Antitussive Pharmacology (Cough & Cold Products) (15)

What is the classification of an acute cough?

< 3 weeks

What is the classification of a subacute cough?

3-8 weeks

What is the classification of a chronic cough?

>8 weeks

What is the pathophysiology of Cough?

Host defense mechanism

What are the phases of a cough?

-Inspiration

-Forced expiration against closed glottis, builds intrathoracic pressure

-Opening of glottis with rapid expulsion of air

What are the causes of acute and subacute coughs?

Viral infections

What are the causes of chronic coughs?

Asthma/COPD

GERD

Postnasal drip

Smoking

Exposures

Medications

What is the bottom line for OTC meds?

There is no strong evidence that they improve acute cough

What are the classes of cough/cold medications?

Decongestants

Expectorants

Antitussives

Antihistamines

Antipyretics

What is the cause of a cough produced when sensory receptors in airway are excited by mechanical and/or chemical stimuli?

Mucus

What are the two systemic decongestants?

Pseudoephedrine

Phenylephrine

What are the adverse effects of systemic decongestants?

Increased blood pressure

Tachycardia

Insomnia

Tremor

Headache

Urinary Retention

What are the non-opioid antitussives?

Benzonatate

Antihistamines

What are the opioid antitussives?

Codeine

Hydrocodone

Dextromethorphan

What is the MOA of Benzonatate?

anesthetizing stretch receptors in respiratory passages

What is the MOA of Antihistamines?

act by reducing histamine release, reduce local congestion and production of secretions

Which generation of antihistamines are more effective in suppression of URI-induced cough?

First

What is the Brand Name for Hydrocodone/Chlorpheniramine?

Tussionex

TussiCaps

What is the Brand Name for Hydrocodone/Guaifenesin?

Obredon

What is the Brand Name for Hydrocodone/homatropine?

Hydromet

Tussigon

What are the OTC Dextromethorphan products?

Dextromethorphan ± antihistamine ± expectorant

What is the RX Dextromethorphan product?

Promethazine DM

What do Expectorants do?

Increase volume and/or hydration of secretions

What are the adverse reactions of Guaifenesin?

N/V

GI discomfort

Dizziness

HA

Which alternative cough/cold product was recalled?

Zicam (Zinc)

Although there is insufficient evidence to support the use of zinc preparations in the treatment of common cold, but in adults, it may

reduce the duration of symptoms if started within 24 hours of symptom onset

Mega-dose prophylaxis and use at onset of symptoms not beneficial regarding what Vitamin?

C

What are the benefits of Echinacea for common cold?

none

What do lozenges do for cough/cold?

Stimulate salivation and decrease throat irritation

What do Saline Nasal drops/irrigation (neti pot) do for cough/cold?

Loosen thick nasal mucus and reduce nasal congestion

Distilled, sterile or boiled water to prevent risk of infection

What is a risk of giving children > 12 months honey?

Botulism

What age are OTC cough and cold products not recommended for children?

< 4 years old

What are some recommended cough and cold therapies for children?

Honey

Nasal Irrigation

Vapor Rub

Zinc Sulfate

Prophylaxis (Vitamin C, zinc)

What are the cough/cold options in Pregnancy?

Humidifier

Nasal Saline

Budesonide/Beclomethasone

Antihistamines (Chlorpheniramine - best) (loratadine and cetirizine okay in 2nd or 3rd trimester)

Decongestants (avoid in 1st trimester)

What is a cough due to acute bronchitis?

cough lasting up to 3 weeks caused by lower airway infection (viral)

What is a cough due to chronic bronchitis?

Chronic cough and sputum production on most days for at least 3 months for 2 consecutive years (smoking)

What is a post-infectious cough?

Cough lasting 3-8 weeks after URI

What are the 2017 guidelines on the common cold?

Suggest against the use of OTC cough/cold medicines

Suggest against the use of nonsteroidal anti-inflammatory agents

Pediatric Patients - honey but careful of side effects

How do you treat a cough due to Upper Airway cough syndrome?

1st generation antihistamine/decongestant combination

What do you use to treat a cough due to acute bronchitis?

SABA for cough with wheezing

Antitussives for short-term use

What do you use to treat a cough due to chronic bronchitis?

SABA

Inhaled ipratropium

LABA + ICS

Antitussives

Smoking Cessation

What do you use to treat a post-infectious cough?

Inhaled Ipratropium

ICS

Prednisone 40mg/day x 2-3 weeks

Antitussives

Benzonatate