chronic rhinitis, cough and cold medications

Question 1

what is an antitussive

Answer 1

substance that suppresses cough

Question 2

what are centrally acting antitussive

Answer 2

dextromethophran
opiates

Question 3

what are locally acting anti-tussives

Answer 3

benzonatate

Question 4

what is the MOA for dextromethophan

Answer 4

crosses the BBB and activates sigma opioid receptors on the cough center in the CNS (Medulla), thereby suppressing the cough reflex
does not affect ciliary activity (in the bronchial tree)

Question 5

what are the indications for dextromethorphan

Answer 5

short-term relief of cough

Question 6

what are the interactions with dextromethophan

Answer 6

avoid co-use with MAOIs and in SSRI/SNRI - can cause serotonin syndrome

Question 7

what are the adverse drug effects with dextromethophan

Answer 7

mild and infrequent dizziness and drowsiness
at very high doses (when used recreationally) can cause hallucinogenic state
serotonergic effects

Question 8

what are the contraindications for dextromethorphan

Answer 8

avoid in chronic cough
avoid in hepatic disease
avoid when operating machinery

Question 9

what is the MOA for codeine

Answer 9

supress cough reflex centrally (though evidence does not necessarily suppport this)
dries bronchial secretions
often co-administed with guaifensesin (expectorant)

Question 10

what are the indications for codeine use

Answer 10

short term relief of cough

Question 11

what are the interactions with codeine

Answer 11

conver to morphine in liver via cytochrome P450
concomitant use of opiates leads to sedation and respiratory depression

Question 12

what are the adverse effects of codeine

Answer 12

tolerance
respiratory depression
sedation
n/v
potential for abuse
pruritus

Question 13

what are the contraindications for codeine

Answer 13

illeus
respiratory depression
head injury
seizures
hepatic failure

Question 14

what is the MOA for benzonatate

Answer 14

anesthetizes the stretch receptors of vagal afferent fibers in the lungs, reducing the urge to cough after deep inhalation; periphally-acting

Question 15

what are the interactions with benzonatate

Answer 15

can be additive to other local anesthetics

Question 16

what are the indications for benzonatate

Answer 16

mostly for relief of chronic cough, but sometimes used for acute cough (with variable success)

Question 17

what are the adverse effects of benzonatate

Answer 17

well tolerated, GI upset, local anesthesia from chewing
overdoses - cardiac arrhythmias, seizure, bronchospasm

Question 18

when are benzonatate contraindicated

Answer 18

avoid in allergy to ester anesthetics

Question 19

what is the MOA of guaifenesin

Answer 19

loosens secretions to allow for more productive cough - increases volume and reduces viscosity of phlegm in trachea/bronchi
cilia can then more easily propel/mobilize secretions upward

Question 20

what are the indications for guaifenesin

Answer 20

treatment of acute cough

Question 21

what are the contraindications for guaifenesin

Answer 21

should not be used for chronic cough
avoid in pediatrics; can lead to seizures in this population

Question 22

what are the adverse effects of guafenesin

Answer 22

rare at recommended doses
excessive use can result in nephrolithiasis

Question 23

what are histamines

Answer 23

produced by mast cells and basophils
released by an immunologic trigger or following a mechanical or chemical stimulus

Question 24

how many receptors do histamines have

Answer 24

4 different types but only two are pharmacologically important

Question 25

where are H1 receptors located

Answer 25

smooth muscle cells. endothelium and brain

Question 26

where are H2 receptors located

Answer 26

gastric mucosa mast cells, immune cells and brain

Question 27

what are the general effects of histamine

Answer 27

local vasodilation transudation of fluid through endothelial cells stimulates nerve endings, producing pain and itching

Question 28

what are organ-specific effects of histamine

Answer 28

lung - bronchoconstriction GI tract: contraction of smooth muscle, potent secretagogue for gastric acid secretion, pepsin and intrinsic factor brain - neurotransmitter

Question 29

what are first generation antihistamines

Answer 29

diphenhydramine (Benadryl) and hydroxyzine (vistaril or atarax)

Question 30

what are the second generation antihistamines

Answer 30

cetirizine, loratadine and fexofenadine

Question 31

when should first generation antihistamines be avoided

Answer 31

elderly - it may cause delirium, dizziness, urinary retention

Question 32

what is the use for cetirizine

Answer 32

crosses BBB a little, little drowsiness but better for itching, hives

Question 33

what are the pharmacokinetics of first generation antihistamines

Answer 33

act quickQ6h sedating hydroxyzine can be used as an anxiolytic agent

Question 34

what are the pharmacokinetics of second generation antihistamines

Answer 34

24 hour non-drowsy formulation

Question 35

what is the MOA for pseudoephedrine

Answer 35

sympathomimetics, alpha and beta 2 adrenergic receptor agonist - direct stimulation of alpha-adrenergic receptors of respiratory mucosa causes vasoconstriction and of beta-adrenergic receptors causes bronchial relaxation reduces tissue hyperemia and edema reduces nasal congestion and opens blocked eustachian tubes

Question 36

what is pseudoephedrine indicated for

Answer 36

decongestant: acute nasal congestion, sinusitis, otitis media

Question 37

what are the adverse effects of pseudoephedrine

Answer 37

increases HR and contractility contraindicated in patients with heart disease, severe HTN or uncontrolled DM

Question 38

what is the chemical precursor to the manufacture of methamphetamine

Answer 38

pseudoephedrine

Question 39

what is the MOA for phenylephrine

Answer 39

binds primarily to alpha1 receptors, causing vasoconstriction

Question 40

what are the indications for phenylephrine

Answer 40

decongestant: nasal decongestant less effective for treatment of rhinitis symptoms than pseudoephedrine

Question 41

what are the pharmacokinetics of phenylephrine

Answer 41

oral or intranasal

Question 42

what are the AE of phenylephrine

Answer 42

increases systolic and diastolic pressure - induces reflex bradycardia

Question 43

what are the interactions with phenylephrine

Answer 43

ACE inhibitors, CCBS can increase clearance, making less effective interaction with MAOIs, TCAs can increase concentration

Question 44

what are the common oral decongestatns

Answer 44

pseudoephedrine phenylephrine

Question 45

what is oxymetazoline

Answer 45

afrin - topical decongestant appropriate for treating acute rhinitis

Question 46

what are the pharmacokinetics of oxymetazoline

Answer 46

long acting form (~12 hours per spray) dosed twice daily for max of 3 days

Question 47

what are the AE of oxymetazoline

Answer 47

longer duration of use can lead to rebound congestion

Question 48

what is the MOA for inhaled nasal fluticasone

Answer 48

glucocorticoid receptor agonist - causes vasoconstriction and inhibitory effects of cells and mediators of inflammation

Question 49

what are the indication for inhaled nasal fluticasone

Answer 49

treatment and prevention of allergic rhinitis; treatment of chronic nasal polyps not indicated for treatment of acute upper respiraotry infections

Question 50

what are the adverse effects of inhaled nasal fluticasone

Answer 50

epistaxis pharyngitis systemic absorption of steroid is possible

Question 51

what are the available inhaled antihistamines

Answer 51

azelastine and olopatadine - intranasal administration

Question 52

what are the indications for inhaled antihistamines

Answer 52

indicated for allergic rhinitis in adults and children > 12

Question 53

what are side effects of inhaled antihistamines

Answer 53

nose bleeds, headaches are possible side effect somnolence, poor taste