Cough and Antitussive Medications

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Questions and Answers

What is the primary role of surfactants like Beractant and Poractant Alpha in newborns?

They promote the production of endogenous surfactant.

They serve as antiepileptic medications for newborns.

They prevent and manage respiratory distress syndrome. (correct)

They are utilized to reduce chronic cough in adults.

Which of the following agents is known for its mucolytic properties used in cystic fibrosis treatment?

Chlorpheniramine

Dornase Alfa (correct)

Phenylephrine

Gabapentin

What common method is used to administer surfactants in neonatal care?

Directly into the tracheobronchial tree (correct)

Oral ingestion

Subcutaneous injection

Intravenous injection

In patients with refractory chronic cough, which treatment has shown potential improvement in cough-related quality of life?

Gabapentin Signup and view all the answers

What is a key characteristic of cystic fibrosis that affects lung function?

Thickening of mucus secretions Signup and view all the answers

Which medication acts as a weak agonist opioid for symptomatic relief of dry cough?

Codeine Signup and view all the answers

What is a key adverse effect associated with antitussive medications?

Respiratory depression Signup and view all the answers

Which condition contraindicates the use of antitussive medications?

Asthma Signup and view all the answers

What is the primary action of mucolytics in respiratory treatment?

Break down mucus structure Signup and view all the answers

Which adverse drug reaction can be caused by dextromethorphan?

Hallucinations Signup and view all the answers

In which of the following conditions is the use of mucolytics particularly important?

Cystic fibrosis Signup and view all the answers

What method can facilitate mucus clearance apart from medications?

Adequate hydration Signup and view all the answers

What is a potential interaction concern with the use of ACE inhibitors related to cough?

Risk of uncontrollable dry cough Signup and view all the answers

What is the primary mechanism of action of acetylcysteine as a mucolytic?

Reduces disulfide bonds in mucus proteins Signup and view all the answers

How does acetylcysteine function as an antidote during a paracetamol overdose?

Restores glutathione levels and acts as a direct antioxidant Signup and view all the answers

What is a critical caution regarding the use of mucolytics such as acetylcysteine?

They may reduce the elasticity of mucus, affecting transport Signup and view all the answers

What role does ambroxol play in the management of mucus in respiratory conditions?

Stimulates surfactant synthesis and reduces mucus viscosity Signup and view all the answers

In what scenario is guaifenesin typically administered?

For the symptomatic management of productive cough to facilitate mucus removal Signup and view all the answers

What is a significant consideration for using expectorants such as ambroxol?

They should not be used if the patient has neuromuscular impairment. Signup and view all the answers

What adverse effect may occur from the overuse of mucolytics?

Impaired mucociliary transport due to decreased mucus elasticity Signup and view all the answers

What is the optimal time frame for administering acetylcysteine following paracetamol overdose for maximum efficacy?

Within 8-10 hours of overdose Signup and view all the answers

Study Notes

Cough

A physiological response that helps to clear the respiratory system of foreign material and excessive secretions.
Encourage smokers to quit to reduce cough episodes.
Discontinue the use of ACE inhibitors if experiencing cough (strong recommendation).

Antitussive Medications

Codeine:
- Opioid drug (weak agonist)
- Provides symptomatic relief from dry cough
- Effective at subanalgesic doses
- Thickens bronchial sputum, inhibiting ciliary activity
Morphine and Methadone:
- Used only for palliative care in lung cancer patients suffering from distressing cough.
Dextromethorphan:
- Opioid derivative that inhibits the cough center in the brainstem.
- Does not cause sedation or analgesia
- Does not lead to respiratory depression or addiction.
- ADRs: Confusion, excitation, nervousness, irritability, and hallucinations.
- Potential for abuse and recreational use.
All centrally acting cough suppressants (opioids) increase the risk of respiratory depression.
Opioid-based cough suppressants are contraindicated in patients with asthma and COPD.

Mucolytics

Mechanism of Action:
- Break down mucus structure, reducing its thickness.
- Important for conditions with increased mucus production, such as cystic fibrosis, COPD, and respiratory infections.
Acetylcysteine:
- Liquefies mucus by reducing disulfide bonds in mucus proteins.
- Used as adjunctive treatment in conditions with altered mucus secretions, including acute and chronic bronchopulmonary disorders, pulmonary complications of cystic fibrosis, and complications after thoracic and cardiovascular surgery.
- Utilized during anesthesia and preparation for diagnostic bronchial studies.
- Acts as an antidote for paracetamol overdose by:
  - Restoring glutathione by providing cysteine precursors.
  - Directly reducing oxidative damage.
- Most effective within 8-10 hours of overdose.
Caution:
- Mucolytics destroy mucus elasticity while reducing viscosity, hindering mucociliary transport.
- Patients must be able to cough effectively to remove mucus.
- Not suitable for patients who cannot cough adequately or in combination with antitussives (elderly and infants).

Expectorants

Mechanism of Action:
- Stimulate mucus expulsion from the respiratory tract, decreasing viscosity and facilitating removal.
- Smoking increases mucus production and viscosity, so expectorants are not recommended for smokers.
Ambroxol:
- Increases mucus volume and decreases viscosity.
- Stimulates surfactant synthesis and release by type II pneumocytes.
- Surfactant reduces mucus adhesion to the bronchial wall.
- Possesses anti-inflammatory properties, relieving sore throat pain.
Guaifenesin:
- Orally administered for symptomatic management of productive cough, loosening and thinning sputum and bronchial secretions to aid expectoration.
- Often combined with other agents for temporary relief of productive cough and other symptoms (nasal congestion, fever).

Surfactants

Beractant, Poractant Alpha:
- Effective in prophylaxis and management of respiratory distress syndrome in newborns, especially premature infants with deficient endogenous surfactant production.
- Derivatives of physiological pulmonary surfactant.
- Administered directly into the tracheobronchial tree via an endotracheal tube.

Other Treatments

Gabapentin:
- Antiepileptic drug that may improve cough-related quality of life in older adults with refractory chronic cough.
Tonsillectomy:
- Reported to reduce cough in patients with chronic cough and enlarged tonsils.

Cystic Fibrosis Treatment

Pulmonary disease characterized by thickened mucus secretions, leading to impaired airway clearance and progressive lung damage.
Dornase Alfa:
- Mucolytic enzyme similar to natural DNAse, reducing sputum viscosity by degrading extracellular DNA.
- Used to improve lung function in cystic fibrosis patients.
- Degrades the thick DNA-rich secretions that accumulate in cystic fibrosis, reducing airway blockages and lowering the risk of chronic respiratory infections.

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Description

This quiz covers the physiological aspects of cough, its implications for smokers, and a detailed overview of antitussive medications like codeine and dextromethorphan. Understand the mechanisms, side effects, and recommendations for managing cough effectively. Test your knowledge on the treatment options available for cough relief.