Pharmacology - Cough/decongestants/a1 agonists/CAM

Question 1

the cough center receives signal from..

Answer 1

the afferent vagal nerve

when the cough center is activated an efferent signal is sent to the diaphragm + others through efferent motor nerves

Question 2

4 phases of cough

Answer 2

irritation
inspiration
compression
expulsion

Question 3

irritation of bronchial mucosa causes….

Answer 3

bronchoconstriction

Question 4

what CAUSES afferent impulses to be sent to the cough center in the medulla

Answer 4

the stimulation of mechano or chemoreceptors

Question 5

during a wet cough, mucus is continuously produced due to irritation of….

Answer 5

the submucosal gland

happens during INFECTION

Question 6

explain what sends the afferent signal to the brain stem (cough center) via the vagal nerve

Answer 6

histamine and leukotriene (LTD4) released by mast cells and eosinophils (cells released from dilated blood vessels)

this histamine and leukotriene irritates the smooth muscle of the airway

also, cytokines like TNFa and PGE2 participate

RAR-C fibers also participate which occur from the TRPV-1 CGRP receptor

Question 7

why is mucus thicker when the patient has infection

Answer 7

immune cells are trapped and also release DNA into the mucus

Question 8

acute vs subacute vs chronic cough

in PEDS what is a chronic cough considered?

Answer 8

acute - less than 3 weeks

sub acute - 3-8 weeks

chronic - over 8 weeks

peds - chronic is more than 4 weeks

Question 9

2 most common causes of chronic cough (over 4 weeks) in infants

what about 2-5 years old? adolescents?

Answer 9

aspiration
congenital heart defects

2-5: foreign body inhalation and hyper reactive airways

adolescents - hyperreactive airways, infection

Question 10

2 types of cough

Answer 10

wet (productive)
dry (nonproductive)

Question 11

what is a “tenacious” cough

Answer 11

productive/wet

Question 12

true or false

a dry cough indicates no infection

Answer 12

true

Question 13

what is an antitussive drug and what kind of cough is it useful for

Answer 13

a cough suppressant

dry cough

Question 14

give 2 examples of when antitussives should be avoided and why

Answer 14

chronic pulmonary infection
-causes thickening of sputum and it gets retained

also DO NOT give antitussives in asthma bc of the risk of respiratory depression

Question 15

explain what a productive cough looks like

Answer 15

cough with sputum/phlegm

will also have a heavy chest, breathlessness, or may have fever/runny nose/drainage into throat

Question 16

term for mucus that has been expectorated

Answer 16

sputum

Question 17

name some causes of productive cough

Answer 17

viral/bacterial lung infections ( ie - common cold)

asthma, pneumonia, COPD, lung abscesses

Question 18

what are “mucoactive” meds and name the 3 classes

Answer 18

drugs that affect the properties of the mucus and promote its clearance

expectorants
mucolytics
mucokinetics

Question 19

differentiate between expectorants, mucolytics, and mucokinetic drugs
(the mucoactive meds)

Answer 19

expectorants - improve ability to expectorate

mucolytics - decrease the viscosity of the mucus by degrading polymers/DNA/fibrin

mucokinetics - increased mucociliary clearance by acting on the cilia

Question 20

antitussives are drugs used to ___________ in the ________ and are given for ________

Answer 20

suppress the cough center in the medulla and are given for SYMPTOMATIC RELIEF - does not cure anything

Question 21

the antitussives can be divided into addicting and nonaddicting. explain the categories

Answer 21

addicting: potent and less potent

potent - morphine and dihydromorphinone

less potent - codeine and pholcodeine

nonaddicting: opioid derivatives and non-opioid derivatives

opioid derivatives: DM and noscapine

non-opioid derivatives: benzonatate, diphenhydramine, tripolidine

Question 22

MOA of codeine

Answer 22

moderate agonist at mu receptors

Question 23

long considered the “gold standard” cough suppressant

Answer 23

codeine

Question 24

codeine is a natural isomer of..

Answer 24

methylated morphine

Question 25

AE of codeine

Answer 25

euphoria, NV, drowsiness, dry mouth, constipation, urinary retention, orthostatic hypotension, miosis

Question 26

true or false chronic use of codeine cannot cause withdrawal symptoms

Answer 26

false - it can

Question 27

true or false codeine is metabolized to morphine

Answer 27

true but only a little bit mainly gets glucuronidated

Question 28

true or false dextromethorphan is synthetic

Answer 28

false - semisynthetic

Question 29

true or false DM has NO analgesic properties

Answer 29

true

Question 30

MOA DM

Answer 30

agonist to opioid sigma 1 and 2 receptor a3/b4 antagonist opioid-like. NMDA antagonist blocks serotonin reuptake and inhibits ciliary action

Question 31

active metabolite of DM any 1st pass concern?

Answer 31

dextrophan 1st pass thru CYP2D6

Question 32

SE of DM

Answer 32

drowsiness, constipation, dizziness, dry mouth, resp depression has a lil abuse potential too

Question 33

MOA of benzonatate

Answer 33

NUMBS the stretch receptors in the lungs

Question 34

SE benzonatate

Answer 34

NVD drowsiness dizziness dysphagia (difficulty swallowing)

Question 35

3 antihistamines that are nonnarcotic antitussives

Answer 35

promethazine chlorpheniramine diphenhydramine (1st gen!) 2nd gen has no antitussive properties

Question 36

MOA of antihistamines as antitussives

Answer 36

suppress the cough center and dry secretions

Question 37

guaifenesin class and MOA

Answer 37

expectorant CNS muscle relaxant reduces mucus production and increased ciliary clearance increased VOLUME and decreased VISCOSITY of bronchial secretions

Question 38

guaifenesin stimulates bronchial secretions via _______

Answer 38

vagal pathways

Question 39

NAC MOA

Answer 39

mucolytic the SH (sulfhydryl) groups on the compound interact with disulfide bonds on the mucoprotein decreased viscosity

Question 40

name 5 mucoactive drugs

Answer 40

hypertonic saline guifenesin NAC bronchodilators surfactants

Question 41

MOA of surfactants as mucoactive drugs

Answer 41

reduced adhesiveness of the mucus

Question 42

diphenhydramine and benzonatate are ____ acting cough suppressnats

Answer 42

peripherally

Question 43

DM is a ____ acting cough suppressant

Answer 43

centrally

Question 44

MOA of volatile oils for couugh

Answer 44

activate nasal sensory afferents which modulates the cough response (nasal instead of lungs)

Question 45

name 2 topical anesthetics for sore throat

Answer 45

benzocaine dyclonine

Question 46

true or false benzocaine has a rapid onset

Answer 46

true less than 1 min but has short duration of 5-10 mins

Question 47

true or false the common cold is a viral lower respiratory tract

Answer 47

FALSE - upper

Question 48

can the common cold cause a fever

Answer 48

yes in severe cases

Question 49

true or false antibiotics are ineffective for the common cold

Answer 49

true

Question 50

treatment for common cold

Answer 50

just relieve the symptoms!!

Question 51

what are the 2 categories of nasal decongestatns

Answer 51

systemic and topical all are alpha agonists

Question 52

name 3 TOPICAL alpha agonists and 2 systemic alpha agonists

Answer 52

topical - oxymetazoline, naphazoline, phenylephrine systemic - phenylephrine, pseudoephedrine

Question 53

true or false codeine is a centrally acting antitussive

Answer 53

true

Question 54

true or false guaifenesin is a peripherally acting cough suppressant

Answer 54

FALSE - it's an expectorant

Question 55

AE of a1 agonists (decongestants)

Answer 55

restlessness, reflex bradycardia, tachycardia, palpitations, heart block

Question 56

*****MOA of nasal decongestants

Answer 56

a1 agonists (and sometimes a2) decreases blood volume due to vasoconstriction this decreases congestion

Question 57

*activation of a1 receptors causes vasoconstriction that reduces the volume of blood WHERE? activation of a2 receptors causes vasoconstriction that reduces the blood flow into WHAT?

Answer 57

A1 - MUCOSA A2 - capillary bed of the nasal mucosa

Question 58

**type of a1 receptor and what pharmacologically happens upon binding

Answer 58

Gq couples to phospholipase C! GPCR increased IP3 and DAG calcium released, calmodulin and protein kinase C activated

Question 59

a1 agonists are what pregnant category and what does this mean

Answer 59

C can harm fetus

Question 60

tricyclic or MAO inhibitors + pseudoephedrine interaction

Answer 60

hypertensive crisis

Question 61

true or false pseudoephedrine may reduce the effectiveness of some antihypertensives

Answer 61

true

Question 62

phenylephrine is mainly metabolized by what

Answer 62

MAO A and MAO b and SULT1

Question 63

zinc data for the common cold

Answer 63

ORAL zinc lozenges may decrease length of common cold if started within 24 hrs no intranasal zinc!! loss of smell

Question 64

vitamin C for the common cold

Answer 64

only slightly reduces length and severity of common cold - safe in normal doses

Question 65

MOA of vitamin C for the common cold

Answer 65

blocks pathway that leadsto apoptosis of T cell T cell proliferation

Question 66

echinacea for common cold

Answer 66

weak evidence

Question 67

**one of best CAM for cough

Answer 67

honey!!!! may even be better than the meds for cough

Question 68

MOA of honey

Answer 68

hydrogen peroxide content gives antimicrobial effect more glucose oxidase = more H202 and the better the honey will work watch the different types of preparations!

Question 69

true or false more glucose oxidase in the honey the better

Answer 69

TRUE means more H2O2 - more antimicrobial action

Question 70

which has best antimicrobial properties artificial honey vs manuka honey vs pasture honey

Answer 70

manuka honey is best

Question 71

*primary MOA that codeine suppresses cough

Answer 71

suppress medullary cough center by mu receptor activation

Question 72

MOA of dextromethorphan as an antitussive

Answer 72

NMDA antagonism and sigma1 agonism

Question 73

how does benzonatate suppress cough

Answer 73

inhibiting stretch receptors in the lungs and pleura (also acts on afferent nerve fibers to numb them)

Question 74

what drug increases mucus clearance by stimulating bronchial secretions via vagal pathways

Answer 74

guaifenesin

Question 75

how do the 1st gen antihistamines have antitussive action

Answer 75

central H1 antagonism and anticholinergic activity

Question 76

phenylephrine _____A1 receptors to induce ________

Answer 76

stimulates a1 receptors to induce vasoconstriction

Question 77

true or false guaifenesin improves mucus cleawrance by decreasing volume and decreasing viscosity of the secretions

Answer 77

FALSE increased volume and decreased viscosity

Question 78

how do volatile oils like menthol exert antitussive effects

Answer 78

anesthizing respiratory tract sensory neurons

Question 79

MOA of NAC as a mucolytic

Answer 79

cleaves disulfide bonds in mucin polymers

Question 80

does NAC stimualte ciliary movement in the airways

Answer 80

NO

Question 81

how does pseudoephedrine relieve nasal congestion

Answer 81

by stimulating a1 adrenergic receptors to decrease mucosal blood flow

Question 82

true or false alpha1 is a Gq receptor that works through the suppression of calcium release

Answer 82

FALSE - causes release of calcium