Podcast
Questions and Answers
A patient is experiencing a persistent cough with thick mucus. Which class of medication would be MOST appropriate to help them clear their airways?
A patient is experiencing a persistent cough with thick mucus. Which class of medication would be MOST appropriate to help them clear their airways?
- Antitussives
- Mast cell stabilizers
- Expectorants (correct)
- Antihistamines
A person has a cold and is wondering whether to take antibiotics. What is the MOST accurate advice to give them?
A person has a cold and is wondering whether to take antibiotics. What is the MOST accurate advice to give them?
- Antibiotics are effective against viral infections like the common cold.
- Antibiotics are not effective against viral cold symptoms and increase the risk of antibiotic resistance. (correct)
- Antibiotics should be taken if the cold symptoms persist for more than a week.
- Antibiotics can help prevent secondary bacterial infections during a cold.
Which medication type would be LEAST helpful for a patient experiencing nasal congestion due to a cold?
Which medication type would be LEAST helpful for a patient experiencing nasal congestion due to a cold?
- Mast cell stabilizers
- Antitussives (correct)
- Decongestants
- Antihistamines
A patient with allergic rhinitis is experiencing a runny nose and sneezing. Which medication would be MOST appropriate?
A patient with allergic rhinitis is experiencing a runny nose and sneezing. Which medication would be MOST appropriate?
If medication helps to regulate the production or viscosity of mucus, into what category does it fall?
If medication helps to regulate the production or viscosity of mucus, into what category does it fall?
Which of the following best describes the mechanism of action of codeine as an antitussive?
Which of the following best describes the mechanism of action of codeine as an antitussive?
A patient reports experiencing drowsiness and constipation after starting codeine for cough. What is the most appropriate explanation for these side effects?
A patient reports experiencing drowsiness and constipation after starting codeine for cough. What is the most appropriate explanation for these side effects?
Why is codeine not recommended as an antitussive for children under 18 years old?
Why is codeine not recommended as an antitussive for children under 18 years old?
What is the primary concern when combining codeine with other CNS depressants?
What is the primary concern when combining codeine with other CNS depressants?
An adult patient is prescribed codeine for cough. What is the typical recommended dose?
An adult patient is prescribed codeine for cough. What is the typical recommended dose?
In individuals who are CYP2D6 ultra-rapid metabolizers, what potential risk is associated with codeine use?
In individuals who are CYP2D6 ultra-rapid metabolizers, what potential risk is associated with codeine use?
A patient has a history of opioid abuse. Which of the following antitussives would be the MOST appropriate and safest choice for this patient?
A patient has a history of opioid abuse. Which of the following antitussives would be the MOST appropriate and safest choice for this patient?
A patient taking codeine is also prescribed an antihistamine for allergies. What potential drug interaction should the patient be warned about?
A patient taking codeine is also prescribed an antihistamine for allergies. What potential drug interaction should the patient be warned about?
N-acetylcysteine reduces mucous viscosity by which mechanism?
N-acetylcysteine reduces mucous viscosity by which mechanism?
A patient with a known history of asthma is prescribed a medication to help with excessive mucus production. Which of the following medications would require the MOST caution given the patient's medical history?
A patient with a known history of asthma is prescribed a medication to help with excessive mucus production. Which of the following medications would require the MOST caution given the patient's medical history?
Which of the following is a known mechanism of action for ambroxol that contributes to its mucokinetic properties?
Which of the following is a known mechanism of action for ambroxol that contributes to its mucokinetic properties?
Which of the following pharmacological effects is NOT associated with bromhexine and its metabolite, ambroxol?
Which of the following pharmacological effects is NOT associated with bromhexine and its metabolite, ambroxol?
A 4-year-old child presents with a persistent cough and cold symptoms. According to the guidelines, which of the following medications should be used with caution?
A 4-year-old child presents with a persistent cough and cold symptoms. According to the guidelines, which of the following medications should be used with caution?
A patient is prescribed carbocisteine for excessive mucus production. Which of the following conditions would be a contraindication for this medication?
A patient is prescribed carbocisteine for excessive mucus production. Which of the following conditions would be a contraindication for this medication?
A 70-year-old patient with a history of mild chronic obstructive pulmonary disease (COPD) is prescribed N-acetylcysteine (NAC) for excessive mucus. What is the MOST important consideration before initiating NAC therapy?
A 70-year-old patient with a history of mild chronic obstructive pulmonary disease (COPD) is prescribed N-acetylcysteine (NAC) for excessive mucus. What is the MOST important consideration before initiating NAC therapy?
A 3-year-old child has cold and flu symptoms. After assessing the benefits and risks, which of the following medications would be the MOST appropriate to consider using with caution?
A 3-year-old child has cold and flu symptoms. After assessing the benefits and risks, which of the following medications would be the MOST appropriate to consider using with caution?
Why are cough and cold medications primarily used in the management of the common cold?
Why are cough and cold medications primarily used in the management of the common cold?
Which of the following is the most likely mechanism by which first-generation antihistamines, such as diphenhydramine, alleviate common cold symptoms?
Which of the following is the most likely mechanism by which first-generation antihistamines, such as diphenhydramine, alleviate common cold symptoms?
What is a significant caution to consider when prescribing codeine as an antitussive, particularly for young patients?
What is a significant caution to consider when prescribing codeine as an antitussive, particularly for young patients?
Which of the following is a common adverse effect associated with the use of first-generation antihistamines like diphenhydramine, particularly in elderly patients?
Which of the following is a common adverse effect associated with the use of first-generation antihistamines like diphenhydramine, particularly in elderly patients?
A patient reports experiencing a 'rose water' odor while using a medication for nasal congestion. Which of the following medications is most likely responsible for this?
A patient reports experiencing a 'rose water' odor while using a medication for nasal congestion. Which of the following medications is most likely responsible for this?
Which of the following explains why first-generation antihistamines, such as diphenhydramine, are more likely to cause sedation compared to second-generation antihistamines like cetirizine or loratadine?
Which of the following explains why first-generation antihistamines, such as diphenhydramine, are more likely to cause sedation compared to second-generation antihistamines like cetirizine or loratadine?
A patient with a history of hypertension is seeking an over-the-counter medication for nasal congestion. Which of the following decongestants should be avoided?
A patient with a history of hypertension is seeking an over-the-counter medication for nasal congestion. Which of the following decongestants should be avoided?
What is the primary mechanism of action of acetylcysteine in the treatment of respiratory conditions?
What is the primary mechanism of action of acetylcysteine in the treatment of respiratory conditions?
A patient is experiencing a non-productive cough associated with a common cold. Which class of medications would be most appropriate for symptomatic relief?
A patient is experiencing a non-productive cough associated with a common cold. Which class of medications would be most appropriate for symptomatic relief?
Which of the following best describes the mechanism of action of intranasal ipratropium in treating symptoms of the common cold?
Which of the following best describes the mechanism of action of intranasal ipratropium in treating symptoms of the common cold?
A patient taking diphenhydramine for cold symptoms reports increased appetite. What receptor antagonism is most likely responsible for this side effect?
A patient taking diphenhydramine for cold symptoms reports increased appetite. What receptor antagonism is most likely responsible for this side effect?
Compared to first-generation antihistamines, what is the key advantage of using second or third-generation antihistamines like loratadine or fexofenadine?
Compared to first-generation antihistamines, what is the key advantage of using second or third-generation antihistamines like loratadine or fexofenadine?
Which of the following is NOT a common viral cause of upper respiratory tract infections (URTIs) associated with the common cold?
Which of the following is NOT a common viral cause of upper respiratory tract infections (URTIs) associated with the common cold?
What is the primary reason for caution when using decongestants like pseudoephedrine in elderly patients?
What is the primary reason for caution when using decongestants like pseudoephedrine in elderly patients?
A patient is prescribed an H1 antihistamine. Which of the following side effects is most directly related to the drug's mechanism of action?
A patient is prescribed an H1 antihistamine. Which of the following side effects is most directly related to the drug's mechanism of action?
A factory worker with a runny nose and nasal congestion is prescribed an intranasal decongestant. What is the MOST important instruction to give this patient regarding the duration of use for this medication?
A factory worker with a runny nose and nasal congestion is prescribed an intranasal decongestant. What is the MOST important instruction to give this patient regarding the duration of use for this medication?
A mother gave her own cough and cold medicine to her 18-month-old daughter. The infant became excitable, then drowsy, with shallow breathing and blue lips. What is the MOST important immediate action?
A mother gave her own cough and cold medicine to her 18-month-old daughter. The infant became excitable, then drowsy, with shallow breathing and blue lips. What is the MOST important immediate action?
An 82-year-old man with mild cognitive impairment 'doctor shops' to get antibiotics, an expectorant (guaifenesin), and a mucolytic (acetylcysteine) for a non-productive cough that isn't affecting his sleep. What is the PRIMARY concern with prescribing antibiotics in this scenario?
An 82-year-old man with mild cognitive impairment 'doctor shops' to get antibiotics, an expectorant (guaifenesin), and a mucolytic (acetylcysteine) for a non-productive cough that isn't affecting his sleep. What is the PRIMARY concern with prescribing antibiotics in this scenario?
An 82-year-old man with mild cognitive impairment is taking guaifenesin. Which of the adverse effects listed is MOST likely to occur with an overdose of guaifenesin?
An 82-year-old man with mild cognitive impairment is taking guaifenesin. Which of the adverse effects listed is MOST likely to occur with an overdose of guaifenesin?
What is the MOST appropriate advice to give an 82-year-old man regarding the timing and method of taking guaifenesin for a non-productive cough?
What is the MOST appropriate advice to give an 82-year-old man regarding the timing and method of taking guaifenesin for a non-productive cough?
What is the MOST important instruction to give to a patient who has been prescribed acetylcysteine for a cough?
What is the MOST important instruction to give to a patient who has been prescribed acetylcysteine for a cough?
A patient with a non-productive cough is considering taking both guaifenesin and acetylcysteine. What is the MOST important consideration when using these medications together?
A patient with a non-productive cough is considering taking both guaifenesin and acetylcysteine. What is the MOST important consideration when using these medications together?
A patient is prescribed both an oral antihistamine and an intranasal decongestant for a runny nose and nasal congestion. Since drowsiness is a concern, what advice is MOST appropriate regarding the antihistamine?
A patient is prescribed both an oral antihistamine and an intranasal decongestant for a runny nose and nasal congestion. Since drowsiness is a concern, what advice is MOST appropriate regarding the antihistamine?
Why is routine use of antibiotics discouraged in the management of common colds?
Why is routine use of antibiotics discouraged in the management of common colds?
Which of the following describes the primary mechanism of action of first-generation antihistamines like diphenhydramine that causes sedation?
Which of the following describes the primary mechanism of action of first-generation antihistamines like diphenhydramine that causes sedation?
What is the most significant caution associated with the use of codeine as an antitussive, especially in children and adolescents?
What is the most significant caution associated with the use of codeine as an antitussive, especially in children and adolescents?
A geriatric patient is prescribed an over-the-counter medication for a cold. Which potential side effect of the medication is of greatest concern, given the patient's age?
A geriatric patient is prescribed an over-the-counter medication for a cold. Which potential side effect of the medication is of greatest concern, given the patient's age?
Which of the following best explains why some cough and cold medicines are not recommended for children under a certain age?
Which of the following best explains why some cough and cold medicines are not recommended for children under a certain age?
An individual reports experiencing a dry mouth, and sinus tachycardia after taking an over-the-counter decongestant. Which mechanism is most likely responsible for these adverse effects?
An individual reports experiencing a dry mouth, and sinus tachycardia after taking an over-the-counter decongestant. Which mechanism is most likely responsible for these adverse effects?
A patient with a history of hypertension is seeking an over-the-counter decongestant. Which of the following ingredients should they avoid?
A patient with a history of hypertension is seeking an over-the-counter decongestant. Which of the following ingredients should they avoid?
What is the primary difference between second and third-generation antihistamines (like cetirizine, loratadine, and fexofenadine) compared to first-generation antihistamines (like diphenhydramine)?
What is the primary difference between second and third-generation antihistamines (like cetirizine, loratadine, and fexofenadine) compared to first-generation antihistamines (like diphenhydramine)?
A patient is experiencing a non-productive cough that is interfering with their sleep. Considering the information provided, which of the following medications would be most appropriate?
A patient is experiencing a non-productive cough that is interfering with their sleep. Considering the information provided, which of the following medications would be most appropriate?
What is the mechanism of action of acetylcysteine?
What is the mechanism of action of acetylcysteine?
Compared to first-generation antihistamines, what is a key advantage of using fexofenadine for managing cold symptoms?
Compared to first-generation antihistamines, what is a key advantage of using fexofenadine for managing cold symptoms?
A patient who is an ultra-rapid metabolizer of CYP2D6 is prescribed codeine for cough suppression. What is the primary concern in this scenario?
A patient who is an ultra-rapid metabolizer of CYP2D6 is prescribed codeine for cough suppression. What is the primary concern in this scenario?
Which of the following decongestants is available in both oral and intranasal formulations?
Which of the following decongestants is available in both oral and intranasal formulations?
Which of the following describes the action of dextromethorphan?
Which of the following describes the action of dextromethorphan?
What is a common adverse effect associated with phenylephrine due to its mechanism of action?
What is a common adverse effect associated with phenylephrine due to its mechanism of action?
Flashcards
Cough & Cold Medications
Cough & Cold Medications
Drugs used to treat symptoms of cough and cold, including antihistamines, mucoregulators, mast cell stabilizers, decongestants, antitussives, expectorants, and mucoactive agents.
Antihistamines
Antihistamines
Medications that block histamine receptors, reducing allergy symptoms like runny nose and sneezing.
Mucoregulators
Mucoregulators
Medications that help regulate mucus production in the respiratory tract.
Mast Cell Stabilizers
Mast Cell Stabilizers
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Decongestants
Decongestants
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Antitussives
Antitussives
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Opioid Antitussives
Opioid Antitussives
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Codeine
Codeine
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Codeine Action
Codeine Action
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Codeine Typical Adult Dose
Codeine Typical Adult Dose
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Codeine Adverse Effects
Codeine Adverse Effects
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CYP2D6 Ultra-Rapid Metabolizers
CYP2D6 Ultra-Rapid Metabolizers
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Codeine & Children
Codeine & Children
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Acetylcysteine Mechanism
Acetylcysteine Mechanism
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Acetylcysteine Adverse Effects
Acetylcysteine Adverse Effects
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Bromhexine/Ambroxol Action
Bromhexine/Ambroxol Action
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Bromhexine/Ambroxol Side Effects
Bromhexine/Ambroxol Side Effects
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Promethazine in Infants
Promethazine in Infants
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Antihistamines/Cough Suppressants/Cold & Flu Products in Young Children
Antihistamines/Cough Suppressants/Cold & Flu Products in Young Children
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Promethazine / Antihistamines / Cough suppressants / Cold and Flu Products for 2 years and above
Promethazine / Antihistamines / Cough suppressants / Cold and Flu Products for 2 years and above
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Mucokinetic Agents
Mucokinetic Agents
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Expectorant
Expectorant
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Active Metabolite
Active Metabolite
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Acetylcysteine
Acetylcysteine
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Dextromethorphan
Dextromethorphan
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Diphenhydramine
Diphenhydramine
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Cetirizine, Loratadine, Fexofenadine
Cetirizine, Loratadine, Fexofenadine
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Phenylephrine
Phenylephrine
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Pseudoephedrine
Pseudoephedrine
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Common Cold
Common Cold
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Cough and Cold Medications
Cough and Cold Medications
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Ipratropium
Ipratropium
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Mucoactive Agents
Mucoactive Agents
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Nasal Decongestant
Nasal Decongestant
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Intranasal Decongestant Use
Intranasal Decongestant Use
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Rebound Congestion
Rebound Congestion
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Guaifenesin
Guaifenesin
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Guaifenesin Overdose Side Effects
Guaifenesin Overdose Side Effects
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Guaifenesin Usage Advice
Guaifenesin Usage Advice
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Ineffective Airway Clearance
Ineffective Airway Clearance
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COX Inhibitors
COX Inhibitors
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Dry Mouth (Cholinergic Antagonism)
Dry Mouth (Cholinergic Antagonism)
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Sedation (H1 Antihistamines)
Sedation (H1 Antihistamines)
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Descarboethoxyloratadine
Descarboethoxyloratadine
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Oral Capsule/Tablet/Syrup
Oral Capsule/Tablet/Syrup
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Intranasal/Inhalation
Intranasal/Inhalation
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Study Notes
Medicines for Cough and Cold
- The lecture covers antihistamines, mucoregulators, mast cell stabilizers, decongestants, antitussives, expectorants, and mucoactive agents
Learning Objectives
- Explain the mechanisms of action and adverse effects of the medicines
- Discuss which drugs are appropriate for specific types of cough versus rhinorrhea/nasal congestion
- Understand cautions when prescribing cough and cold medications to pediatric and geriatric patients
Common Cold
- The common cold is an upper respiratory tract infection (URTI) typically caused by viruses
- Common cold viruses: rhinovirus, coronavirus (e.g., types 229E, NL63, OC43, HKU1), and respiratory syncytial virus
- Symptoms include runny nose/sneezing, sore throat, headache, fever, and cough
- Typical duration is approximately 3-7 days
- Cough and cold medications aim for symptomatic relief
Nasal Congestion
- It is associated with sympathetic vasoconstriction and parasympathetic stimulation of mucus secretion
- The sinuses and entire nasal cavity are lined with the nasal mucosa
- The nasal mucosa, also known as the mucociliary layer, is responsible for transporting mucus
Medications Based on Symptoms
- For rhinorrhea/nasal congestion/post-nasal drip, use antihistamines and decongestants
- Consider mucoregulators or mast cell stabilizers for more severe symptoms of rhinorrhea/nasal congestion/post-nasal drip
- Antitussives are appropriate for cough that is non-productive ("dry") and is causing discomfort etc
- Expectorants and mucoactives are appropriate for cough that is productive ("wet")
Mucoregulators: Ipratropium
- Ipratropium is used to control severe cold symptoms by decreasing mucus hypersecretion
- It is a short-acting muscarinic receptor antagonist (SAMA)
- It blocks inflammation-induced parasympathetic cholinergic receptor (M3) activation
- Volume of mucus output and sputum are decreased
- Basal secretion is not dried, and normal viscosity is not increased
- Side effects are few as little enters systemic circulation through the intranasal route
- Possible side effects when used as a mucoregulator: unpleasant taste, dry mouth, and urinary retention in the elderly
Mast Cell Stabilizers: Cromoglicic Acid
- Cromoglicic acid (cromolyn) is administered intranasally or inhaled for severe cold symptoms
- It controls chloride (Cl-) channels to inhibit cellular activation; and mast cell degranulation induced by IgE-mediated FcεRI crosslinking
- It inhibits the secretion of inflammatory mediators from eosinophils, neutrophils, and macrophages
- Increases Secretion of annexin A1, which inhibits prostaglandin and leukotriene production
- Possible side effects include throat and nasal irritation, mouth dryness, dry cough, and an unpleasant/bitter taste
H1-Antihistamines
- Cholinergic antagonism: dry mouth, urinary retention, sinus tachycardia
- α-adrenergic antagonism: hypotension, dizziness, reflex tachycardia
- 5-HT receptor antagonism: increased appetite
First Generation:
- crosses the blood brain barrier (BBB), resulting in sedation
- CNS effects: sedation, impaired cognitive & psychomotor function, increased appetite
- Duration of action: 4-6 hours
- Second Generation:
- Less CNS penetration due to lower lipophilicity, high affinity interaction with P-glycoprotein efflux pump, resulting in little to no sedation
- More selective for H1 histamine receptors
- Duration of action is 12-24 hours
- Both antihistamines and antitussives: Diphenhydramine and Chlorpheniramine
- Frequently formulated in oral cough & cold medicines: Triprolidine and Promethazine
Decongestants
- They are sympathomimetic agents including phenylephrine, oxymetazoline, naphazoline, pseudoephedrine, and ephedrine
- They can be administered orally or intranasally.
- Alpha-1 selective: Phenylephrine (oral or intranasal)
- Non-selective: Oxymetazoline (intranasal) / naphazoline (intranasal)
- Indirect increase in release of adrenaline/noradrenaline: Pseudoephedrine (oral) / Ephedrine (intranasal)
- They work through vasoconstriction of nasal blood vessels, reducing inflammation and secretion of mucus
- Nasal glucocorticoids like fluticasone and mometasone are administered intranasally
- Intranasal fluticasone has a reported "rose water" odor that some people dislike
- Nasal glucocorticoids work through anti-inflammatory action to reduce inflammation, congestion, and mucus secretions
Decongestants - Adverse Effects
- Rebound congestion can occur with prolonged use of topical decongestants (> few days)
- CNS stimulation is more often seen with oral decongestants causing restlessness, tremors, irritability, anxiety, and insomnia
- Cardiovascular effects, such as hypertension and tachycardia, are more likely with oral decongestants
- Glucocorticoids have limited systemic side effects as they are administered by intranasal delivery
Administration of Nasal Drops and Nasal Spray
- Educate patients on the correct nasal administration procedure to avoid accidental ingestion when administrating
- Formulations are frequently sympathomimetics/decongestants, for example; phenylephrine, oxymetazoline, and ephedrine
- Glucocorticoids, like fluticasone and mometasone, are additionally available for these routes
Antitussives
- Antitussives are divided into Opioid Antitussives and Nonopioid Antitussives
- Opioid Antitussives include codeine:
- Has abuse potential and respiratory depression
- Administer with cation to children
- Some Nonopioid Antitussives include dextromethorphan and diphenhydramine
- Dextromethorphan: GI adverse effects, abuse potential at high doses
- Diphenydramine: sedation
- 1st gen antihistamines
Opioid Antitussives: Codeine
- Codeine is effective cough suppressant
- It acts in the central nervous system (CNS) to suppress cough
- CNS sedation and abuse potential can be adverse effects
- It can cause respiratory depression, especially in patients with severe respiratory insufficiency
- Ultra-rapid metabolizers of CYP2D6 should take caution as codeine needs to e metabolized to morphine to have an effect of cough; with this population, there is a greater morphing effect that could lead respiratory side effects
- It is not recommended as antitussive for children under 18 years old due to respiratory depression risk
Non-Opioid Antitussives: Dextromethorphan
- Dextromethorphan is active ingredient found in over-the-counter cough medicines
- The typical adult dose: 10-30mg every 4-8 hours; is not recommended in children < 4 yearls old
- There is limited evidence for cough in cold and flu situations
- Multiple actions: nonselective serotonin reuptake inhibitor, sigma-1 receptor agonist, and (at high dose) NMDA receptor block
- Some of the adverse effects of dextromethorphan are a result of a chemical derived from components of opioid
Expectorants: Guaifenesin
- Comes in oral solution or tablet form
- Often in cough mixture formulations
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