Cough & Cold

Question 1

Cough suppressants

Answer 1

Opiate agonist (Codeine, hydrocodone), dextromethorphan

Question 2

Contraindications for cough suppressants

Answer 2

Opiate agonist: <18yo, dextromethorphan <4yo

Question 3

MoA of opiate agonist

Answer 3

mu opioid receptor agonist, acts on cough centre in brain (centrally-acting)

Question 4

MoA of dextromethorphan

Answer 4

NMDA receptor –> block Ca, Na influx –> stimulate S1R in ER –> channel Ca into mitochondria –> channel function modulation

Question 5

SE of the opiate agonist

Answer 5

respiratory depression, constipation, sedation

Question 6

SE of dextromethorphan

Answer 6

confusion, nervousness; high dose: headaches; extremely high dose: euphoria

Question 7

Which has higher risk of addiction

Answer 7

Opiate agonists. Dextromethorphan is non-narcotic

Question 8

mucolytics

Answer 8

N-acetylcysteine, carbocisteine

Question 9

indications of mucolytics

Answer 9

URTI, asthma, COPD, CF

Question 10

MoA of NAC

Answer 10

Break double sulfide bonds –> decrease mucus viscosity

Question 11

MoA of carbocisteine

Answer 11

Break double sulfide bonds –> decrease mucus viscosity

Increase sialomucin –> decrease mucus adherence to airways

Question 12

Expectorants

Answer 12

Guaifenesin (not indicated in <2yo)

Question 13

MoA of Guaifenesin

Answer 13

Increase volume of hydration and liquidity of mucus, decrease adherence to airways, increase mucociliary transport –> promote productive cough

Question 14

SE of Guaifenesin

Answer 14

Nausea, vomiting, kidney stones (maintain hydration and increase urinary pH)

Question 15

Mucokinetics

Answer 15

B2 agonist, ambroxol

Question 16

MoA of B2 agonist

Answer 16

Increase cilia beat frequency and transportability of mucus, increase Cl/H2O secretion into mucus, decrease adherence of mucus –> increase mucociliary clearance`

Question 17

SE of B2 agonist

Answer 17

Increase mucus secretion, mucus plug

Question 18

MoA of Ambroxol

Answer 18

increase cilia beat frequency, decrease mucus adherence, stimulate surfactant production –> decrease adherence of mucus to alveolar and bronchial walls

Question 19

SE of ambroxol

Answer 19

Allergic reaction, cutaneous adverse events`

Question 20

Mucoregulators

Answer 20

Anticholinergics (ipratropium, tiotropium), macrolide (erythro/clarithro/azithromycin)

Question 21

MoA of anticholinergics

Answer 21

Block inflammation-induced M3 cholinergic receptor activation of submucosal glands –> decreased stimulated output –> decrease mucus volume

Question 22

MoA of macrolide

Answer 22

Inhibits MUC5AC gene expression and production, inhibit IL-13 induced mucus production –> decrease sputum volume

Question 23

Nasal decongestant

Answer 23

Sympathomimetic amides & direct, fast-acting imidazolin

Question 24

Sympathomimetic amides

Answer 24

Phenylephrine (a1 agonist), pseudoephedrine (a1,a2 agonist)

Question 25

Imidazolin

Answer 25

Oxymetazoline (a1,a2 agonist), xylometazoline (a2 agonist)

Question 26

MoA of decongestants

Answer 26

Vasoconstriction of BV --> decrease swelling of nasal mucosa

Question 27

SE of decongestants

Answer 27

HTN, tachycardia, tremors, restlessness

Question 28

Contraindications of decongestants

Answer 28

CVD, HTN, DM, BPH, MAOI (for oral sympathomimetic amides)

Question 29

Combination therapy

Answer 29

Nasal decongestant + antihistamine ± analgesic or antitussive Nasal decongestant + analgesic/ antipyretic Expectorant + antitussive or decongestants