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PULM > PULM cough suppressants > Flashcards

PULM cough suppressants Flashcards

1
Q

describe the affarent pathways that regulate cough?

A

SAR, RAR, and cough receptors provide input via vagus nerve to NTS relay neurons that send affarents to central cough generator
-central cough generator then coordinates the output to the muscles that cause cough

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2
Q

describe the efferent pathways that regulate cough?

A

central cough generator sends efferents via phrenic, spinal motor nerves, and recurrent laryngeal nerves to the diaphragm, intercostal muscles, laryngeal and abdominal muscles to cause cough

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3
Q

define acute cough

A

0-3 wks

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4
Q

define subacute cough

A

3-8 wks

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5
Q

define chronic cough

A

more than 8 wks

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6
Q

describe a productive cough

A 
wet cough w/ secretions
clear-bronchitis
-purulent-bacterial infection
-yellow-inflammatory disorders
-malodorous-anaerobic infectino
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7
Q

describe a non-productive cough

A

dry hacking cough that does not remove sputum from the respiratory tract

  • viral illness
  • bronchospasm
  • allergies
  • asthma
  • airway obstruction
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8
Q

what are some of the complications of cough

A 
exhaustion
urinary incontinence
pain
insomnia
syncope
stroke
rib fractures
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9
Q

what are some of the non pharmacologic treatments of cough?

A 
eliminating irritants
hard candies like Jolly ranchers
lozenges
humidifiers or vaporizers
hydration
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10
Q

MOA of dextromethorphan

A

suppresses the cough reflex by a direct action on the cough center in the medulla of the brain

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11
Q

how is dextromethorphan metabolized?

A

by CYP2D6 into active metabolite dextrorphan

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12
Q

describe the safety of dextromethorphan?

A

wide margin of safety, huge doses can produce dissociative hallucinogenic effect)
-non opiod (equal potency as codeine)

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13
Q

what are some of the adverse effects of dextromethorphan?

A 
dizziness
drowsiness
nausea
upset stomach
vomiting
diarrhea
irritability
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14
Q

what are the need to know contraindications for dextromethorphan?

A

don’t take w/ MAO inhibitor, anti-depressants, advanced resp. insufficiency or hepatic disease, hypersensitivity to ingredients in product

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15
Q

MOA of diphenhydramine

A

antihistamine-H1 receptor antagonist (has many effects on NT’s in the brain)

  • suppresses the cough reflex by a direct effect on the cough center
  • antitussive effects due to its anticholinergic effects (muscarinic receptor blocker)
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16
Q

what is the cough indication for diphenhydramine?

A

2nd line agent, indicated for nonproductive cough caused by irritation

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17
Q

what are some adverse effects of diphenhydramine?

A 
drowsiness
respiratory depression
blurred vision
dry mouth
urinary retention
constipation
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18
Q

what are some contraindications for diphenhydramine?

A 
prostate hypertrophy (if you block the muscarinic receptors then you have major restriction at prostate)
-asthma, COPD, peptic ulcer, pts on MAO inhibitors
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19
Q

what is the MOA of codeine

A

opioid analgesic and antitussive related to morphine

  • acts on mu receptors but has lower affinity than morphine
  • it depresses the cough reflex by a direct action on the cough center in the CNS
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20
Q

what are the side effects of codeine?

A 
constipation
sedation
histamine release
vasodilation
orthostatic hypotension
dizziness
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21
Q

what are the contraindications for codeine?

A 
pts w/ acute resp. depression, asthma or COPD
hypersensitivity
labor of premature birth
Preg. Cat. C
prostatic hypertrophy
pts on sedatives
22
Q

what are the topical cough agents?

A

ointments and creams: camphor, menthol, eucalyptus
Lozenges: menthol
Inhalation: camphor or menthol

23
Q

How does camphor work?

A

they have initial stimulation hot receptors and then desensitization

24
Q

MOA of guaifenesin

A

Expectorant-loosens and thins LRT secretion by increasing the volume and reducing the viscosity of secretions

25
Q

what are the uses of guaifenesin?

A

symptomatic relief of ineffective productive coughs (chest congestion)
-not used for chronic coughs

26
Q

what are some side-effects of guaifenesin?

A 
dizziness
dry mouth
rash
diarrhea
drowsiness
nausea
vomiting
uric acid nephrolithiasis (in large doses)
27
Q

how do nasal decongestants work in general?

A

vasoconstrictive drugs that reduce nasal congestion

  • doesnt affect release of histamine or other mediators of allergic rxn
  • commonly formulated w/ antihistamines
28
Q

how does pseudoephedrine work?

A

sympathomimetic adrenergic agonist that enters nerves (alpha-2, alpha-2, Beta-1) and causes them to release NE at post synaptic site–> vasoconstriction and decreased blood supply to nose, and decreased mucosal edema

29
Q

How does phenylephrine work?

A

alpha-1 agonist that causes constriction of blood vessels and stops congestion

30
Q

what enzymes metabolize Pseudoephedrine?

A

MOA and COMT in the GI mucosa, liver and other tissues

31
Q

what is an advantage of pseudoephedrine over phenylephrine?

A

pseudoephedrine has better bioavailability

32
Q

what are some side effects of systemic decongestants?

A

CV stimulation
CNS stimulation
children & elderly are more likely to experience
Cause of rebound congestion alpha1 constriction too long prevents blood to mucosa–>bacterial infection

33
Q

Contraindications for decongestants?

A 
children & elderly
hyperthyroidism (increased exp. of beta-receptors in heart)
bradycardia
partial heart block
hypersensitivity
uncontrolled HTN
v. tach
34
Q

what is oxymetazoline

A

selective alpha-1 agonist as a spray

35
Q

what are the advantages of decongestant sprays

A
  • fast onset
  • cheap
  • simple
  • cover large surface area
36
Q

what are disadvantages of decongestant sprays

A

imprecise dosage

-tip tends to get blocked

37
Q

what is advantage of decongestant drops?

A

for children

38
Q

what are the disadvantages of decongestant drops?

A

awkward to use
cover limited surface area
pass easily into larynx
easily contaminated if dropper touches nose

39
Q

what are some diseases that you would treat with mucolytics?

A 
Cystic fibrosis
COPD
bronchiectasis
resp. infections
MTB
40
Q

what chemical bonds hold mucus together?

A

intramolecular: dipeptide lin
intermolecular: disulfide and hydrogen bonds

41
Q

what are nonpharmocologic ways to facilitate mucus clearance?

A

provide adequate hydration (increase fluid intake)
remove causative factors (smoking, pollutants)
Optimize tracheobronchial clearance
reduce inflammation

42
Q

how do bland aerosols work?

A

dilutes mucus molecule (aka wetting agents)

may act more like irritant than wetter, mostly types of water and saline

43
Q

what is the MOA of mucolytics

A

N-acetyl Cysteine, works by breaking bonds by substituting a sulfydryl radical-HS

44
Q

what is a side effect of N-acetyl cysteine

A

bronchospasm

-asthma: may be a problem during acute asthma attack (use w/ bronchodilator)

45
Q

what are some precautions with N-acetyl cysteine?

A

increased mucus production (be prep. to suction a pt who cant cough or who is intubated)

  • dont mix w/ antibiotics
  • N/V
  • disagreeable odor
46
Q

MOA of amiloride

A

Na+ channel blocker that can be given by aerosol for pts w/ cystic fibrosis (prevents dehydration of the mucus is prevented)

47
Q

where are the cough receptors anatomically located?

A

at bifurcations in the larynx and at distal esophagus (link to affarents via vagus and superior laryngeal nerves to cough center)

48
Q

what happens if you use oxymetazoline for more than 3-5 days?

A

alpha1 constriction too long, prevents blood supply to mucosa–>bacterial infection

49
Q

what is the route of n-acetyl cysteine

A

aerosol or direct instillation into the ET tube

50
Q

how does menthol work?

A

acts on cold receptors causing stimulation and then later desensitization

PULM (14 decks)

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