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m1 > respi - drugs for cough and cold > Flashcards

respi - drugs for cough and cold Flashcards

1
Q

prescription for rhinorrhoea

A
  1. antihistamines
  2. decongestants
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2
Q

prescription for severe rhinorrhoea

A
  1. mucoregulators
  2. mast cell stabilisers
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3
Q

prescription for non-productive cough

A

antitussive

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4
Q

prescription for productive cough

A
  1. expectorant
  2. mucoactive agent (mucolytic, mucokinetic)
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5
Q

name 3 antihistamines

A
  1. promethazine
  2. diphenhydramine
  3. chlorpheniramine
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6
Q

adverse effects of antihistamines

A
  • sedation (1st gen)
  • anticholinergic effects
  • QT prolongation, palpitations (1st gen)
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7
Q

contraindications for 1st gen antihistamines

A

narrow angle glaucoma

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8
Q

moa of ipatropium

A
  • mucoregulator
  • given intranasally
  • SAMA, blocks M3 activation of submucosal glands/goblet cells → ↓ stimulated mucus output and sputum vol
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9
Q

adverse effects of ipatropium

A
  1. dry mouth
  2. unpleasant taste → non-compliance
  3. urinary retention in elderly
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10
Q

moa of cromoglicic acid

A
  • 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
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11
Q

adverse effects of cromoglicic acid

A
  • throat and nasal irritation, dry mouth, cough
  • unpleasant taste → non-compliance
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12
Q

5 eg. of sympathomimetic decongestants

A
  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)
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13
Q

2 eg. of glucocorticoid decongestants

A
  1. Fluticasone
  2. Mometasone
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14
Q

moa of sympathomimetic decongestants

A
  • vasoconstriction of nasal blood vessels
  • ↓ inflam and secretion of mucus
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15
Q

moa of glucocorticoid decongestants

A
  • anti-inflam → ↓ inflam → ↓ congestion and mucus secretion
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16
Q

adverse effects of sympathomimetic decongestants

A
  1. rebound congestion
  2. CNS stimulation (restlessness, tremors, irritability, anxiety, insomnia)
  3. hypertension
  4. tachycardia (indir agents only)
17
Q

adverse effect of glucocorticoid decongestants

A

local mucosal dryness and irritation

18
Q

adverse effect specific to intranasal fluticasone

A

rose water odour that may affect compliance

19
Q

3 eg. of antitussives

A
  1. codeine (opiod)
  2. dextromethorphan (non-opioid)
  3. diphenhydramine (non-opioid)
20
Q

advantages and disadvantages of codeine

A

adv:
1. most effective antitussive

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

21
Q

advantages and disadvantages of dextromethorphan

A

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)

22
Q

advantages and disadvantages of diphenhydramine

A

adv:
1. no risk of addiction

disadv:
1. sedation
2. anticholinergic adverse effects

23
Q

which groups should codeine be used with caution in?

A
  1. cyp2d6 ultra-rapid metabolisers
  2. not rec in < 18yo
24
Q

below what age is dextromethorphan not recommended?

25
Q

in which grp is diphenhydramine contraindicated

A

pts w narrow-angle glaucoma

26
Q

moa of guaifenesin

A
  • expectorant
  • given orally (soln/tablet)
  • ↓ prodn of respi tract fluids to ↑ viscosity of secretions
27
Q

adverse effects of guaifenesin

A
  • GI disturbance, nausea
  • kidney stones on od
28
Q

caution of use of guaifenesin

A
  • 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
29
Q

2 eg. of mucolytics

A

acetylcysteine, carbocisteine

30
Q

moa of mucolytics

A

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

31
Q

adverse effects of mucolytics

A
  1. bronchospasm
  2. anaphylactoid rxns (rash, hypotension, dyspnea, wheeze)
  3. GI disturbance
32
Q

in which groups should mucolytics be used with caution?

A
  1. elderly/debilitated pts w severe respi insufficiency
  2. asthma pts (due to bronchospasm as adverse effect)
33
Q

in which grp is carbocisteine contraindicated?

A

pts w active peptic ulcer

34
Q

2 eg. of mucokinetics

A
  1. bromhexine
  2. ambroxol
35
Q

moa of mucokinetics

A
  • 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)
36
Q

adverse effects of mucokinetics

A

cutaneous adverse effects

37
Q

caution of use of mucokinetics

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

m1 (11 decks)

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