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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?

  • 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?

  • 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?

  • 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?

<p>Antihistamines (D)</p> Signup and view all the answers

If medication helps to regulate the production or viscosity of mucus, into what category does it fall?

<p>Mucoactive agent (B)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of codeine as an antitussive?

<p>It acts in the central nervous system (CNS) to suppress the cough reflex. (C)</p> Signup and view all the answers

A patient reports experiencing drowsiness and constipation after starting codeine for cough. What is the most appropriate explanation for these side effects?

<p>These are common adverse effects of codeine related to its CNS activity and opioid properties. (D)</p> Signup and view all the answers

Why is codeine not recommended as an antitussive for children under 18 years old?

<p>Children are more sensitive to opioid-induced respiratory depression due to immature respiratory centers and liver development. (B)</p> Signup and view all the answers

What is the primary concern when combining codeine with other CNS depressants?

<p>Increased risk of respiratory depression. (D)</p> Signup and view all the answers

An adult patient is prescribed codeine for cough. What is the typical recommended dose?

<p>15 to 30 mg every 3 to 4 hours. (C)</p> Signup and view all the answers

In individuals who are CYP2D6 ultra-rapid metabolizers, what potential risk is associated with codeine use?

<p>Increased risk of severe respiratory depression, even at normal doses. (B)</p> Signup and view all the answers

A patient has a history of opioid abuse. Which of the following antitussives would be the MOST appropriate and safest choice for this patient?

<p>Dextromethorphan (D)</p> Signup and view all the answers

A patient taking codeine is also prescribed an antihistamine for allergies. What potential drug interaction should the patient be warned about?

<p>Increased sedation and drowsiness. (D)</p> Signup and view all the answers

N-acetylcysteine reduces mucous viscosity by which mechanism?

<p>Opening disulfide bonds in mucoproteins via free sulfhydryl groups (D)</p> Signup and view all the answers

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?

<p>N-acetylcysteine (C)</p> Signup and view all the answers

Which of the following is a known mechanism of action for ambroxol that contributes to its mucokinetic properties?

<p>Increasing ciliary beat frequency and stimulating surfactant production (D)</p> Signup and view all the answers

Which of the following pharmacological effects is NOT associated with bromhexine and its metabolite, ambroxol?

<p>Increased adherence of mucus to cilia (B)</p> Signup and view all the answers

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?

<p>Codeine (D)</p> Signup and view all the answers

A patient is prescribed carbocisteine for excessive mucus production. Which of the following conditions would be a contraindication for this medication?

<p>Active peptic ulcer (B)</p> Signup and view all the answers

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?

<p>Monitoring for potential bronchospasm, especially in elderly patients (B)</p> Signup and view all the answers

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?

<p>Diphenhydramine (D)</p> Signup and view all the answers

Why are cough and cold medications primarily used in the management of the common cold?

<p>They provide symptomatic relief from the discomfort associated with the infection. (C)</p> Signup and view all the answers

Which of the following is the most likely mechanism by which first-generation antihistamines, such as diphenhydramine, alleviate common cold symptoms?

<p>Blockade of histamine H1 receptors and induction of sedation through CNS penetration. (C)</p> Signup and view all the answers

What is a significant caution to consider when prescribing codeine as an antitussive, particularly for young patients?

<p>Potential for addiction and respiratory depression, especially in ultra-rapid CYP2D6 metabolizers. (D)</p> Signup and view all the answers

Which of the following is a common adverse effect associated with the use of first-generation antihistamines like diphenhydramine, particularly in elderly patients?

<p>Urinary retention. (D)</p> Signup and view all the answers

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?

<p>Phenylephrine. (D)</p> Signup and view all the answers

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?

<p>First-generation antihistamines readily cross the blood-brain barrier, affecting histamine receptors in the CNS. (C)</p> Signup and view all the answers

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?

<p>Pseudoephedrine. (C)</p> Signup and view all the answers

What is the primary mechanism of action of acetylcysteine in the treatment of respiratory conditions?

<p>Modifying the structure of mucus to decrease its viscosity. (D)</p> Signup and view all the answers

A patient is experiencing a non-productive cough associated with a common cold. Which class of medications would be most appropriate for symptomatic relief?

<p>Antitussives. (B)</p> Signup and view all the answers

Which of the following best describes the mechanism of action of intranasal ipratropium in treating symptoms of the common cold?

<p>Anticholinergic effect to reduce nasal secretions. (D)</p> Signup and view all the answers

A patient taking diphenhydramine for cold symptoms reports increased appetite. What receptor antagonism is most likely responsible for this side effect?

<p>5-HT receptor antagonism. (D)</p> Signup and view all the answers

Compared to first-generation antihistamines, what is the key advantage of using second or third-generation antihistamines like loratadine or fexofenadine?

<p>Reduced risk of sedation and cognitive impairment. (D)</p> Signup and view all the answers

Which of the following is NOT a common viral cause of upper respiratory tract infections (URTIs) associated with the common cold?

<p>Streptococcus pneumoniae. (D)</p> Signup and view all the answers

What is the primary reason for caution when using decongestants like pseudoephedrine in elderly patients?

<p>Exacerbation of cardiovascular conditions like hypertension and tachycardia. (A)</p> Signup and view all the answers

A patient is prescribed an H1 antihistamine. Which of the following side effects is most directly related to the drug's mechanism of action?

<p>Reduced nasal congestion. (B)</p> Signup and view all the answers

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?

<p>Limit use to 5-7 days to avoid rebound congestion. (C)</p> Signup and view all the answers

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?

<p>Rush the infant to the hospital emergency department. (B)</p> Signup and view all the answers

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?

<p>The antibiotics are unlikely to be effective against a viral cough and contribute to antibiotic resistance. (A)</p> Signup and view all the answers

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?

<p>Nausea and vomiting (A)</p> Signup and view all the answers

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?

<p>Take guaifenesin with plenty of water to help loosen mucus. (D)</p> Signup and view all the answers

What is the MOST important instruction to give to a patient who has been prescribed acetylcysteine for a cough?

<p>Increase fluid intake while taking acetylcysteine. (B)</p> Signup and view all the answers

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?

<p>These medications can be used together, as guaifenesin helps bring up mucus, and acetylcysteine thins it. (B)</p> Signup and view all the answers

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?

<p>Use a non-sedating antihistamine, as they have a lower risk of causing drowsiness. (D)</p> Signup and view all the answers

Why is routine use of antibiotics discouraged in the management of common colds?

<p>They are ineffective against viral infections and contribute to antibiotic resistance. (B)</p> Signup and view all the answers

Which of the following describes the primary mechanism of action of first-generation antihistamines like diphenhydramine that causes sedation?

<p>H1 antihistamine activity in the central nervous system. (C)</p> Signup and view all the answers

What is the most significant caution associated with the use of codeine as an antitussive, especially in children and adolescents?

<p>Potential for addiction and respiratory depression. (B)</p> Signup and view all the answers

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?

<p>Urinary retention. (D)</p> Signup and view all the answers

Which of the following best explains why some cough and cold medicines are not recommended for children under a certain age?

<p>Children are more susceptible to paradoxical reactions and severe side effects from certain medications. (A)</p> Signup and view all the answers

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?

<p>Cholinergic antagonism. (B)</p> Signup and view all the answers

A patient with a history of hypertension is seeking an over-the-counter decongestant. Which of the following ingredients should they avoid?

<p>Pseudoephedrine. (B)</p> Signup and view all the answers

What is the primary difference between second and third-generation antihistamines (like cetirizine, loratadine, and fexofenadine) compared to first-generation antihistamines (like diphenhydramine)?

<p>It is less likely to cause sedation. (D)</p> Signup and view all the answers

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?

<p>An antitussive like dextromethorphan (B)</p> Signup and view all the answers

What is the mechanism of action of acetylcysteine?

<p>Breaking disulfide bonds in mucus, reducing viscosity (A)</p> Signup and view all the answers

Compared to first-generation antihistamines, what is a key advantage of using fexofenadine for managing cold symptoms?

<p>Fexofenadine has a lower risk of causing sedation. (D)</p> Signup and view all the answers

A patient who is an ultra-rapid metabolizer of CYP2D6 is prescribed codeine for cough suppression. What is the primary concern in this scenario?

<p>The codeine will be converted to its active metabolite at an accelerated rate, increasing the risk of toxicity. (C)</p> Signup and view all the answers

Which of the following decongestants is available in both oral and intranasal formulations?

<p>Phenylephrine (B)</p> Signup and view all the answers

Which of the following describes the action of dextromethorphan?

<p>Suppresses the cough reflex. (C)</p> Signup and view all the answers

What is a common adverse effect associated with phenylephrine due to its mechanism of action?

<p>Hypertension (D)</p> Signup and view all the answers

Flashcards

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

Medications that block histamine receptors, reducing allergy symptoms like runny nose and sneezing.

Mucoregulators

Medications that help regulate mucus production in the respiratory tract.

Mast Cell Stabilizers

Medications that stabilize mast cells, preventing the release of histamine and other inflammatory mediators.

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Decongestants

Medications that relieve nasal congestion by constricting blood vessels in the nasal passages reducing swelling.

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Antitussives

Drugs that suppress the cough reflex.

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Opioid Antitussives

Antitussives that work by acting on opioid receptors in the CNS.

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Codeine

An opioid antitussive that is effective at suppressing cough.

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Codeine Action

Acts in the central nervous system (CNS) to reduce the cough reflex.

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Codeine Typical Adult Dose

15 to 30 mg every 3 to 4 times a day.

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Codeine Adverse Effects

Sedation, potential for abuse, and respiratory depression.

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CYP2D6 Ultra-Rapid Metabolizers

Individuals who metabolize codeine very quickly, increasing risk of adverse effects.

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Codeine & Children

Not recommended as an antitussive for those under 18 years old due to increased risk of respiratory depression.

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Acetylcysteine Mechanism

Opens disulfide bonds in mucoproteins, lowering mucous viscosity.

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Acetylcysteine Adverse Effects

Bronchospasm, anaphylactoid reactions, and GI disturbance.

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Bromhexine/Ambroxol Action

Promotes mucus clearance by increasing ciliary beat frequency and stimulating surfactant production.

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Bromhexine/Ambroxol Side Effects

Allergic reactions and cutaneous adverse effects.

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Promethazine in Infants

Not recommended for children under 6 months.

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Antihistamines/Cough Suppressants/Cold & Flu Products in Young Children

Use only when benefits outweigh risks for 6 months - 2 years old.

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Promethazine / Antihistamines / Cough suppressants / Cold and Flu Products for 2 years and above

Use with caution

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Mucokinetic Agents

Increase ciliary beat frequency and decreases adherence of mucus to cilia

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Expectorant

Clears foreign material from the airways.

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Active Metabolite

A drug that is pharmacologically active after it has been metabolized.

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Acetylcysteine

A cysteine derivative used as a mucolytic agent.

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Dextromethorphan

A non-opioid antitussive, one of the more potent options available.

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Diphenhydramine

Older antihistamine with both antihistamine and antitussive effects.

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Cetirizine, Loratadine, Fexofenadine

Newer generation antihistamines with reduced sedation.

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Phenylephrine

Oral and intranasal decongestant, can cause hypertension and tachycardia.

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Pseudoephedrine

Oral decongestant, can cause restlessness, tremors, and insomnia.

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Common Cold

A viral infection of the upper respiratory tract, usually resolves in 3-7 days.

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Cough and Cold Medications

Medications provide symptomatic relief only for common cold.

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Ipratropium

Intranasal spray that can help dry up a runny nose.

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Mucoactive Agents

Medications that help to loosen and clear mucus from the airways.

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Nasal Decongestant

An intranasal decongestant that shrinks swollen nasal blood vessels, relieving congestion.

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Intranasal Decongestant Use

Administer with head upright; spray once or twice into each nostril, avoiding overuse to prevent rebound congestion.

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Rebound Congestion

An adverse reaction where nasal congestion worsens with prolonged decongestant use, leading to dependence.

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Guaifenesin

An expectorant that loosens mucus, making coughs more productive.

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Guaifenesin Overdose Side Effects

Nausea, vomiting, and gastrointestinal upset are common.

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Guaifenesin Usage Advice

Drink plenty of water to help loosen mucus; follow dosage instructions carefully.

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Ineffective Airway Clearance

Removal of foreign material from airways, which does not help and can increase the risk of antibiotic resistance.

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COX Inhibitors

A group of drugs that inhibits cyclooxygenase enzymes.

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Dry Mouth (Cholinergic Antagonism)

A side effect caused by blocking cholinergic receptors, leading to reduced saliva production.

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Sedation (H1 Antihistamines)

A common side effect of older antihistamines.

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Descarboethoxyloratadine

A metabolite of Loratadine, also an antihistamine.

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Oral Capsule/Tablet/Syrup

A common dosage form for cough and cold medications.

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Intranasal/Inhalation

Medications applied directly into the nasal passages or inhaled into the lungs.

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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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