Pharmacology Chapter 12: Cough
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Pharmacology Chapter 12: Cough

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Questions and Answers

What is the main purpose of a productive cough?

  • To expel secretions from the lower respiratory tract (correct)
  • To prevent infection
  • To reduce inflammation
  • To improve ventilation

    • Which of the following is NOT a classification of cough?

  • Recurrent (correct)
  • Subacute
  • Acute
  • Chronic

    • What is a common symptom of anaerobic bacterial infections?

  • Chest pain
  • Fever
  • Malodor (correct)
  • Purulent secretions

    • Which of the following is a complication of chronic cough?

    <p>Economic burden</p> Signup and view all the answers

    What is the term for cough that is initiated by stimulation of vagally mediated sensory pathways?

    <p>Defensive cough</p> Signup and view all the answers

    Which of the following is a cause of subacute cough?

    <p>Post infectious cough</p> Signup and view all the answers

    What is the term for the cough that is characterized by the presence of secretions that are difficult to expel?

    <p>Ineffective cough</p> Signup and view all the answers

    Which of the following is a risk factor for chronic cough?

    <p>All of the above</p> Signup and view all the answers

    What is the primary goal of self-treatment of cough?

    <p>To reduce the number and severity of cough episodes</p> Signup and view all the answers

    What type of cough is associated with viral and atypical bacterial infections?

    <p>Nonproductive cough</p> Signup and view all the answers

    What is a common complication of cough?

    <p>Excessive perspiration</p> Signup and view all the answers

    What is the purpose of protussives in treatment of cough?

    <p>To change the consistency of mucus and increase the volume of expectorated sputum</p> Signup and view all the answers

    What should be treated to stop the cough?

    <p>The underlying disorder</p> Signup and view all the answers

    Why should antitussives not be used to treat productive coughs?

    <p>Because they may lead to retention of lower respiratory tract secretions</p> Signup and view all the answers

    What is a consequence of prolonged coughing?

    <p>Prolonged absence from work or school</p> Signup and view all the answers

    What is the mechanism of action of antitussives?

    <p>They control or eliminate cough</p> Signup and view all the answers

    What is the primary mechanism of codeine in reducing cough?

    <p>By acting centrally on the medulla to increase the cough threshold</p> Signup and view all the answers

    What is a potential complication of using humidifiers in nonpharmacologic therapy?

    <p>Increased environmental mold and dust mites</p> Signup and view all the answers

    Why are coolmist humidifiers and vaporizers preferred in nonpharmacologic therapy?

    <p>Fewer bacteria grow at the cooler temperatures and there is less risk of scalding</p> Signup and view all the answers

    What is a common side effect of codeine?

    <p>Nausea</p> Signup and view all the answers

    What is the purpose of propping infants upright when they sleep and raising the head of the bed at night?

    <p>To promote drainage of nasal secretions</p> Signup and view all the answers

    What is a contraindication for the use of codeine?

    <p>In patients with known codeine hypersensitivity</p> Signup and view all the answers

    What is the maximum amount of codeine allowed per 100 milliliters in codeine-containing products?

    <p>200 mg</p> Signup and view all the answers

    What is the purpose of using a rubber bulb nasal syringe in nonpharmacologic therapy?

    <p>To clear the nasal passages and reduce cough</p> Signup and view all the answers

    Combining antitussives and protussives may be beneficial in treating cough.

    <p>False</p> Signup and view all the answers

    Codeine acts peripherally to decrease the cough threshold.

    <p>False</p> Signup and view all the answers

    Codeine is contraindicated in infants under 6 months old.

    <p>True</p> Signup and view all the answers

    Dextromethorphan is a non-opioid antitussive that can cause respiratory depression.

    <p>False</p> Signup and view all the answers

    Concomitant use of codeine and central nervous system depressants causes subtractive CNS depression.

    <p>False</p> Signup and view all the answers

    Diphenhydramine can cause CNS depression and exacerbate respiratory depression.

    <p>True</p> Signup and view all the answers

    Humidifiers can increase environmental mold, dust mites, minerals, and microorganisms.

    <p>True</p> Signup and view all the answers

    Codeine is contraindicated in patients with known codeine hypersensitivity only during labor.

    <p>False</p> Signup and view all the answers

    The combination of opioids and non-opioid antitussives can increase the risk of respiratory depression.

    <p>True</p> Signup and view all the answers

    Respiratory tract irritation can be caused by inhaled medications.

    <p>True</p> Signup and view all the answers

    Coolmist humidifiers and vaporizers are preferred because they promote bacterial growth.

    <p>False</p> Signup and view all the answers

    Cough medications can exacerbate underlying respiratory conditions like asthma.

    <p>True</p> Signup and view all the answers

    Non-medicated lozenges can increase cough by stimulating throat irritation.

    <p>False</p> Signup and view all the answers

    Cough is a symptoms of GERD.

    <p>True</p> Signup and view all the answers

    Codeine-containing products can contain more than 200 mg of codeine per 100 milliliters.

    <p>False</p> Signup and view all the answers

    Anaerobic bacterial infections are associated with a distinct malodor.

    <p>True</p> Signup and view all the answers

    Dextromethorphan is a type of opioid with analgesic properties.

    <p>False</p> Signup and view all the answers

    Patients with impaired respiratory reserve should use codeine with caution.

    <p>True</p> Signup and view all the answers

    Diphenhydramine is a second-generation antihistamine with antitussive activity.

    <p>False</p> Signup and view all the answers

    Dextromethorphan has a narrow margin of safety.

    <p>False</p> Signup and view all the answers

    The combination of monoamine oxidase inhibitors (MAOIs) and dextromethorphan may cause serotonin syndrome.

    <p>True</p> Signup and view all the answers

    Codeine is approximately equipotent with dextromethorphan.

    <p>False</p> Signup and view all the answers

    Dextromethorphan is indicated for the treatment of productive coughs.

    <p>False</p> Signup and view all the answers

    Additive CNS depression occurs with the combination of dextromethorphan and psychotropic medications.

    <p>True</p> Signup and view all the answers

    What is a concern when combining codeine with central nervous system depressants?

    <p>additive CNS depression</p> Signup and view all the answers

    What is a potential complication of using dextromethorphan in combination with monoamine oxidase inhibitors (MAOIs)?

    <p>serotonin syndrome</p> Signup and view all the answers

    What is a side effect of diphenhydramine that can exacerbate respiratory depression?

    <p>CNS depression</p> Signup and view all the answers

    What is a risk associated with using humidifiers and vaporizers in non-pharmacologic therapy?

    <p>increased environmental mold, dust mites, minerals, and microorganisms</p> Signup and view all the answers

    What is a contraindication for the use of codeine?

    <p>infants under 6 months old, known codeine hypersensitivity during labor</p> Signup and view all the answers

    What is a characteristic of dextromethorphan?

    <p>narrow margin of safety</p> Signup and view all the answers

    What is a concern when using opioids and non-opioid antitussives together?

    <p>increased risk of respiratory depression</p> Signup and view all the answers

    What is a potential complication of respiratory tract irritation caused by inhaled medications?

    <p>exacerbation of underlying respiratory conditions</p> Signup and view all the answers

    What is the primary mechanism of action of codeine in reducing cough?

    <p>Codeine acts centrally on the medulla to increase the cough threshold.</p> Signup and view all the answers

    What is a potential complication of using humidifiers in nonpharmacologic therapy?

    <p>High humidity may increase environmental mold, dust mites, minerals, and microorganisms.</p> Signup and view all the answers

    What is the purpose of using a rubber bulb nasal syringe in nonpharmacologic therapy?

    <p>To clear the nasal passages and reduce cough if postnasal drip causes cough.</p> Signup and view all the answers

    What is a common side effect of codeine?

    <p>Nausea, vomiting, sedation, dizziness, and constipation.</p> Signup and view all the answers

    What is the maximum amount of codeine allowed per 100 milliliters in codeine-containing products?

    <p>200 mg.</p> Signup and view all the answers

    What is the purpose of propping infants upright when they sleep and raising the head of the bed at night?

    <p>To promote drainage of nasal secretions.</p> Signup and view all the answers

    What is a contraindication for the use of codeine?

    <p>Patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.</p> Signup and view all the answers

    Why are coolmist humidifiers and vaporizers preferred in nonpharmacologic therapy?

    <p>Fewer bacteria grow at the cooler temperatures and there is less risk of scalding if they are tipped over.</p> Signup and view all the answers

    What is the primary concern for patients with impaired respiratory reserve when taking codeine?

    <p>Respiratory depression</p> Signup and view all the answers

    What is the main difference between codeine and dextromethorphan?

    <p>Dextromethorphan has no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses</p> Signup and view all the answers

    What is the potential interaction between diphenhydramine and other medications?

    <p>Additive CNS depression</p> Signup and view all the answers

    Why should monoamine oxidase inhibitors (MAOIs) and dextromethorphan not be used together?

    <p>Serotonin syndrome</p> Signup and view all the answers

    What is the primary mechanism of action of dextromethorphan in reducing cough?

    <p>Acts centrally in the medulla to increase the cough threshold</p> Signup and view all the answers

    What is the primary indication for dextromethorphan?

    <p>Suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation</p> Signup and view all the answers

    What is the potential complication of combining opioids and non-opioid antitussives?

    <p>Increased risk of respiratory depression</p> Signup and view all the answers

    What is the primary mechanism of action of diphenhydramine in reducing cough?

    <p>Acts centrally in the medulla to increase the cough threshold</p> Signup and view all the answers

    Diphenhydramine may cause _______________, especially in children.

    <p>excitability</p> Signup and view all the answers

    Diphenhydramine potentiates the depressant effects of _______________ on the CNS.

    <p>narcotics</p> Signup and view all the answers

    Chlophedianol is an alkylamine _______________ derivative with antitussive, moderate local anesthetic, and mild anticholinergic effects.

    <p>antihistamine</p> Signup and view all the answers

    Diphenhydramine should be used with caution in patients with diseases potentially exacerbated by drugs with _______________ activity.

    <p>anticholinergic</p> Signup and view all the answers

    Diphenhydramine can cause _______________ depression and exacerbate respiratory depression.

    <p>CNS</p> Signup and view all the answers

    Chlophedianol is indicated for the suppression of nonproductive cough caused by _______________ or mechanical respiratory tract irritation.

    <p>chemical</p> Signup and view all the answers

    Diphenhydramine containing antitussives should not be used with any other _______________ containing product, including topical products.

    <p>diphenhydramine</p> Signup and view all the answers

    Large doses of chlophedianol are associated with _______________, vertigo, visual disturbances, nausea, vomiting, and drowsiness.

    <p>dry mouth</p> Signup and view all the answers

    Patients with impaired respiratory reserve (e.g., asthma or COPD) or preexisting respiratory depression, ______ addicts, and individuals who take other respiratory depressants or sedatives, including alcohol, should use codeine with caution.

    <p>drug</p> Signup and view all the answers

    Dextromethorphan is considered approximately ______ with codeine.

    <p>equipotent</p> Signup and view all the answers

    Dextromethorphan is a nonopioid with no ______, sedative, respiratory depressant, or addictive properties at usual antitussive doses.

    <p>analgesic</p> Signup and view all the answers

    Dextromethorphan has a ______ margin of safety.

    <p>wide</p> Signup and view all the answers

    The combination of ______ oxidase inhibitors (MAOIs) and dextromethorphan may cause serotonergic syndrome.

    <p>monoamine</p> Signup and view all the answers

    Diphenhydramine is a nonselective (first-generation) ______ with significant sedating and anticholinergic properties.

    <p>antihistamine</p> Signup and view all the answers

    Diphenhydramine acts centrally in the ______ to increase the cough threshold.

    <p>medulla</p> Signup and view all the answers

    Additive CNS depression occurs with the combination of ______ and psychotropic medications.

    <p>dextromethorphan</p> Signup and view all the answers

    Codeine acts centrally on the ______ to increase the cough threshold.

    <p>medulla</p> Signup and view all the answers

    The concomitant use of codeine and ______ depressants causes additive CNS depression.

    <p>central nervous system</p> Signup and view all the answers

    Non-medicated lozenges may reduce cough by decreasing ______ irritation.

    <p>throat</p> Signup and view all the answers

    Diphenhydramine can cause ______ depression and exacerbate respiratory depression.

    <p>CNS</p> Signup and view all the answers

    Humidifiers can increase environmental ______, dust mites, minerals, and microorganisms.

    <p>mold</p> Signup and view all the answers

    Codeine is contraindicated in patients with known ______ hypersensitivity.

    <p>codeine</p> Signup and view all the answers

    Codeine-containing products must contain one or more non-codeine active ingredients and no more than ______ mg of codeine per 100 milliliters.

    <p>200</p> Signup and view all the answers

    The most common side effects of codeine are ______, vomiting, sedation, dizziness, and constipation.

    <p>nausea</p> Signup and view all the answers

    Match the following medications with their effects:

    <p>Codeine = Increases the cough threshold Diphenhydramine = Causes CNS depression Dextromethorphan = Is a non-opioid antitussive Humidifiers = Increases environmental mold, dust mites, minerals, and microorganisms</p> Signup and view all the answers

    Match the following medication interactions with their effects:

    <p>Codeine and CNS depressants = Additive CNS depression Dextromethorphan and MAOIs = Serotonin syndrome Opioids and non-opioid antitussives = Increases the risk of respiratory depression Antitussives and protussives = Potentially counterproductive</p> Signup and view all the answers

    Match the following medication contraindications with their reasons:

    <p>Codeine = Known codeine hypersensitivity and during labor Dextromethorphan = Impaired respiratory reserve Diphenhydramine = History of respiratory depression Humidifiers = Inhalation of bacteria and mold</p> Signup and view all the answers

    Match the following respiratory effects with their causes:

    <p>Respiratory depression = Combination of opioids and non-opioid antitussives Respiratory tract irritation = Inhaled medications Cough exacerbation = Underlying respiratory conditions like asthma GERD symptoms = Cough</p> Signup and view all the answers

    Match the following non-pharmacologic therapies with their effects:

    <p>Non-medicated lozenges = Reduces cough by decreasing throat irritation Humidifiers = Soothes irritated airways Vaporizers = Produces medicated vapor Propping infants upright = Promotes drainage of nasal secretions</p> Signup and view all the answers

    Match the following antitussives with their characteristics:

    <p>Codeine = Acts centrally to increase the cough threshold Dextromethorphan = Is a non-opioid antitussive with a narrow margin of safety Diphenhydramine = Has antitussive activity and causes CNS depression Antitussives = Combining with protussives may be counterproductive</p> Signup and view all the answers

    Match the following medication effects with their consequences:

    <p>Codeine = May cause nausea, vomiting, sedation, dizziness, and constipation Dextromethorphan = May cause respiratory depression Diphenhydramine = May exacerbate respiratory depression Humidifiers = May increase environmental mold, dust mites, minerals, and microorganisms</p> Signup and view all the answers

    Match the following medication interactions with their risks:

    <p>Codeine and CNS depressants = Additive CNS depression Dextromethorphan and MAOIs = Serotonin syndrome Opioids and non-opioid antitussives = Increased risk of respiratory depression Antitussives and protussives = Counterproductive effects</p> Signup and view all the answers

    Match the following antitussives with their properties:

    <p>Dextromethorphan = Non-opioid with no analgesic, sedative, or addictive properties Codeine = Opioid with analgesic properties Diphenhydramine = Antihistamine with sedating and anticholinergic properties Levorphanol = Codeine analogue</p> Signup and view all the answers

    Match the following medications with their effects on the central nervous system:

    <p>Dextromethorphan = No CNS depression at usual doses Codeine = Additive CNS depression with other CNS depressants Diphenhydramine = Significant sedating and anticholinergic properties Antihistamines = Additive CNS depression with dextromethorphan</p> Signup and view all the answers

    Match the following patient populations with their precautions for using codeine:

    <p>Patients with impaired respiratory reserve = Use codeine with caution Drug addicts = Use codeine with caution Individuals taking other respiratory depressants = Use codeine with caution Pregnant women = No specific precautions mentioned</p> Signup and view all the answers

    Match the following medications with their interactions with other drugs:

    <p>Dextromethorphan = May cause serotonin syndrome with MAOIs Codeine = Additive CNS depression with antihistamines Diphenhydramine = Additive CNS depression with psychotropic medications MAOIs = Contraindicated with dextromethorphan for at least 14 days</p> Signup and view all the answers

    Match the following medications with their indications:

    <p>Dextromethorphan = Suppression of nonproductive cough Codeine = Pain relief and cough suppression Diphenhydramine = Suppression of nonproductive cough and allergic reactions Loratadine = Allergic reactions, but no antitussive activity</p> Signup and view all the answers

    Match the following side effects with the medications:

    <p>Drowsiness, nausea, vomiting, stomach discomfort, or constipation = Dextromethorphan Respiratory depression = Codeine CNS depression and anticholinergic effects = Diphenhydramine No common side effects mentioned = Loratadine</p> Signup and view all the answers

    Match the following medications with their mechanisms of action:

    <p>Dextromethorphan = Acts centrally in the medulla to increase the cough threshold Codeine = Acts peripherally to decrease the cough threshold Diphenhydramine = Acts centrally in the medulla to increase the cough threshold Levorphanol = Codeine analogue with unknown mechanism of action</p> Signup and view all the answers

    Match the following medications with their safety profiles:

    <p>Dextromethorphan = Wide margin of safety Codeine = Narrow margin of safety due to respiratory depression risk Diphenhydramine = Significant sedating and anticholinergic properties MAOIs = Contraindicated with dextromethorphan due to serotonin syndrome risk</p> Signup and view all the answers

    Match the following medications with their potential side effects:

    <p>Diphenhydramine = CNS depression, hypotension, and CNS stimulation Chlophedianol = Excitation, hyperirritability, nightmares, hallucinations Codeine = Respiratory depression, nausea, vomiting, and drowsiness Dextromethorphan = Not mentioned in the text</p> Signup and view all the answers

    Match the following medications with their antitussive mechanisms:

    <p>Codeine = Acts peripherally to decrease the cough threshold Dextromethorphan = Non-opioid antitussive mechanism not specified in the text Diphenhydramine = Anticholinergic effect Chlophedianol = Moderate local anesthetic and mild anticholinergic effects</p> Signup and view all the answers

    Match the following medications with their indications:

    <p>Diphenhydramine = Not specified in the text Chlophedianol = Suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation Codeine = Not specified in the text Dextromethorphan = Not specified in the text</p> Signup and view all the answers

    Match the following medication interactions with their effects:

    <p>Codeine and central nervous system depressants = Additive CNS depression Dextromethorphan and monoamine oxidase inhibitors (MAOIs) = Serotonin syndrome Diphenhydramine and MAOIs = Increased anticholinergic effect Codeine and non-opioid antitussives = Not mentioned in the text</p> Signup and view all the answers

    Match the following medications with their cautions:

    <p>Diphenhydramine = Should be used with caution in patients with diseases potentially exacerbated by drugs with anticholinergic activity Codeine = Should be used with caution in patients with known codeine hypersensitivity and impaired respiratory reserve Chlophedianol = No specific cautions mentioned in the text Dextromethorphan = Should be used with caution when combining with opioids and psychotropic medications</p> Signup and view all the answers

    Match the following medications with their properties:

    <p>Codeine = Opioid with analgesic properties Dextromethorphan = Non-opioid antitussive with a narrow margin of safety Diphenhydramine = Antihistamine derivative with antitussive and anticholinergic effects Chlophedianol = Centrally acting oral antitussive with moderate local anesthetic and mild anticholinergic effects</p> Signup and view all the answers

    Match the following medications with their interactions:

    <p>Diphenhydramine and opioids = Potentiates the depressant effects of opioids on the CNS Codeine and non-opioid antitussives = May be beneficial in treating cough Dextromethorphan and opioids = Increases the risk of respiratory depression Chlophedianol and MAOIs = Not mentioned in the text</p> Signup and view all the answers

    Match the following medications with their formulations:

    <p>Chlophedianol = Oral liquids, solutions, and syrups Codeine = Not specified in the text Diphenhydramine = Topical products and oral formulations Dextromethorphan = Not specified in the text</p> Signup and view all the answers

    Study Notes

    Cough

    • Cough is a vital defensive respiratory reflex that can have significant physical, psychological, and economic consequences.
    • It is the most common symptom for which patients seek medical care.

    Etiology of Cough

    • Acute cough causes: viral URTI, pneumonia, acute left ventricular failure, asthma, and foreign body aspiration.
    • Subacute cough causes: post-infectious cough, bacterial sinusitis, and asthma.
    • Chronic cough causes: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis, autoimmune disease, left ventricular failure, and aspiration secondary to pharyngeal dysfunction.

    Clinical Presentation of Cough

    • Coughs can be productive (wet or "chesty" cough) or nonproductive (dry or "hacking" cough).
    • Productive coughs may be effective or ineffective, and the appearance of secretions is not always a reliable diagnostic indicator.
    • Nonproductive coughs serve no useful physiologic purpose and are associated with viral and atypical bacterial infections, GERD, cardiac disease, and some medications.
    • Common complications of cough include exhaustion, insomnia, musculoskeletal pain, hoarseness, excessive perspiration, and urinary incontinence.

    Treatment of Cough

    • The primary goal of self-treatment of cough is to reduce the number and severity of cough episodes, and the second goal is to prevent complications.
    • The underlying disorder must be treated to stop the cough.
    • Antitussives (cough suppressants) are used to control or eliminate cough and are the drugs of choice for nonproductive coughs.
    • Protussives (expectorants) change the consistency of mucus and increase the volume of expectorated sputum and may provide relief for coughs that expel thick, tenacious secretions.

    Nonpharmacologic Therapy

    • Nonpharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.
    • Non-medicated lozenges may reduce cough by decreasing throat irritation.
    • Humidifiers increase the amount of moisture in inspired air, which may soothe irritated airways.

    Pharmacologic Therapy

    • Codeine is a medication used to treat cough, acting centrally on the medulla to increase the cough threshold.
    • Codeine-containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters.
    • Common side effects of codeine include nausea, vomiting, sedation, dizziness, and constipation.

    Cough Therapy

    • FDA allows various combinations of antitussives, protussives, analgesics, decongestants, and antihistamines, but combinations of antitussives and protussives are potentially counterproductive.
    • Non-pharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.

    Non-Pharmacologic Therapy

    • Non-medicated lozenges reduce cough by decreasing throat irritation.
    • Humidifiers (ultrasonic, impeller, and evaporative) increase moisture in inspired air, soothing irritated airways, but high humidity may increase environmental mold, dust mites, minerals, and microorganisms.
    • Vaporizers produce a medicated vapor, with cool-mist humidifiers and vaporizers preferred due to fewer bacteria growth and less risk of scalding.
    • Babies and young children (up to 2 years) can't blow their noses, so a rubber bulb nasal syringe may be used to clear nasal passages and reduce cough.
    • Propping infants upright when sleeping and raising the head of the bed promotes drainage of nasal secretions.

    Pharmacologic Therapy

    • Codeine acts centrally on the medulla to increase the cough threshold, but has side effects like nausea, vomiting, sedation, dizziness, and constipation.
    • Concomitant use of codeine and CNS depressants causes additive CNS depression.
    • Codeine is contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.

    Cough

    • Cough is an important defensive respiratory reflex with potential physical, psychological, and economic consequences.
    • Cough is the most common symptom for which patients seek medical care.
    • Cough is initiated by stimulation of chemically and mechanically sensitive vagally mediated sensory pathways in laryngeal, esophageal, and tracheobronchial airway epithelium.

    Etiology of Cough

    • Acute cough: viral URTI, pneumonia, acute left ventricular failure, asthma, foreign body aspiration.
    • Subacute cough: post-infectious cough, bacterial sinusitis, asthma.
    • Chronic cough: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis.

    Clinical Presentation of Cough

    • Coughs are described as productive or nonproductive.
    • Productive cough expels secretions from the lower respiratory tract.
    • The appearance of secretions is not always a reliable diagnostic indicator.

    Dextromethorphan

    • Considered approximately equipotent with codeine, dextromethorphan is a nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties.
    • Dextromethorphan acts centrally in the medulla to increase the cough threshold.
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
    • Has a wide margin of safety, with uncommon side effects including drowsiness, nausea, vomiting, stomach discomfort, or constipation.

    Diphenhydramine

    • Diphenhydramine is a nonselective antihistamine with significant sedating and anticholinergic properties, acting centrally in the medulla to increase the cough threshold.
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
    • Second-generation antihistamines (e.g., loratadine and fexofenadine) lack antitussive activity.

    Cough Therapy

    • FDA allows various combinations of antitussives, protussives, analgesics, decongestants, and antihistamines, but combinations of antitussives and protussives are potentially counterproductive.
    • Non-pharmacologic therapy includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration.

    Non-Pharmacologic Therapy

    • Non-medicated lozenges reduce cough by decreasing throat irritation.
    • Humidifiers (ultrasonic, impeller, and evaporative) increase moisture in inspired air, soothing irritated airways, but high humidity may increase environmental mold, dust mites, minerals, and microorganisms.
    • Vaporizers produce a medicated vapor, with cool-mist humidifiers and vaporizers preferred due to fewer bacteria growth and less risk of scalding.
    • Babies and young children (up to 2 years) can't blow their noses, so a rubber bulb nasal syringe may be used to clear nasal passages and reduce cough.
    • Propping infants upright when sleeping and raising the head of the bed promotes drainage of nasal secretions.

    Pharmacologic Therapy

    • Codeine acts centrally on the medulla to increase the cough threshold, but has side effects like nausea, vomiting, sedation, dizziness, and constipation.
    • Concomitant use of codeine and CNS depressants causes additive CNS depression.
    • Codeine is contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated.

    Cough

    • Cough is an important defensive respiratory reflex with potential physical, psychological, and economic consequences.
    • Cough is the most common symptom for which patients seek medical care.
    • Cough is initiated by stimulation of chemically and mechanically sensitive vagally mediated sensory pathways in laryngeal, esophageal, and tracheobronchial airway epithelium.

    Etiology of Cough

    • Acute cough: viral URTI, pneumonia, acute left ventricular failure, asthma, foreign body aspiration.
    • Subacute cough: post-infectious cough, bacterial sinusitis, asthma.
    • Chronic cough: UACS, asthma, GERD, COPD, ACEIs, bronchogenic carcinoma, carcinomatosis, sarcoidosis.

    Clinical Presentation of Cough

    • Coughs are described as productive or nonproductive.
    • Productive cough expels secretions from the lower respiratory tract.
    • The appearance of secretions is not always a reliable diagnostic indicator.

    Dextromethorphan

    • Considered approximately equipotent with codeine, dextromethorphan is a nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties.
    • Dextromethorphan acts centrally in the medulla to increase the cough threshold.
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
    • Has a wide margin of safety, with uncommon side effects including drowsiness, nausea, vomiting, stomach discomfort, or constipation.

    Diphenhydramine

    • Diphenhydramine is a nonselective antihistamine with significant sedating and anticholinergic properties, acting centrally in the medulla to increase the cough threshold.
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation.
    • Second-generation antihistamines (e.g., loratadine and fexofenadine) lack antitussive activity.

    Diphenhydramine

    • Symptoms of diphenhydramine overdose include mild to severe CNS depression, hypotension, and CNS stimulation
    • Causes excitability, especially in children
    • Potentiates the depressant effects of narcotics, nonnarcotic analgesics, benzodiazepines, tranquilizers, and alcohol on the CNS
    • Intensifies the anticholinergic effect of MAOIs and other anticholinergics
    • Should be used with caution in patients with diseases potentially exacerbated by drugs with anticholinergic activity

    Chlophedianol

    • Centrally acting oral antitussive
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
    • Has antitussive, moderate local anesthetic, and mild anticholinergic effects
    • Side effects include excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria
    • Patients with impaired respiratory reserve or preexisting respiratory depression should use with caution

    Dextromethorphan

    • Nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses
    • Acts centrally in the medulla to increase the cough threshold
    • Indicated for the suppression of nonproductive cough caused by chemical or mechanical respiratory tract irritation
    • Has a wide margin of safety
    • Side effects with usual doses are uncommon, but may include drowsiness, nausea or vomiting, stomach discomfort, or constipation
    • Additive CNS depression occurs with alcohol, antihistamines, and psychotropic medications

    Nonpharmacologic Therapy

    • Includes non-medicated lozenges, humidification, interventions to promote nasal drainage, and hydration
    • Non-medicated lozenges may reduce cough by decreasing throat irritation
    • Humidifiers increase the amount of moisture in inspired air, which may soothe irritated airways
    • Vaporizers produce a medicated vapor
    • Propping infants upright when they sleep and raising the head of the bed at night promotes drainage of nasal secretions

    Pharmacologic Therapy

    • Codeine containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters
    • Codeine acts centrally on the medulla to increase the cough threshold
    • The most common side effects are nausea, vomiting, sedation, dizziness, and constipation
    • Concomitant use of codeine and CNS depressants causes additive CNS depression
    • Contraindicated in patients with known codeine hypersensitivity and during labor when a premature birth is anticipated

    Nonpharmacologic Therapy

    • Non-medicated lozenges reduce cough by decreasing throat irritation
    • Humidifiers (ultrasonic, impeller, and evaporative) soothe irritated airways by increasing moisture in inspired air
    • Vaporizers produce a medicated vapor, with coolmist humidifiers and vaporizers preferred due to fewer bacteria growth and lower scalding risk
    • Babies and young children up to 2 years old cannot blow their noses, so a rubber bulb nasal syringe is used to clear nasal passages and reduce cough
    • Propping infants upright when sleeping and raising the head of the bed promotes nasal secretion drainage

    Pharmacologic Therapy

    Codeine

    • Codeine-containing products must contain one or more non-codeine active ingredients and no more than 200 mg of codeine per 100 milliliters
    • Codeine acts centrally on the medulla to increase the cough threshold
    • Side effects include nausea, vomiting, sedation, dizziness, and constipation
    • Contraindications: known codeine hypersensitivity, labor when premature birth is anticipated, impaired respiratory reserve, preexisting respiratory depression, drug addicts, and individuals taking other respiratory depressants or sedatives

    Dextromethorphan

    • Equipotent with codeine, but nonopioid with no analgesic, sedative, respiratory depressant, or addictive properties at usual antitussive doses
    • Acts centrally in the medulla to increase the cough threshold
    • Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
    • Wide margin of safety, but side effects include drowsiness, nausea or vomiting, stomach discomfort, or constipation
    • Additive CNS depression occurs with alcohol, antihistamines, and psychotropic medications

    Diphenhydramine

    • Nonselective (first-generation) antihistamine with sedating and anticholinergic properties
    • Acts centrally in the medulla to increase the cough threshold
    • Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
    • Side effects include excitability, especially in children, and potentiates CNS depressant effects of other drugs
    • Contraindications: diseases exacerbated by anticholinergic activity, such as narrow angle glaucoma, stenosing peptic ulcer, and cardiovascular disease

    Chlophedianol

    • Centrally acting oral antitussive with antitussive, moderate local anesthetic, and mild anticholinergic effects
    • Indicated for suppressing nonproductive cough caused by chemical or mechanical respiratory tract irritation
    • Side effects include excitation, hyperirritability, nightmares, hallucinations, hypersensitivity, and urticaria

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