Treatment of Cough Flashcards
Expectorants are for which type of cough?
productive
Antitussives are used for what type of cough?
non productive
What is the purpose of Pharyngeal demulcents?
soothing effect on throat
What are some examples of pharyngeal demulcents?
lozenges
cough drops
What is the purpose of expectorants?
increase bronchial secretions
decrease viscosity of mucous secretions
What is the mechanism of action of directly acting expectorants?
to stimulate bronchial glands
What are some directly acting expectorants?
sodium and potassium citrate or acetate
potassium iodide
guaiacol
guaiphensin
balsam or tolu,
Vasaka
Terpin hydrate
What is the mechanism of action of reflexly acting expectorants?
irritate gastric or bronchial mucosa
Name some reflexly acting expectorants.
ammonium chloride or carbonate,
potassium iodide
Mucolytics
medicines that make the mucus less thick and sticky and easier to cough up.
Name some mucolytic drugs.
Bromhexine
ambroxol
Acetylcysteine
carbocisteine
How do antitussives act in general?
Cough centre suppressants
Reduce tussal impulses in respiratory tract
What are some opioids used as antitussives?
Codeine, pholcodeine,
Morphine, ethyl morphine
Morphine not so commonly used?
What are some non-opioid antitussives used?
noscapine
Dextromethorphan, Oxeladin,
chlophedianol
What are some antihistamines used as antitussives?
Chlorpheniramine
Diphenhydramine
promethazine
What is the standard antitussive?
codeine
How long does codeine suppress cough?
6 hours
What drug blocks antitussive action of codeine?
naloxone
What are some adverse effects of codeine?
constipation
drowsiness
respiratory depression
What are some contraindications of using codeine?
asthmatics
diminished respiratory reserve
Which drugs antitussive action isn’t blocked by naloxone?
dextrometharphan
Describe the d-isomer and i-isomer of dextrometharphan.
d-isomer - increases threshold of cough centre
l-isomer - analgesic
What are some adverse effects of dexrometharphan?
Dryness of mouth, vertigo, irritability
Does detromethrphan depress mucociliary function?
no
Know the different treatment approachers to cough of these various etiologies in this chart.
Reproduce chart.
Do expectorants suppress cough reflex?
no
What are side effects of mucolytic drugs?
rhinorrhea, lacrimation, GI irritation, hypersensitivity
MOA of dextromethorphan?
synthetic codeine analog] Central Antitussive (antagonizes NMDA glutamate receptors).
What is the benefit of using dextromethorphan over codeine?
mild abuse potential and less constipation
S/E dextromethorphan.
May cause serotonin syndrome if combined with other serotonergic agents.
In which drug that we discussed in treatment of cough is use of children less than 6 years of age prohibited?
Dextromethorphan
MOA Benzonatate.
Unlike the opioids, benzonatate suppresses the cough reflex through peripheral action.
It anesthetizes the stretch receptors located in the respiratory passages, lungs, and pleura.
Does Benzonatate have abuse potential?
no
How do nasal decongestants act?
shrink swollen turbinates
Decrease resistance to airflow by vasoconstriction of the mucosal blood vessels which in turn reduces edema of the nasal mucosa.
What are the most effective agents to relieve nasal congestion?
nasal decongestants
What are some topical nasal decongestants?
Ephedrine, oxymetazoline, xylometazoline
What are some systemic nasal decongestants?
Pseudoephedrine, phenylephrine
Oxymetazoline acts through what receptors?
A1
Xylometazoline acts selectively for what receptor?
alpha - 2
What are some ADRs of nasal decongestants?
stinging, burning, dryness of the mucosa, atrophic rhinitis
Would you use nasal decongestants for long or short period of time?
short periods (palliative are)
Systemic or topical nasal decongestants. Which has more ADRs?
systemic
