Pharmacology Chapter 12: Cough
120 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

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

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Cough Treatment PDF

    Description

    Learn about the symptoms, causes, and consequences of cough, a common defensive respiratory reflex. Explore the physical, psychological, and economic impacts of cough.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser