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Respiratory Module > Pharmacology cough > Flashcards

Pharmacology cough Flashcards

1
Q

Cough

A

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

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2
Q

What trigger cough

A

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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3
Q

Cough physiology

A

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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4
Q

Two types of cough

A

Productive which expels secretion and exudates

unproductive due to local irritation

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5
Q

Class of drugs usedfor cough

A

Antitussives
Expectorants
Mucolytics

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6
Q

Antitussives action

A

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

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7
Q

When are antitussives useful

A

Dry painful cough associated with bronchial carcinoma

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8
Q

When should you avoid Antitussives

A

Chronic pulmonary infection ( undesirable thickening and retention of sputum)

Asthma ( respiratory depression possible)

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9
Q

2 classes of anti tussives

A

Centrally acting

Peripherally acting

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10
Q

2 classes of centrally acting antitussive

A

Addicting

Non addicting

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11
Q

2 classes of addicting centrally acting antitussive

A

Potent addicting

Less potent addicting

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12
Q

Peripherally non addicting 2 sub classes

A

Opioid derivatives

Mon opioid derivative

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13
Q

Centrally acting antitussive MOA

A

Depression of medullary center or higher centres

Increased treshold of cough center

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14
Q

Peripherally acting antitussive MOA

A

Interruption of tussle impulses from respiratory tract

Soothing effect

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15
Q

Potent addicting central antitussive

A

Morphine

Dihydromorphinone

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16
Q

Less Potent addicting central antitussive

A

Codeine

Dihydrocodeine u

Pholcodine

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17
Q

Non addicting central antitussive opioid derivatives

A

Dextromethorphan

Noscapine

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18
Q

Non addicting central antitussive non opioid derivatives

A

Benzonatate

Diphenhydramine (1st gen antihistamine)

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19
Q

Peripheral antitussive pharyngeal demulcent

A 
Natural : 
Pectin 
Glycerin
Honey 
Syrup

Synthetic :

Methylcellulose
Propylene glycol
Glycerin

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20
Q

Peripheral antitussive steam inhalation

A

Tincture of benzoin/ menthol

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21
Q

Peripheral antitussive local anesthetic activity

A

Benzonatate

Lidocaine

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22
Q

Pharyngeal demulcents

A

Soothing action on irritated mucosa

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23
Q

Benzonatate action

A

Both central and peripheral also have anesthetic effect on stretch receptor

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24
Q

Peripheral antitussive use

A

Dry unproductive cough

If cough unduly and tiring
Disturbs sleep

Hernia ,piles of abdominal surgery

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25
Q

Codeine action

A

Increase treshold for cough

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26
Q

Codeine time of action

A

Suppress cough for 6h

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27
Q

Antagonist of codeine

A

Naloxone which suppresses antitussive action

28
Q

Adverse effect of codeine

A 
Constipation 
Respiratory depression 
Drowsiness
Impaired driving
Not used in asmathicd and low respiratory reserve
29
Q

Pholcodine action ( homocodeine)

A

Centrally suppress center in medulla

30
Q

Duration action of pholcodine

A

Longer acting - 12h

31
Q

Adverse effect of pholcodine

A

Nausea

Drowsiness

32
Q

Noscapine MOA

A

Depresses cough
No dependance

Same efficacy as codeine

33
Q

Noscapine adverse effect

A

Headache

Nausea

34
Q

Main use of noscapine

A

Spasmodic cough

35
Q

Dextromethorphan MOA

A

No CNS depression

36
Q

Dextromethorphan duration of action

A

6h

37
Q

Can baladine inhibit Dextromethorphan

A

No because does not work through opioids receptors

38
Q

Dextromethorphan side effects

A

Diziness
Nausea
Drowsiness
Ataxia

39
Q

Levopropoxyphene

A

Non addicting
No opioid effect
Sedative property

40
Q

Antihistamines MOA In cough

A

Non addicting antitussive

Relive cough by sedation and anticholinergic effect
Lack selectivity for cough center

41
Q

When do you use antihistamine in cough

A

Allergic cough and may reduce secretion by anticholinergic action

42
Q

Antihistamine most common

A

Diphenhydramine

Promethazine

43
Q

Why are 2ndgen qntihkstamine not usd

A

Because cannot cross BBB so no sedative effect

44
Q

Linctus

A

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

45
Q

Throat lozenges

A

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

46
Q

Bronchodilators

A

b2 agonist

Used when cough due to bronchospasm

47
Q

Use of bronchodilators

A

Only when patient has bronchial hyperactivity

48
Q

Example of bronchodilators

A

Salbutamol

Terbutaline

49
Q

Benzonatate

A

Antitussive action on stretch or cough receptor in lungs

Central effects too

50
Q

Benzonatate adverse effect

A 
Headache 
Dizziness 
Pruritis
Nasal congestion 
Burning of eyes 
Tightness In chest
51
Q

Expectorant (bronchomucotropic/ mucokinetic agents)

A

Help relive secretion and exudate from trachea bronchi and lungs

52
Q

Expectorants effect

A

Liquify biscuit mucus or mucopurulent exudate

53
Q

Expectorant MOA

A

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

54
Q

Expectorants names

A 
Ipecacunha
Ammonium chloride
Ammonium bicarbonate 
Terepin hydrate 
Potassium iodide
Guaiphenesin
Sodium or potassium citrate
55
Q

Ammonium salts expectorants

A

Gastric irritants which enhance bronchial secretion

Used in combinations with antitussive

56
Q

Ipecacuanha actio

A

Expectorant at small doses

Emetic agent at late dose

Liquifies thick secretion
Used for emesis in accendital poisoning

57
Q

Guaiphenesin MOA

A

Decrease sputum viscosity
Increase sputum volume
Decreas difficulty in expectoration

58
Q

Use of guaiphenesin

A

Relief of dry non productive cough in presence of mucus

59
Q

Adverse effect of guaiphenesin

A

Git disturbances

Drowsiness

60
Q

Mucolytics

A

Render sputum less viscous so that more easily cleared

61
Q

Mucolytics classification

A

Inhalation

Oral

62
Q

Inhalational mucolytics

A

Acetylcysteine

Tyloxapol

63
Q

Oral mucolytics

A

Acetylcysteine

Bromohexine

Carboxcysteine

Methylcysteine

64
Q

Mucolytics MOA

A

Split disulfide bonds in mucoprotein in sputum

Reduced viscosity

65
Q

Bromohexine clinical use

A

Acute and chronic bronchitis

Bronchial asthma

66
Q

Bromohexine adverse effect

A

CNS headache tinnutis
GIT gastric irritation, disturbances

Skin : urticaria, rhinorrhea, lacrimation

Respiratory Module (5 decks)

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