respi - drugs for cough and cold

Question 1

prescription for rhinorrhoea

Answer 1

1. antihistamines
2. decongestants

Question 2

prescription for severe rhinorrhoea

Answer 2

1. mucoregulators
2. mast cell stabilisers

Question 3

prescription for non-productive cough

Answer 3

antitussive

Question 4

prescription for productive cough

Answer 4

1. expectorant
2. mucoactive agent (mucolytic, mucokinetic)

Question 5

name 3 antihistamines

Answer 5

1. promethazine
2. diphenhydramine
3. chlorpheniramine

Question 6

adverse effects of antihistamines

Answer 6

• sedation (1st gen)
• anticholinergic effects
• QT prolongation, palpitations (1st gen)

Question 7

contraindications for 1st gen antihistamines

Answer 7

narrow angle glaucoma

Question 8

moa of ipratropium

Answer 8

• mucoregulator
• given intranasally
• SAMA, blocks M3 activation of submucosal glands/goblet cells → ↓ stimulated mucus output and sputum vol

Question 9

adverse effects of ipratropium

Answer 9

1. dry mouth
2. unpleasant taste → non-compliance
3. urinary retention in elderly

Question 10

moa of cromoglicic acid

Answer 10

• mast cell stabiliser
• given via nasal spray
• controls Cl- channels to inhibit cellular activation
• ↓ mast cell degranulation
• ↓ secretion of inflam mediators
• ↑ secretion of annexin A1 → inhibit prostaglandin + leukotriene prodn

Question 11

adverse effects of cromoglicic acid

Answer 11

• throat and nasal irritation, dry mouth, cough
• unpleasant taste → non-compliance

Question 12

5 eg. of sympathomimetic decongestants

Answer 12

1. Phenylephrine (α1, oral/intranasal)
2. Oxymetazoline (non-selective α, intranasal)
3. Naphazoline (non-selective α, intranasal)
4. Pseudoephedrine (indir, oral)
5. Ephedrine (indir, intranasal)

Question 13

2 eg. of glucocorticoid decongestants

Answer 13

1. Fluticasone
2. Mometasone

Question 14

moa of sympathomimetic decongestants

Answer 14

• vasoconstriction of nasal blood vessels
• ↓ inflam and secretion of mucus

Question 15

moa of glucocorticoid decongestants

Answer 15

• anti-inflam → ↓ inflam → ↓ congestion and mucus secretion

Question 16

adverse effects of sympathomimetic decongestants

Answer 16

1. rebound congestion
2. CNS stimulation (restlessness, tremors, irritability, anxiety, insomnia)
3. hypertension
4. tachycardia (indir agents only)

Question 17

adverse effect of glucocorticoid decongestants

Answer 17

local mucosal dryness and irritation

Question 18

adverse effect specific to intranasal fluticasone

Answer 18

rose water odour that may affect compliance

Question 19

3 eg. of antitussives

Answer 19

1. codeine (opiod)
2. dextromethorphan (non-opioid)
3. diphenhydramine (non-opioid)

Question 20

advantages and disadvantages of codeine

Answer 20

adv:
1. most effective antitussive

disadv:
1. potential for abuse
2. sedation
3. respi depression on od

Question 21

advantages and disadvantages of dextromethorphan

Answer 21

adv:
1. less risk of addiction
2. most effective non-opioid antitussive

disadv:
1. drowsiness, dizziness
2. nausea, vomiting, stomach pain
3. potential for abuse at high doses (dissociative anaesthetic-like effect)

Question 22

advantages and disadvantages of diphenhydramine

Answer 22

adv:
1. no risk of addiction

disadv:
1. sedation
2. anticholinergic adverse effects

Question 23

which groups should codeine be used with caution in?

Answer 23

1. cyp2d6 ultra-rapid metabolisers
2. not rec in < 18yo

Question 24

below what age is dextromethorphan not recommended?

Answer 24

< 4yo

Question 25

in which grp is diphenhydramine contraindicated

Answer 25

pts w narrow-angle glaucoma

Question 26

moa of guaifenesin

Answer 26

- expectorant - given orally (soln/tablet) - ↑ prodn of respi tract fluids to ↓ viscosity of secretions

Question 27

adverse effects of guaifenesin

Answer 27

- GI disturbance, nausea - kidney stones on od

Question 28

caution of use of guaifenesin

Answer 28

- caution in < 6yo - not indicated in < 2yo - not for persistent cough assoc w asthma/smoking - take adequate fluid to make secretions less viscous and protect renal func

Question 29

2 eg. of mucolytics

Answer 29

acetylcysteine, carbocisteine

Question 30

moa of mucolytics

Answer 30

free sulfhydryl group open disulphide bonds in mucoproteins → break down mucous by lowering viscosity

Question 31

adverse effects of mucolytics

Answer 31

1. bronchospasm 2. anaphylactoid rxns (rash, hypotension, dyspnea, wheeze) 3. GI disturbance

Question 32

in which groups should mucolytics be used with caution?

Answer 32

1. elderly/debilitated pts w severe respi insufficiency 2. asthma pts (due to bronchospasm as adverse effect)

Question 33

in which grp is carbocisteine contraindicated?

Answer 33

pts w active peptic ulcer

Question 34

2 eg. of mucokinetics

Answer 34

1. bromhexine 2. ambroxol

Question 35

moa of mucokinetics

Answer 35

- increase ciliary beat freq - stimulate surfactant prodn to ↓ adherence of mucus to cilia - antioxidant - anti-inflam (↓ cytokines) - suppresses influenza virus multiplication - local anaesthetic (blocks Na+ channel)

Question 36

adverse effects of mucokinetics

Answer 36

cutaneous adverse effects

Question 37

caution of use of mucokinetics

Answer 37

- caution in < 6yo - not indicated in < 2yo - avoid in pts w asthma, peptic ulcer disease