Respiratory System Pharmacology- Treatment of Cough
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| Types of Drugs used in Cough: | Antitussive Drugs
Protussive Drugs
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| Purpose of the Cough reflex: | A useful protective reflex
Indicator of an underlying illness
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| How is the cough reflex induced? | Mechanically or Chemically
Mechanically: stimulation of large respiratory passages
Chemically: stimulation of alveoli
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| Cough can refer to: | Exhaustion
Insomnia
Musculoskeletal pain
Hoarseness
Urinary incontinence
Dizziness, headache, syncope
Fear of cancer, AIDS, or TB
Nausea, vomiting, retching, and anorexia
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| What is the function of antiussive drugs? | Controls, inhibits or eliminates cough
Useful to suppress intensity and frequency of coughing when it is unproductive and distressing
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| What is the function of protussive drugs? | Makes cough more effective
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| Treatment of Cough is usually done based on: | Etiology or pathophysiological mechanism
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| Different causes of cough: | Asthma
Sinusitis
Allergic or perennial non allergic sinusitis
GERD
Bronchitis
Sarcoidosis
CHF
ACEI-induced cough
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| When is non-specific treatment of cough used? | When definitive therapy cannot be given either because:
a. the cause is unknown
b. definitive therapy did not have the chance to work or will not work( cancer metastatic to lung)
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| What are the categories of non-specific treatment of drugs? | 1) Drugs that may alter mucociliary factors
2) Drugs acting on the afferent limb
3) Drugs acting on the cough center
4) Drugs acting on the efferent limb
5) Drugs acting on the respiratory skeletal muscles
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| How do drugs that may alter mucociliary factors function? | Increased volume of the secretions
Decrease mucus production
Change the consistency of mucus (i.e. Mucolytics)
Increase mucociliary clearance
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| Examples of drugs that alter mucociliary factors: | Ipecacuanha
Squill
Volatile oils
Iodinated glycerol
Aromatic chest rub
Bromhexine
Carbocisteine
Ammonium chloride.
Hydration
Ipratropium bromide.
Beta adrenergic agonists.
Theophylline.
Sodium chromoglycate.
Beclomethasone.
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| Natural products which have direct effect on CNS and principally cause emesis which is preceded by increased secretions: | Ipecacuanha and Squill
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| Which drugs have direct action on the bronchi and come in lemon, anise, and pine flavor? | Volatile oils
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| Which drugs are excreted through bronchial glands and stimulate secretions directly? | Iodinated glycerol
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| Which drugs can cause congenital hypothyroidism, so are contraindicated in pregnancy and during lactation? | Iodinated glycerol
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| Which drugs increase lysosome activity leading to increased enzyme secretion and hydrolysis of mucopolysacharides? | Bromhexine
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| Which drugs work as an aerosol through their SH group to reduce disulfide bonds in mucoproteins leading to enhancement of flow? | Carbocisteine
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| Hydration can be done either: | Orally or IV
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| Which drugs act on the afferent limb? | Local anesthetics: Lidocaine
Opoids
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| Which drug when applied topically, has transient antitussive effect and when administered Intravenously, could have a central effect? | Lidocaine
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| Which drugs act on the cough center? | Narcotic:
Codiene
Diamorphine
Morphine
Non narcotic:
Dextromethorphan
Diphenhydramine
Pholcodine
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| Which drug acts on the efferent limb? | Ipratropium Bromide
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| How is Ipratropium Bromide administered? | As an aerosol
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| Ipratropium Bromide is effective in: | Asthma
Chronic bronchitis
Persistent cough following URTI
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| Examples of drugs acting on the respiratory skeletal muscles: | Nondepolarizing blockers like pancuronium
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| When are drugs acting on the respiratory skeletal muscles used? | In patients who can not be mechanically ventilated because of uncontrollable spasms of coughing
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| Function of protussive therapy: | Increases cough effectiveness with or without increasing frequency
Increase superficial velocity or alter mucus factors
Indicated when cough performs a useful function, and needs to be encouraged
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| In which cases is protussive therapy used? | Bronchiectasis
Cystic fibrosis
Pneumonia
Postoperative atelectasis
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| Drugs used in protussive therapy: | Hypertonic Saline Aerosol
Amiloride Aerosol
Bronchodilators
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| Function of hypertonic saline aerosol: | Improves cough clearance but not pulmonary function or subjective assessment
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| In which case is Amiloride aerosol used? | Cystic fibrosis
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| What mechanical measures are used in protussive therapy? | Manual compression of the lower thorax and abdomen
Abdominal push manoevure to assist expiration
Combining abdominal binding and muscle training of pectoralis major
Combination of positive exp. pressure and chest physiotherapy in chronic bronchitis
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