Cough

Question 1

What is a cough?

Answer 1

A protective reflex that clears the respiratory tract of accumulated
secretions, exudates or foreign substances/bodies. It involves an
initial bronchospasm and the closing of the glottis, after which air is
forced out with tremendous power

Question 2

List the underlying causes of cough

Answer 2

Tuberculosis
* Foreign bodies in the airway
* Cystic fibrosis
* Immune deficiencies should be ruled out.
* Nocturnal cough = asthma or early congestive heart failure
* Smoking
* Side effects of drugs such as ACE inhibitors

Question 3

Describe dry cough and its treatment

Answer 3

No mucus, persistent.
Tx: Antitussive = cough suppressant

Question 4

Describe wet cough and its Tx

Answer 4

Mucus – white (viral)
Yellow-green (bacterial)

Tx:
-Expectorant or
Mucolytic + adequate
hydration to reduce
viscosity of mucus
- Antibiotic

Question 5

Describe mild cough and Tx

Answer 5

Irritating, no bacterial
infection, no bronchospasm

Tx
Simple linctus
Honey &lemon

Question 6

____________________ preparations reduce frequency of exacerbations of COPD

Answer 6

Cysteine-based mucolytic preparations reduce frequency of
exacerbations of COPD

Question 7

What may be the cause of acute cough in children?

Answer 7

Cause
Viral respiratory tract infection

Question 8

Tx of allergic cough with allergic rhinitis

Answer 8

Treatment
Antihistamines + topical nasal steroids

Question 9

Chronic cough in children

Answer 9

Exclude asthma and other underlying conditions

Question 10

Indication for antitussives

Answer 10

Treatment for
unproductive persistent
cough, which exhausts
the patient.
* NOT for productive
cough, withholds the
mucus, NOT for bacterial
infections

Question 11

Examples of antitussive agents

Answer 11

Codeine phosphate
Dihydrocodeine**
Methadone**
Noscapine**
Pholcodine (Pholtex®)xxxxxx
(+ Antihistamine)
Dextromethorphan

Question 12

Why was pholcodine discontinued in SA?

Answer 12

Increased risk of sudden, severe, and life-threatening
allergic reactions occurring during surgery. (ANAPHYLAXIS INPTs RECEIVES NMBAs)

Question 13

Opiod-related side effects:

Answer 13

Suppress cough centre (medulla)
Side-effect & Abuse potential – limit use
C/I: Not < 2yr

Question 14

No-opiod-related side effects:

Answer 14

Suppress cough centre
BUT
No analgesic, euphoric or constipating effects

Question 15

List side effects of antitussives (cough suppressants)

Answer 15

Dizziness, drowsiness, sedation: Avoid alcohol, CNS depressants
* Headaches
* Confusion, excitement (children ++)
* Epigastric discomfort, N, V
* Constipation + biliary colic (opioids)

Question 16

What happens with antitussive OD?

Answer 16

Respiratory depression

Question 17

Abuse and addiction is most common with ________________ and _____________________

Answer 17

Codeine & Antihistamine

Question 18

CI of cough suppressants:

Answer 18

Asthmatic patients, chronic bronchitis

Question 19

Indications of Expectorants

Answer 19

Facilitate coughing up of mucous and other material from the lungs
* Used for patients with thick, tenacious respiratory secretions, dry
non-productive coughing, sinusitis to increase airway hydration

Question 20

MOA of expectorants

Answer 20

Stimulates bronchial secretions, thinning mucus for easy removal

Question 20

Example of an expectorant

Answer 20

Guaifenesin

Question 21

Mucolytics MOA

Answer 21

Dissolves thick mucus & usually used to relieve respiratory difficulties
* MOA: Liquifies mucus by dissolving the mucopolysaccharides (long chain
sugar molecules found in mucus & fluid in joints), reducing its viscosity,
thereby enabling pt. to cough up mucus more easily.

Question 22

Examples of mucolytics:

Answer 22

Bromhexine (Bisolvon®) (+ bronchodilator), Carbocisteine
(Mucospect®) , N-acetylcysteine (Salmucol®)

Question 23

Adverse effects of mucolytics

Answer 23

Epigastric discomfort, N, V
* Tinnitus, headache
* Fever, skin rash, urticaria
* Bronchospasm

Question 24

What is another use of N-acetylcysteine?

Answer 24

Antidote for paracetamol poisoning

Question 25

Precautions for cough medicine:

Answer 25

Cough suppressants C/I: Asthma patients & Chronic bronchitis
* Diabetic patients: Pholcodine, Noscapine, Bromhexine +
bronchodilator
* Combining Cough suppressant + Expectorant = No justification!
* Dryness & irritation of throat:
* Gargle with salt water i.e.
* 2.5g salt in 250ml water