Antihistamines, Decongestants, Antitussives, Expectorants & Mucolytic

Question 1

When cough is beneficial, do you need medicine ?

Answer 1

Do not medicate as the purpose is to clear foreign material from airway

Question 2

When it is a productive cough, What medicine should be given ?

Answer 2

Expectorants
- Guaifenesin
Mucolytic
- Ambroxol
- Bromhexine
- Acetylcysteine (Cysteine derivatives)
- Carbocisteine (Cysteine derivatives)

Cysteine is an amino acid found naturally in the human body

Question 3

When it is a non productive(dry) cough, What medicine should be given ?

Answer 3

Antitussives
Opioid
-Codeine
Non-Opioid
-Dextromethorphan
-Diphenhydramine

Question 4

Is there is a nasal congestion due to allergic rhinitis. What medicine to use?

Answer 4

H1 Anti histamine
-1st Gen - Will sedate & dry mouth , cross into CNS,
Cholinergic antagonism: dry mouth, urinary retention, sinus tachycardia
α-adrenergic antagonism: hypotension, dizziness, reflex tachycardia
Serotonin receptor antagonism: increased appetite
-2nd and 3rd gen will not sedate

Intranasal Corticosteroids
- Fluticasone

Question 5

What decongestants medication to use when nose block

Answer 5

Direct

• Phenylophrine (Alpha 1 Agonist)
• Oxymetazoline (dry mouth)

Indirect

• Ephedrine
• Pseudoephedrine

Question 6

What happen during a common cold ?

Answer 6

• Viral infection of upper respiratory tract
• Resolve within 3-7 days
• Cough and cold medication for symptomatic

Question 7

What is Antihistamines ?

Answer 7

inverse agonists

Question 8

Name the first Generation antihistamine drug

Answer 8

Chlorpheniramine
Diphenhydramine
Promethazine

Question 9

Name the first Generation antihistamine drug use to treat motion sickness

Answer 9

Diphenhydramine
Dimenhydrinate
Cyclizine

Question 10

How do H1 antihistamines work?

Answer 10

-Physically blocking the H1 receptors so histamine from reaching its target. decreases your body’s reaction to allergens

Question 11

First generation Anti histamine also interact with ______?

Answer 11

• Beside H1 , it also interact with muscarinic cholinergic, alpha-adrenergic and serotonin receptors

Question 12

Second generation Anti histamine also interact with ______?

Answer 12

Reduced lipophilicity or greater p-glycoprotein efflux pump
affinity and so reduced CNS effects

Question 13

Name all the 2nd Generation ANti histamine drug

Answer 13

Centrizine - Abit sedation
Fexofenadine
Loratadine

Question 14

Name all the 3rd Generation ANti histamine drug

Answer 14

Levocetrizine
Desloratadine

Question 15

What is the effective duration for 1st generation vs 2nd generation Anti histamine drug ?

Answer 15

1st Gen - 4-6H
2nd Gen - 12-24H

Question 16

Which human organ is use to metabolise the 1st generation vs 2nd generation Anti histamine drug ?

Answer 16

1st Generation - Liver
2nd Generation - Liver P450 with active metabolites

Question 17

Discuss how 1st generation vs 2nd generation Anti histamine drug is excreted ?

Answer 17

1st Generation - Urine
2nd Generation - Urine , Feces

Question 18

Name all the Decongestants drugs use to clear congestion (Oral)

Answer 18

Oral / Intranasal

• Phenylephrine
• Pseudoephedrine
• ephedrine
• Oxymetazoline

Mechanism of action
- “Peseu & ephedrine”increase adrenaline
- “Phen & Oxy “ work on Alpha 1 adrenoceptor agonist
• Vasoconstriction of nasal blood vessels
• Reduce inflammation and secretion of mucus

Question 19

Name the adverse effect of Sympathomimetic Agents that help in decongestion

Answer 19

• Rebound congestion
• Occurs with prolonged (> few days) use of topical intranasal
decongestants
• CNS stimulation
• More likely with oral decongestants
• Restlessness, tremors, irritability, anxiety and insomnia
• Cardiovascular
• More likely with oral decongestants
• Hypertension due to vasoconstriction
• Palpitations (indirect sympathomimetics e.g. pseudoephedrine)

Question 20

Name all the Decongestants drugs use to clear congestion (Intranasal)

Answer 20

Intranasal
Fluticasone - Nasal Glucocorticoid

Mechanism of Action:
• Anti-inflammatory

Question 21

Name all the Glucocorticoids Decongestants adverse effect.

Answer 21

• Systemic side effects limited by intranasal delivery
• Local mucosal dryness and irritation

Question 22

Name a few Antihistamine-Decongestant Combinations

Answer 22

Chlopheniramine + Pseudephedrine
Diphenhydramine + Pseudephedrine

Question 23

Name the advantage and disadvantage og Opioid Antitussives

Answer 23

Question 24

Name the advantage and disadvantage of NON-Opioid Antitussives

Answer 24

Question 25

Names the action mechanism and adverse effect?

Answer 25

Mechanism of Action: Acts in CNS to suppress cough - CNS – sedation - Weak opioid but still has abuse potential at high dose - Respiratory depression • Should not occur at normal clinical doses • Risk on overdose • Risk in patients with severe respiratory insufficiency - Do not combine with other CNS depressants

Question 26

What is the recommended does of codeine for adult and children ?

Answer 26

Adult - 10 to 20 mg every 4 to 6 times a day Children not recommended as liver and respiratory centre are not developed

Question 27

Name the working mechanism and adverse effect of Non Opioid Antitussives - Dextromethorphan

Answer 27

Mechanism of Action: • Acts in CNS to suppress cough Adverse Effects: • CNS – drowsiness, dizziness • Gastrointestinal – nausea, vomiting, stomach pain • Abuse potential at high dose (dissociative anaesthetic-like effect)

Question 28

Name the working mechanism and adverse effect of Non Opioid Antitussives - Diphenhydramine

Answer 28

Mechanism of Action: • Antihistamine; Mechanism of antitussive action unknown Adverse Effects: • Sedative, anticholinergic

Question 29

``` Name Guaifenesin (expectorants) mechanism of action and adverse effects It is a component in many cough mixture formulations ``` Mechanism of action: • Increases production of respiratory tract fluids to help liquefy and reduce viscosity of tenacious secretions Adverse Effects: • Gastrointestinal disturbance, nausea Cannot use for patient with persistence cough associated with asthma and smoking . Take more fluid

Question 30

Name the Mucolytics mechanism of action and adverse effect

Answer 30

Mechanism of action: • Free sulfhydryl group opens disulphide bonds in mucoproteins • Lowers mucous viscosity Adverse Effects: • Bronchospasm • Anaphylactoid reactions – rash, hypotension, dyspnea, wheezing • Gastrointestinal disturbance Caution : • Cannot use for Elderly or debilitated patients with severe respiratory insufficiency • Patients with asthma

Question 31

List all Mucolytics drug

Answer 31

Acetylcysteine, carbocisteine, ambroxol, bromhexine

Question 32

Can cought and cold medicine use for children? (e.g. Promethazine, Antihistamine, cough suppressants, cold and flu product)

Answer 32

Below 6 month - Not recommended for all 6mth- 2years old - Promethazine cannot use while all other use if benefits outweight risk 2 years above - Use with cayion for all

Question 33

Is cough and cold medication suotable for elderly use

Answer 33