PHARMA - Antitussives Drugs

Cough reflex

What reflex clears mucus and irritants from the airways?

Antitussive and Protussive

What two broad pharmacologic strategies treat cough symptoms?

Treat cause

What is the main priority before using symptomatic cough drugs?

Acute cough

What cough type is usually viral and self limiting?

Over 8 weeks

What cough duration defines chronic cough in adults?

Mu opioid agonist

What is the primary mechanism of codeine’s antitussive effect?

CYP2D6

Which enzyme converts codeine into morphine?

Dry cough

What is the clinical use of codeine for cough?

Respiratory depression

What major adverse effect risks respiratory suppression?

Constipation

What common adverse effect causes bowel slowing?

Dependence

What long-term problem can develop with codeine use?

Ultra rapid metabolisers

What patient group requires caution because of metabolism variability?

Oral

What route is codeine commonly administered for cough?

1/7th

What is codeine’s relative potency compared to morphine?

Mu opioid agonist

What receptor mediates morphine’s antitussive action?

Respiratory depression

What major toxicity limits morphine use for cough?

Sedation

What other common adverse effect occurs with morphine?

Severe pain

What is a primary clinical use for morphine besides cough?

NMDA glutamate

What central receptor does dextromethorphan antagonize?

Dry cough

What cough type is dextromethorphan used for?

Hallucinogenic effects

What abuse-related effect can occur at high doses?

Less respiratory depression

What is the principal advantage of dextromethorphan over opioids?

Impaired clearance

What patient condition is dextromethorphan contraindicated with excess mucus?

H1 receptor

What receptor does diphenhydramine primarily block?

Anticholinergic effect

What antitussive property does diphenhydramine have?

Postnasal drip

For what cough syndrome is diphenhydramine most useful?

Drowsiness

What common side effect causes daytime impairment?

Blurred vision

What anticholinergic adverse effect affects vision and urination?

Liver

What organ primarily metabolizes diphenhydramine?

Elderly patients

What patient population should use diphenhydramine cautiously?

Mast cell stabilizer

What is the main mechanism of disodium cromoglycate?

Asthma associated

For which cough associated condition is disodium cromoglycate used?

Tachykinin signaling

What sensory pathway does it affect to suppress cough?

Inhaled

What route is disodium cromoglycate commonly given?

Mast cell stabilizer

What is the pharmacologic action of nedocromil sodium?

ACE inhibitor cough

Nedocromil is particularly used for cough from which drug class?

Chloride depolarization

What ionic movement is involved in its effect?

Sensory C fibers

What sensory fibers does levodropropizine inhibit?

Nonproductive cough

What cough type is levodropropizine indicated for?

No sedation

What advantage does levodropropizine have over central agents?

Oral

What is the route typically used for levodropropizine?

Excess mucus

What is a contraindication common to peripheral antitussives?

Secretagogue action

What is the primary mechanism proposed for guaifenesin?

Productive cough

For which cough type is guaifenesin indicated?

1 hour

What is the major pharmacokinetic half-life of guaifenesin?

Urinary metabolites

How is guaifenesin primarily eliminated?

Nausea

What is a common mild adverse effect of guaifenesin?

Supportive therapy

What guideline role does guaifenesin play for productive cough?

Disulfide bonds

What chemical bond does acetylcysteine break in mucus?

Acetaminophen toxicity

What non-respiratory indication uses high-dose acetylcysteine?

Bronchospasms

What inhaled adverse effect can acetylcysteine provoke in asthmatics?

Beta lactams

What drug class interacts adversely with acetylcysteine by inactivation?

Anaphylactoid reaction

What systemic toxic reaction has been reported rarely with acetylcysteine?

Antioxidant action

What additional property does acetylcysteine possess besides mucolysis?

Mucolytic action

What general effect do carbocysteine, bromhexine, and ambroxol produce?

Dornase alfa

Which mucolytic specifically degrades DNA in sputum?

Cystic fibrosis

What disease is dornase alfa especially used in?

Epidermal growth factor

What class of agents may reduce mucus production via cellular signaling?

Thick secretions

What is a shared clinical use of other mucolytics?

Coughing

What common side effect can mucolytics provoke when inhaled?

Voltage gated sodium

What ion channel does lidocaine block to reduce cough?

Suppress gag reflex

What is a typical use of topical lidocaine in airway procedures?

Cardiac arrhythmia

What systemic toxicity can high doses of lidocaine cause?

Peripheral anesthesia

What is the mechanism of benzonatate in cough suppression?

Seizures

What dangerous adverse event can occur with benzonatate overdose?

Oral capsules

How is benzonatate usually administered?

Do not chew

What precaution is important with benzonatate capsules?

Histamine 2 receptor

What receptor does ranitidine block to reduce acid?

Gastroesophageal reflux

What GI condition treated by ranitidine can reduce reflux cough?

H2 antagonist

What class does ranitidine belong to?

Hydrogen potassium ATPase

What enzyme does omeprazole inhibit?

Proton pump inhibitor

What is omeprazole’s drug class?

Hypomagnesemia

What is a long-term concern with proton pump inhibitor use?

Dopamine receptor antagonist

What receptor class does metoclopramide block to enhance motility?

Increased gastric emptying

What effect helps reduce reflux-related cough?

Tardive dyskinesia

What extrapyramidal adverse effect can metoclopramide cause?

Peripheral dopamine antagonist

What is domperidone’s primary pharmacologic action?

Less central effects

What advantage does domperidone have over metoclopramide?

Cardiac arrhythmia

What precaution limits domperidone use in some countries?

Vitex negundo

What plant is lagundi derived from?

DOH BFAD

What agency approved lagundi in the Philippines?

Leukotriene release

What principal anti-inflammatory mediator does lagundi inhibit?

Gastrointestinal upset

What common minor side effects are reported with lagundi tablets?

Bronchodilator

What additional property does lagundi exhibit besides antitussive?

Excessive mucus

What is the general contraindication for antitussives in productive cough?

NICE guideline

What major guideline warns against routine antibiotics for acute cough?

Antihistamine therapy

What symptomatic class should be prioritized for chronic cough due to postnasal drip?

Speech therapy

What nonpharmacologic therapy is recommended for refractory chronic cough?

Respiratory rate

What monitoring parameter is critical when prescribing opioids for cough?

Reduced clearance

What is a pharmacokinetic concern with elderly patients for many antitussives?

Benzodiazepines

What drug class effect increases sedation when combined with sedating antitussives?

Impaired expectoration

What is the pharmacologic reason to avoid antitussives postoperatively when secretions are thick?

Liver function

What common lab organ should be checked for drugs heavily metabolized by liver?

Cytochrome P450

What enzyme family metabolizes many cough drugs like codeine and dextromethorphan?

Tolerance

What pharmacodynamic phenomenon reduces antitussive efficacy over time?

Respiratory disease

What patient history should be reviewed before using opioid antitussives?

Fatal respiratory depression

What pediatric risk is associated with codeine in young children?

Separate dosing

What precaution is recommended when combining acetylcysteine and beta-lactams?

Hydration

What common supportive advice improves expectoration with expectorants?

Thin secretions

What is the primary pharmacologic goal when using protussives?