Pharmacy Practice: Cough Reflex and Management

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Questions and Answers

What is the primary function of the cough reflex?

To clear the airways of mucus and irritants (correct)

To stimulate the diaphragm

To produce mucus

To aid in swallowing

Where are the afferent cough receptors located?

In the upper and lower respiratory tract, pericardium, esophagus, diaphragm, and stomach (correct)

In the brain and lungs

Only in the lower respiratory tract

Only in the upper respiratory tract

What is the most common cause of coughs presenting in a pharmacy?

Bacterial infection

Viral upper respiratory tract infection (correct)

Allergies

Throat irritants

How is a cough classified as chronic?

If it lasts more than 8 weeks Signup and view all the answers

What is a characteristic of a productive cough?

It expels secretions from the lower respiratory tract Signup and view all the answers

What is the typical appearance of secretions in a viral infection such as a cold or flu virus?

Clear or whitish Signup and view all the answers

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

To reduce the number and severity of cough episodes Signup and view all the answers

What type of cough is caused by upper respiratory tract infections such as influenza and common cold?

Acute productive cough Signup and view all the answers

What is a common cause of postnasal drip?

Excess mucus production in the nose or sinuses Signup and view all the answers

Which medication is likely to cause cough in patients with asthma or COPD?

All of the above Signup and view all the answers

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

To prevent complications Signup and view all the answers

What is a common cause of chronic cough?

Gastro-Esophageal Reflex Disease (GERD) Signup and view all the answers

How can cough caused by allergens be treated?

By taking antihistamines and avoiding triggers Signup and view all the answers

What is the underlying principle of cough treatment?

Symptomatic treatment Signup and view all the answers

What is the mechanism of action of dextromethorphan at high doses?

It acts as an NMDA receptor antagonist Signup and view all the answers

Which of the following medications should not be taken with dextromethorphan?

MAO inhibitors Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

What is the primary mechanism of action of mucolytics such as N-Acetyl Cysteine?

They decrease the viscosity of mucus Signup and view all the answers

What is the mechanism of action of mucoregulators such as glucocorticoids?

They decrease the secretion of mucus Signup and view all the answers

What is the primary mechanism of action of expectorants such as guaifenesin?

They increase the expulsion of mucus and cough reflex Signup and view all the answers

What is an additional use of N-Acetyl Cysteine?

It is used as an antidote for acetaminophen toxicity Signup and view all the answers

What is the primary use of bromhexine in patients with abnormal mucus secretions?

As a mucolytic Signup and view all the answers

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 Signup and view all the answers

What is ambroxol, and what effects does it have?

A metabolite of bromhexine with both mucolytic and secretomotric effects Signup and view all the answers

What is a contraindication for the use of ambroxol?

First trimester of pregnancy Signup and view all the answers

What is the primary mechanism of action of guaifenesin?

Reduces bronchial sputum surface tension Signup and view all the answers

What is not an indication for the use of guaifenesin?

Chronic cough associated with asthma Signup and view all the answers

What is the primary use of sympathomimetic decongestants like ephedrine and pseudoephedrine?

To treat dilated blood vessels and swollen nasal mucosa Signup and view all the answers

What is a potential side effect of sympathomimetic decongestants?

Insomnia, restlessness, and tachycardia Signup and view all the answers

What is the effect of oxymetazoline and xylometazoline when applied to mucous membranes?

Reduce swelling and congestion Signup and view all the answers

How long does the effect of oxymetazoline and xylometazoline last?

Up to 12 hours Signup and view all the answers

What is the recommended frequency of dosing for oxymetazoline and xylometazoline?

Two or three times a day Signup and view all the answers

What is a potential complication of using oxymetazoline and xylometazoline for longer than 5 days?

Rebound nasal congestion Signup and view all the answers

Which of the following medications should not be used in patients with hypertension?

MeLrousm and BroNchicum Signup and view all the answers

What is a contraindication for using Nocuf Syrup?

Allergic reactions Signup and view all the answers

Why should liquorice-containing cough medication not be used in high doses for patients with hypertension?

It increases blood pressure Signup and view all the answers

Which of the following is a reason to refer patients to their primary care provider?

Cough with thick yellow or green sputum Signup and view all the answers

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

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Description

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.