TREATMENT OF COUGH Flashcards
What is meant by cough?
A proctective reflex that clears the respiratory tract of accumulated secretion, exudate or foreign bodies. It involves the initial bronchospasms and the closing of epiglottis after which air is forced outside with the trendemous power.
where is the cough centre?
Medulla oblongata
Underlying causes of cough
TB
Foreign bodies in the airway
* Cystic fibrosis
* Immune deficiencies should be ruled out.
* Nocturnal cough = asthma or early congestive heart failure
* Smoking
* Side effects of drugs such as ACE inhibitors
What is the dry cough?
cough characterized by no mucus and occur persistant
treatment of dry cough
Antitussive=cough suppresants
what is wet cough?
Mucus-white(viral)
Yellow-green- bacterial
treatmnet of wet cough
expectorant or mucolytic plus adequate hydration to reduce viscosity of the mucus
Antibiotics
what is mild cough?
irritating, no bronchospasm, no bacterial infection
treatment of mild cough
honey and lemon
Simple linctus
Evidence for effectiveness of cough preparations
Evidence of the efficacy of cough preparations is limited
* Seldom necessary to suppress a cough (might be beneficial in nonproductive
coughs due to fibrosing alveolitis, lung cancer / other
terminal diseases)
* Cysteine-based mucolytic preparations reduce frequency of
exacerbations of COPD
* No good evidence for efficacy of expectorants
what causes acute cough in children
Viral respiratory tract infection
what is the treatment of allergic cough and allergic rhinitis in children
Antihistamines, plus topical nasal steriods
types of cough in children that excludes asthma and other underlying conditions
chronic cough
For dry cough
* Treatment for
unproductive persistent
cough, which exhausts
the patient.
list medicines
Codiene phosphate
Dihydrocodiene
Methadone
for dry cough
NOT for productive
cough, withholds the
mucus, NOT for bacterial
infections.
List medicines
Noscapine
Pholcodine (+Antihistamine)
Dextromethorphan
Opiods related side effects of:
1. Dihydrocodeine
2. codeine phosphate
3. Methodone
- Suppress cough centre in medulla
- Side effect and abuse potential-limit use
- C/I: not<2yrs
Non-opiods related side effects of:
1. Noscapine
suppress cough centre but no anagelsic, euphoric and constipating effects
Cough suppresants side effects
Adverse effects
* Dizziness, drowsiness, sedation: Avoid alcohol, CNS depressants
* Headaches
* Confusion, excitement (children ++)
* Epigastric discomfort, N, V
* Constipation + biliary colic (opioids)
* O/Dose: Respiratory depression
* Abuse & Addiction: with Codeine & Antihistamine
* C/I: Asthmatic patients, chronic bronchitis
Clinical indication of Expectorants
Facilitate coughing up mucus and other materials from the lungs
Used for patients with thick, tenacious respiratory secretion, dry non productive coughing, sinusitis to increases airway hydration
MOA of exepectorant
stimulates bronchial secretion, thinning of mucus for easy removal
The use mucolytic
use to dissolve thick mucus and usually used to relieve rspiratory difficulties
MOA of mucolytic
Liquifies mucus by dissolving the mucopolysaccharides (long chain
sugar molecules found in mucus & fluid in joints), reducing its viscosity,
thereby enabling pt. to cough up mucus more easily.
examples of mucolytic
Bromhexine (Bisolvon®) (+ bronchodilator), Carbocisteine
(Mucospect®) , N-acetylcysteine (Salmucol®)
Adverse effects of mucolytic
Adverse effects:
* Epigastric discomfort, N, V
* Tinnitus, headache
* Fever, skin rash, urticaria
* Bronchospasm
which drug is used as antidote in paracetamol poisoning
N-acetycycsteine
precautions for cough medication
- Cough suppressants C/I: Asthma patients & Chronic bronchitis
- Diabetic patients: Pholcodine, Noscapine, Bromhexine +
bronchodilator - Combining Cough suppressant + Expectorant = No justification!
- Dryness & irritation of throat:
- Gargle with salt water i.e.
- 2.5g salt in 250ml water
