adverse effects of drugs such as angiotensin converting enzyme inhibitor’s

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Cough physiology

Ion channel opening on vagus nerve due to signal (tRPV activation, cytokines release due to inflammation, mechanoreceptor from mass)

Nerve send signal to central cough generator
Central cough generator send signal to other nerves ( phrenic, recurrent laryngeal, spinal motor) to act in muscles for cough ( diaphragm, intercostal muscles, laryngeal muscles, abdominal muscle )

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Two types of cough

Productive which expels secretion and exudates

unproductive due to local irritation

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Class of drugs usedfor cough

Antitussives
Expectorants
Mucolytics

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Antitussives action

Inhibit or suppress coughing so should not be used in productive cough

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When are antitussives useful

Dry painful cough associated with bronchial carcinoma

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When should you avoid Antitussives

Chronic pulmonary infection ( undesirable thickening and retention of sputum)

Asthma ( respiratory depression possible)

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2 classes of anti tussives

Centrally acting

Peripherally acting

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2 classes of centrally acting antitussive

Addicting

Non addicting

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2 classes of addicting centrally acting antitussive

Potent addicting

Less potent addicting

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Peripherally non addicting 2 sub classes

Opioid derivatives

Mon opioid derivative

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Centrally acting antitussive MOA

Depression of medullary center or higher centres

Increased treshold of cough center

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Peripherally acting antitussive MOA

Interruption of tussle impulses from respiratory tract

Soothing effect

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Potent addicting central antitussive

Morphine

Dihydromorphinone

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Less Potent addicting central antitussive

Codeine

Dihydrocodeine u

Pholcodine

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Non addicting central antitussive opioid derivatives

Dextromethorphan

Noscapine

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Non addicting central antitussive non opioid derivatives

Benzonatate

Diphenhydramine (1st gen antihistamine)

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Peripheral antitussive pharyngeal demulcent

Natural : 
Pectin 
Glycerin
Honey 
Syrup

Synthetic :

Methylcellulose
Propylene glycol
Glycerin

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Peripheral antitussive steam inhalation

Tincture of benzoin/ menthol

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Peripheral antitussive local anesthetic activity

Benzonatate

Lidocaine

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Pharyngeal demulcents

Soothing action on irritated mucosa

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Benzonatate action

Both central and peripheral also have anesthetic effect on stretch receptor

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Peripheral antitussive use

Dry unproductive cough

If cough unduly and tiring
Disturbs sleep

Hernia ,piles of abdominal surgery

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Codeine action

Increase treshold for cough

Codeine time of action

Suppress cough for 6h

Antagonist of codeine

Naloxone which suppresses antitussive action

Adverse effect of codeine

``` Constipation Respiratory depression Drowsiness Impaired driving Not used in asmathicd and low respiratory reserve ```

Pholcodine action ( homocodeine)

Centrally suppress center in medulla

Duration action of pholcodine

Longer acting - 12h

Adverse effect of pholcodine

Nausea | Drowsiness

Noscapine MOA

Depresses cough No dependance Same efficacy as codeine

Noscapine adverse effect

Headache | Nausea

Main use of noscapine

Spasmodic cough

Dextromethorphan MOA

No CNS depression

Dextromethorphan duration of action

Can baladine inhibit Dextromethorphan

No because does not work through opioids receptors

Dextromethorphan side effects

Diziness Nausea Drowsiness Ataxia

Levopropoxyphene

Non addicting No opioid effect Sedative property

Antihistamines MOA In cough

Non addicting antitussive Relive cough by sedation and anticholinergic effect Lack selectivity for cough center

When do you use antihistamine in cough

Allergic cough and may reduce secretion by anticholinergic action

Antihistamine most common

Diphenhydramine Promethazine

Why are 2ndgen qntihkstamine not usd

Because cannot cross BBB so no sedative effect

Linctus

Thick liquid preparation with sucrose and medicinal substance Sedative and demulcent properties

Throat lozenges

Small medicated tablets that dissolve slowly in mouth Lubrication and soothing effect on throat Fontaine benzocaine or Dextromethorphan

Bronchodilators

b2 agonist Used when cough due to bronchospasm

Use of bronchodilators

Only when patient has bronchial hyperactivity

Example of bronchodilators

Salbutamol | Terbutaline

Benzonatate

Antitussive action on stretch or cough receptor in lungs | Central effects too

Benzonatate adverse effect

``` Headache Dizziness Pruritis Nasal congestion Burning of eyes Tightness In chest ```

Expectorant (bronchomucotropic/ mucokinetic agents)

Help relive secretion and exudate from trachea bronchi and lungs

Expectorants effect

Liquify biscuit mucus or mucopurulent exudate

Expectorant MOA

Direct acting -> stimulate secretory cells which dilute sputum and decrease irritation and viscosity of mucus Indirect acting -> irritate gastric mucosa and increase respiratory tract fluid secretion and decrease viscosity of sputum

Expectorants names

``` Ipecacunha Ammonium chloride Ammonium bicarbonate Terepin hydrate Potassium iodide Guaiphenesin Sodium or potassium citrate ```

Ammonium salts expectorants

Gastric irritants which enhance bronchial secretion | Used in combinations with antitussive

Ipecacuanha actio

Expectorant at small doses Emetic agent at late dose Liquifies thick secretion Used for emesis in accendital poisoning

Guaiphenesin MOA

Decrease sputum viscosity Increase sputum volume Decreas difficulty in expectoration

Use of guaiphenesin

Relief of dry non productive cough in presence of mucus

Adverse effect of guaiphenesin

Git disturbances | Drowsiness

Mucolytics

Render sputum less viscous so that more easily cleared

Mucolytics classification

Inhalation Oral

Inhalational mucolytics

Acetylcysteine | Tyloxapol

Oral mucolytics

Acetylcysteine Bromohexine Carboxcysteine Methylcysteine

Mucolytics MOA

Split disulfide bonds in mucoprotein in sputum | Reduced viscosity

Bromohexine clinical use

Acute and chronic bronchitis | Bronchial asthma

Bromohexine adverse effect

CNS headache tinnutis GIT gastric irritation, disturbances Skin : urticaria, rhinorrhea, lacrimation