38 Questions
What is the primary function of the cough reflex?
To clear the airways of mucus and irritants
Where are the afferent cough receptors located?
In the upper and lower respiratory tract, pericardium, esophagus, diaphragm, and stomach
What is the most common cause of coughs presenting in a pharmacy?
Viral upper respiratory tract infection
How is a cough classified as chronic?
If it lasts more than 8 weeks
What is a characteristic of a productive cough?
It expels secretions from the lower respiratory tract
What is the typical appearance of secretions in a viral infection such as a cold or flu virus?
Clear or whitish
What is the primary goal of self-treatment of cough?
To reduce the number and severity of cough episodes
What type of cough is caused by upper respiratory tract infections such as influenza and common cold?
Acute productive cough
What is a common cause of postnasal drip?
Excess mucus production in the nose or sinuses
Which medication is likely to cause cough in patients with asthma or COPD?
All of the above
What is the secondary goal of self-treatment of cough?
To prevent complications
What is a common cause of chronic cough?
Gastro-Esophageal Reflex Disease (GERD)
How can cough caused by allergens be treated?
By taking antihistamines and avoiding triggers
What is the underlying principle of cough treatment?
Symptomatic treatment
What is the mechanism of action of dextromethorphan at high doses?
It acts as an NMDA receptor antagonist
Which of the following medications should not be taken with dextromethorphan?
MAO inhibitors
What is the primary mechanism of action of first-generation antihistamines in relieving cough?
They have a sedative effect, which can be helpful if cough is disrupting sleep
What is the mechanism of action of topical antitussives such as camphor and menthol?
They create a local anesthetic sensation and a sense of improved airflow
What is the primary mechanism of action of mucolytics such as N-Acetyl Cysteine?
They decrease the viscosity of mucus
What is the mechanism of action of mucoregulators such as glucocorticoids?
They decrease the secretion of mucus
What is the primary mechanism of action of expectorants such as guaifenesin?
They increase the expulsion of mucus and cough reflex
What is an additional use of N-Acetyl Cysteine?
It is used as an antidote for acetaminophen toxicity
What is the primary use of bromhexine in patients with abnormal mucus secretions?
As a mucolytic
What is a precaution to be taken when using bromhexine in certain patients?
Use with caution in patients with a history of gastric or duodenal ulcers
What is ambroxol, and what effects does it have?
A metabolite of bromhexine with both mucolytic and secretomotric effects
What is a contraindication for the use of ambroxol?
First trimester of pregnancy
What is the primary mechanism of action of guaifenesin?
Reduces bronchial sputum surface tension
What is not an indication for the use of guaifenesin?
Chronic cough associated with asthma
What is the primary use of sympathomimetic decongestants like ephedrine and pseudoephedrine?
To treat dilated blood vessels and swollen nasal mucosa
What is a potential side effect of sympathomimetic decongestants?
Insomnia, restlessness, and tachycardia
What is the effect of oxymetazoline and xylometazoline when applied to mucous membranes?
Reduce swelling and congestion
How long does the effect of oxymetazoline and xylometazoline last?
Up to 12 hours
What is the recommended frequency of dosing for oxymetazoline and xylometazoline?
Two or three times a day
What is a potential complication of using oxymetazoline and xylometazoline for longer than 5 days?
Rebound nasal congestion
Which of the following medications should not be used in patients with hypertension?
MeLrousm and BroNchicum
What is a contraindication for using Nocuf Syrup?
Allergic reactions
Why should liquorice-containing cough medication not be used in high doses for patients with hypertension?
It increases blood pressure
Which of the following is a reason to refer patients to their primary care provider?
Cough with thick yellow or green sputum
Study Notes
Cough Reflex and Classification
- Cough is a defensive respiratory reflex action to clear airways of mucus and irritants.
- Cough reflex is stimulated from afferent cough receptors located in the upper and lower respiratory tract, pericardium, esophagus, diaphragm, and stomach.
- The majority of coughs presenting in the pharmacy are caused by a viral upper respiratory tract infection, making most coughs self-limiting.
- Classification of cough based on duration:
- Acute: < 3 weeks
- Subacute: 3-8 weeks
- Chronic: > 8 weeks
- Classification of cough based on character:
- Productive (wet): expels secretions from the lower respiratory tract
- Non-productive (dry): a cough where no mucus is produced, often associated with viral infections, allergies, or throat irritants
Causes of Cough
- Upper respiratory tract infections (e.g., influenza, common cold)
- Lower respiratory tract infections (e.g., bronchitis, pneumonia)
- Allergic rhinitis
- Inhaled irritants (e.g., dust, smoke)
- Laryngitis or pharyngitis
- Medications (e.g., ACEIs, beta-adrenergic blockers, Aspirin, NSAIDs)
- Gastro-Esophageal Reflex Disease (GERD)
- COPD
- Heart failure
- Lung cancer
- Postnasal drip
Treatment of Cough
- Primary goal: reduce the number and severity of cough episodes
- Secondary goal: prevent complications
- Treatment is symptomatic; the underlying disorder must be treated to stop the cough
- Antitussives:
- Dextromethorphan (non-addictive, non-opioid): 15-30 mg PO q 6-8 hrs
- Non-addictive, non-opioids: first-generation antihistamines (e.g., Diphenhydramine, Promethazine), Butamirate
- Mucoactives:
- Mucolytics (e.g., N-Acetyl Cysteine, Bromhexine): decrease mucus viscosity
- Mucoregulators (e.g., Anticholinergics, Glucocorticoids): regulate mucus secretion
- Mucokinetics (e.g., Ambroxol, Bronchodilators): increase muco-ciliary clearance
- Expectorents (e.g., Guaifenesin, Hypertonic Saline): increase mucus expulsion and cough reflex
- Decongestants:
- Sympathomimetics (e.g., Ephedrine, Pseudoephedrine): treat dilated blood vessels and swollen nasal mucosa
- Topical decongestants (e.g., Oxymetazoline, Xylometazoline): reduce swelling and congestion when applied to mucous membranes
- Bronchodilators:
- B-2 agonist (e.g., Albuterol): not recommended for treatment of acute cough in non-asthmatic patients
- Anticholinergics (e.g., Ipratropium): improve acute and chronic cough
This quiz covers the basics of cough as a defensive respiratory reflex action, including its causes, stimulation, and management in a pharmacy setting. It is suitable for pharmacy students and professionals.
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