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Pulmonary Week 2 > Cough Suppression, Decongestants > Flashcards

Cough Suppression, Decongestants Flashcards

1
Q

Describe the physiological process of coughing

A

Cough is a 3-phase expulsive motor act characterized by
an inspiratory effort (inspiratory phase), followed by a forced expiratory effort against a closed glottis
(compressive phase), followed by opening of the glottis and rapid expiratory airflow (expulsive phase).

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2
Q

Neural pathways for cough

A

Cough receptors at the airway bifurcations in the larynx and at the distal esophagus (innervated by sensory nerve endings), link to cough afferents through the vagus and superior laryngeal nerves to the cough center and
cerebral cortex.

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3
Q

How does cough occur?

A

Laryngeal and pulmonary receptors, RARs, C-fibers, and SARs, provide input to the brainstem medullary central cough generator through the intermediate relay neurons in the nucleus tractus solitaires (NTS). The cough generator then coordinates output to the muscles that cause cough via the phrenic nerves, etc (via release of Ach).

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4
Q

How are afferents relayed?

A

via TRPV-1 channels (sensitive to temp, capcasin, irritants)

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5
Q

C-fibers are sensitive to what?

A

TRPM-8 (melastatin-8) channels sensitive to cold or menthol (and pain)

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6
Q

TRPa-1 is sensitive to what?

A

wasabi, garlic, onion (noxious stimuli)

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7
Q

What is an acute cough?

A

lasting less than 3 weeks

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8
Q

What is a subacute cough?

A

lasting 3-8 weeks (chronic 8+)

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9
Q

A productive cough with clear sputum suggests what? Malodorous?

A

Clear- bronchitis

Malodorous- anaerobic infection

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10
Q

A productive cough with purulent sputum suggests what? Yellow?

A

Purulent- bronchial infection

yellow-inflammation

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11
Q

What things can cause a non-productive cough?

A
  • viral infection
  • bronchospasm/allergies/asthma
  • GERD
  • airway obstruction
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12
Q

What are some systemic antitussives?

A
  1. Dextromethorphan
  2. Diphenhydramine
  3. Codeine
  4. Benzonatate (Tessalon Perles)
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13
Q

What are some topical antitussives?

A

Camphor and Menthol

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14
Q

What does Guaifenesin do?

A

it is DOC for productive cough with thick secretions to dilute them

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15
Q

Dextromethorphan is the active ingredient in what drugs?

A
  • NyQuil
  • Muxinex DM
  • Robitussin
  • Vicks
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16
Q

How does Dextromethorphan work?

A

suppresses the cough reflex by a direct action on the cough center in the medulla (non-opioid)

not THAT effective

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17
Q

How is Dextromethorphan metabolized?

A

CYP2D6 (into active dextrorphan)

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18
Q

Large doses of Dextromethorphan can cause what?

A

dissociative hallucinogenic effect (via antagonizing the NMDA receptor)

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19
Q

What are the AEs of Dextromethorphan?

A
  • dizziness, drowsiness, N/V
  • constipation
  • tachycardia

ICNREASE SEROTONIN LEVELS

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20
Q

Contraindications of Dextromethorphan

A
  • those taking MAO and serotonin uptake inhibitors

- advanced respiratory insufficiency or hepatic disease

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21
Q

What can Dextromethorphan do to children?

A

can release histamine and cause allergic reaction

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22
Q

What is serotonin syndrome?

A

causes seizures, aggitation, tachycardia, etc.

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23
Q

What does Diphenhydramine do?

A

antihistamine H1-receptor antagonist that suppresses the cough reflex by a direct action on the cough center (anticholingeric)

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24
Q

What is Diphenhydramine indicated for?

A

2nd line for nonproductive cough caused by irritation

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25
Q

What are the other uses of Diphenhydramine (Benadryl)?

A

cold, allergic rhinitis, urticaria, motion sickness, insomnia, parkinsonism

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26
Q

AEs of Diphenhydramine?

A
  • Drowsiness
  • respiratory depression
  • dry mouth
  • blurred vision
  • urinary retention/constipation
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27
Q

Contraindications of Diphenhydramine?

A
  • BPH
  • urinary obstruction
  • asthma/COPD
  • peptic ulcer (via H2 receptor blocking- they produce gastric secretions)
  • MAOIs
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28
Q

T or F. The concurrent use of Diphenhydramine with other serotonin increasing drugs is contraindicated

A

T.

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29
Q

How does codeine work?

A

it is an opiod analgesic and antitussive that acts on mu receptors and depresses the cough reflex by direct action

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30
Q

Onset of codeine? DOA?

A

10-30 minutes and acts 4-6 hrs

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31
Q

AEs of codeine?

A

constipation, sedation

  • histamine release
  • orthostatic hypotensions
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32
Q

Contraindications of codeine?

A
  • hypersensitivity
  • labor of premature birth
  • BPH
  • asthma/COPD/respiratory failure
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33
Q

T or F. Codeine use in certain children after tonsillectomy and/or adenoidectomy may lead to death

A

T.

34
Q

How does Benzonatate work?

A

(nonnarcotic) decreases sensitivity of stretch receptors in the airways by its local anesthetic effect

stretch= activation of TRP channels

35
Q

When is Benzonatate indicated?

A

-cough in emphysema, bronchitis, pneumonia, and influenza

36
Q

Benzonatate is more effective when used with what?

A

Mucinex

37
Q

AEs of Benzonatate?

A

skin rash, nasal congestion, hallucinations

  • hypersensitivity reaction (cardiac arrest eventually) if chewed or sucked
  • headache, NV
38
Q

Contraindications of Benzonatate?

A
  • antihistamines, sleep or anxiety drugs, muscle relaxants
  • children under 10
  • allergies to tetracaine or procaine
39
Q

How do camphor and menthol work?

A

initially activating and then desensitizing TRPV1 and TRPA1 and TRPM8 channels

40
Q

How does Guaifenesin (Mucinex) work?

A

loosens and thins lower respiratory secretions by increasing the volume and reducing the viscosity of secretions (not for chronic cough)

41
Q

AEs of Guaifenesin?

A
  • dry mouth, dizziness, N/V

- uric acid nephrolithiasis in large doses

42
Q

Contraindications of Guaifenesin?

A

Hypersensitivity

43
Q

What is the main cause of nasal congestion?

A

mucosal inflammation

44
Q

What mediators cause congestion?

A

histamine, PGD2 (chemottractant), others from mast cells which cause increased permeability and inflammation from recruited vessels, as well as venous engorgement

45
Q

What causes coughing and sneezing in rhinorrhea?

A

affarents via the trigeminal ganglion stimulates the brain and activation of the parasympathetics (and decrease in SNS action) to produce mucus and

substance P and CGRP are produced (cause vasodilation)

46
Q

How do you treat nasal congestion?

A

vasoconstrictive drugs (do not affect histamine release but are commonly combined with antihistamines)

47
Q

How does vasoconstriction occur in the nose?

A

stimulation of alpha-adrenergic receptors constricting blood vessels throughout the body and reducing blood supply to the nose and mucosal edema

48
Q

What are some a1 specific agonists?

A

Phenylephrine and Oxymetazoline (partial a2 agonist)

49
Q

T or F. PO Phenylephrine is NOT effective as a decongestant

A

T. Nasally inhalant is though (not metabolized the same way). Oxymetazoline can be given PO

50
Q

How is Phenylephrine metabolized?

A

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

51
Q

How does Pseudoephreine (Sedated) work as a decongestant?

A

(PO) releases Nor from a adrenergic nerves (indirect effect)

52
Q

How is Pseudoephreine metabolized?

A

only minorly, by N-demethylation

53
Q

How long can Oxymetazoline be used for?

A

3-5 days (longer may cause rebound congestion)- rhinitis medicamentosa

54
Q

What are the advantages of sprays of nasal decongestants?

A
  • faster onset

- cheap, easy

55
Q

What are the disadvantages of sprays of nasal decongestants?

A

imprecise dose, tip tends to get blocked

56
Q

What are the advantages of drops of nasal decongestants?

A

works for small children

57
Q

What are the disadvantages of drops of nasal decongestants?

A

-cover a limited surface area, pass easily into the larynx, and can easily be contaminated

58
Q

What are the side effects of Pseudoephedrine?

A

-CV stimulation
-restlessness, anxiety, tremors, fear
(most common in children and elderly)

59
Q

What are some contraindications for Pseudoephedrine?

A
  • children/elderly
  • hyperthyroidism
  • bradycardia/heart block
  • HTN
  • ventricular tachycardia
  • hypersensitivity
60
Q

What are some inhaled nasal decongestants?

A
  • Levamfetamine (won’t cause rebound)

- Prophylhexedrine

61
Q

What does stimulation of H1 receptors result in?

A

bronchoconstriciton, vasodilation, urticaria, inflammation,e tc.

62
Q

What are the 1st gen H1 receptor antagonists?

A
  • Diphenhydramine (Benadryl)
  • Chlorpheniramine
  • Promethazine
63
Q

What are the 2nd gen H1 receptor antagonists?

A
  • Fexofenadine (allegra)
  • Loratidine (Claritin)
  • Cetirizine (Zyrtec)
64
Q

What are the uses of H1 antagonists?

A

common cold, allergic rhinitis, pruritis, nausea, vertigo

to produce sleep

atopic dermatitis, sinusitis

65
Q

AEs of H1 antagonists?

A

-sedation, dizziness, dry mouth, constipation and urinary retention

66
Q

What diseases have increased mucus production?

A

CF, COPD, bronchiectasis, TB

67
Q

Describe mucus

A

glycoproteins with polypeptides that make up the backbone held together by disulfide, hydrogen, and dipeptide bonds

68
Q

What are some basic things that can be done to increase mucus clearance?

A

provide hydration, remove causative factors, reduce inflammation

69
Q

What is the main function of bland aerosols?

A

they function more as an irritant to stimulate cough than a wetter

70
Q

What are some expectorants?

A
  • Iodides/Iodinated Glycerol
  • Guiafenesin (at high doses, stimulates bronchial gland secretion)
  • Bromohexine
71
Q

How does Bromohexine work?

A

secretolytic, increases the production of serous mucus in the RT and decreases viscosity of phlegm

72
Q

How does N-acetyl cysteine work as a mucolytic?

A

breaks the SH bonds

73
Q

How can N-acetyl cysteine be given?

A
  • aerosol or by direct instillation into the ET tube

- PO to reduce liver injury with acetaminophen overdose

74
Q

AEs of N-acetyl cysteine?

A
  • bronchospasm (must use with a bronchodilator in asthma)
  • N/V
  • increased mucus production
  • has a bad odor
75
Q

T or F. N-acetyl cysteine should not be mixed with ABX

A

T.

76
Q

How does sodium bicarbonate work as a mucolytic?

A

increase pH of mucus which weakens polysaccharide chains

77
Q

How does Dornase Alfa (Pulmozyme) work as a mucolytic?

A

it is a clone of pancreatic DNase enzyme which digests extracellular DNA and reduced viscosity of secretions during an INFECTION

78
Q

When is Pulmozyme used?

A

CF, chronic bronchitis, or bronchiectasis (has no effect on non-infected sputum)

79
Q

AEs of Pumozyme?

A
  • voice alteration
  • rash
  • chest pain
  • conjunctivitis
  • pharyngitis/laryngitis
80
Q

Contraindications of Pulmozyme?

A

Hypersensitivity to chinese hamster ovary cell products

81
Q

How does Amiloride work as a mucolytic?

A

diuretic blocks Na+ absorption and prevents dehydration of mucus

Pulmonary Week 2 (25 decks)

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