P H R M A C O L O G Y - NOTE 1 - Treatment of Cough

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4

It clears the excess secretions
& inhaled foreign matters.
Expectorants are used.
Productive Cough
Dry cough has no useful
function.
Anti-tussives are used.
Non-Productive
Cough
1) Acute Respiratory Infection.
Upper respiratory infection.
Pneumonia.
Bronchitis
2) Chronic Respiratory Infection.
TB.
Postnasal drip.
3) Airway Diseases.
Asthma.
COPD.
4) Irritants.
Cigarettes smoking.
Inhaled foreign bodies.
5) Drug Induced.
Inhaled drugs (aerosols).
ACE-inhibitors (anti-hypertensive).
Common causes of Cough:
Anti-tussive
They should be used for dry cough.
because it suppress cough reflex, it should not be used in
the presence of bronchial secretions.
Locally anti-
tussive
It reduces the sensitivity of periphral cough receptors to it's
activators which include irritants & autacoids (Bradykinine).
Mucoactive
Agents
They clear airway from mucus secretion by:
ability to expectorate sputum.
mucus hyper secretion.












P H R M A C O L O G Y - NOTE 1 - Treatment of Cough


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5

DRUDS FOR COUGH
Anti-tussives
Drugs
Centrally
Opioid
Dervatives
Codeine
Pholcodeine
Dextrome-
thorphan
Noscapine
Anti-histamins
Diphenhydram
ine
Peripherally
Above Larynx
Lozenge
Syrup
Below Larynx
steam with or without
(menthol & benzoin
tincture)
Nebulized
Lignocaine
Nebulized
Benzocaine
Centrally &
Periphrally
Benzonatate
Mucoactive
Agents
Expectorants
Hyperosmolar
saline
Na citrate
K citrate
Na
bicarbonate
Ammonium
Cloride
Na Iodide
K Iodide Guaifenesin
Creosote Guaicolate
Mucolytics
Classic
mucolytic
NAS
Peptide
mucolytic
Dornase alpha
others
Bromhexine
Ambroxol
Mucoregulatory
Anti-
cholinergic
Ipratropium
Atropine
Macrolide
Antibiotics
Azithromycin
Anti-
inflammatory
Indomethacin Corticosteroids






















P H R M A C O L O G Y - NOTE 1 - Treatment of Cough


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6

Anti-Tussives (cough suppressent)

DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT



A
c
t
i
n
g

C
e
n
t
a
r
l
l
y

O
p
i
o
i
d


D
e
r
v
a
t
i
v
e

Codeine They suppress cough reflex by
Derict inhibition of Cough Center in the
medulla.

Nausea.
Dizziness.
Urenary retention.
Constipation.(vi)
Pholcode
Dextromethorphan
Noscapine
A
n
t
i
-

H
i
s
t
a
m
i
n
e
Diphenhydramine

It depresses CNS including Cough Center. Sedation.
Drowsiness.
Dizziness.
A
c
t
i
n
g

P
e
r
i
p
h
r
a
l
l
y

A
b
o
v
e


L
a
r
y
n
x
Lozenges They are demulcents. They form gelatious coat that protects the
inflammed skin
Used for cough of
Sore throat.
Pharyngitis.

Syrup (honey)
B
e
l
o
w

L
a
r
y
n
x

Steam Without tooking,
it taken by
inhalation .
Taken with or
without (menthol
& benzoin
tincture)
Promote secretion of dilute mucus,
To protect inflammed mucosa

Nebulized Ligocaine 1) Local anesthesia.
2) Blooking mucosal cough receptors.
During fiber optic bronchoscopy.
intractable cough in bronchial carcinoma.

Nebulized
Benzocaine
Acting both
Centrally
&Periphrally
Benzonatate Chemichally, it is related to
tetracaine (local ansthesia).
1) In lungs, acting on
Stretch & cough receptors.
2) Act on CNS

Mucoactive Agents (Expectorants)
o They volume or hydration of airway secretion.
o They improve expectoration of respiratory mucus secretion.

DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
E
x
p
e
c
t
o
r
a
n
t
s


Hyperosmolar Saline (10 ml of 6% saline).
Inhaled by ultrasonic nebulisation.
Used in fibross & bronchiectasis.
Na citrate 1) Stimulate secretion of low viscosity watery
mucus & sissolve it.
To make it thinner less sticky.
2) elasticity of bronchi.
To easily expectorate the mucus.
Used in early dry stage of acute bronchitis.
K citrate
Na bicarbonate
Ammonium Cloride Stimulate secretion of low viscosity watery mucus
By stimulation of sensory nerve ending in
the stomach.

Na Iodide 1) Stimulate secretion of low viscosity watery mucus
2) has mucolytic action.
Chronic respiratory disease.
Chronic asthma.

K Iodide
Guaifenesin 1) respiratory secretion.
2) adhesiveness & surface tension of viscid sputum

Creosote 1) sputum.
2) has mild antiseptic & deodrant action.
Lung absess.
Chronic bronchitis.
Bronchiectasis.

Guaicolate
P H R M A C O L O G Y - NOTE 1 - Treatment of Cough


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7

Muocoactive Agentgs (Mucolytic)
o They viscosity & of elasticity airway secretion & mucociliary & cough clearance.

DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
C
l
a
s
s
i
c

M
u
c
o
l
y
t
i
c

N-acetulcysteine (NAC) Taken orally or by inhalation.
It is a precursor of intracellular
cysteine & glutathione.
1) Hydrolyse disulfid bond of mucin.
So, mucus loss its viscosity & elasticity.
2) Act as antioxidant.
So, it prevent pulmonary injury in patient
with COPD or lung cancer.
In condition associated with viscous mucus
secretion:
Chronic bronchitis, emphysema,
brochiectasis & cystic fibrosis.
(ARD): bronchitis, pneumonia & asthma.
Post-operative & post-traumatic
pulmonary complications.
Care of tracheostomy.
Act as antidote for paracetamol overdose.
Bronchospasm.
Prevent by
2-agonist.
Disagreeable odor.
Sulfur odor &
taste.
GI irritation.
Nausea.
Vomiting.
Stomatitis.
P
e
p
t
i
d
e

M
u
c
o
l
y
t
i
c
Dornase alpha
Taken by nebulisation.

For cystic fibrosis.
Allergic reaction.
Pharyngitis.
Laryngitis.
Voice alteration.
O
t
h
e
r
s

Bromhexine It is an expectorant & mucolytic
drug.
Taken orally, parentral or by
inhalation.
1) Liquefy mucus.
By viscosity of bronchial secretion.
2) Enhance expectoration.
By the rate of microciliary.
Acute bronchitis.
Chronic bronchitits.
COPD.
Rhinorrhea.
Lacrimation.
Gastric irritant.
Avoid with
antacid. Ambroxol Taken orally.
has less GI irritant.
Mucoactive Agents (Mucoregulatory Agents)
o They airway mucus hyper secretion which caused by goblet cells & submucosal gland.

DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
A
n
t
i
-
i

n
f
l
a
m
m
a
t
o
r
y


Indomethacine
inflammation which leading to mucus hyper
secretion.
Panbronchiolits


Corticosteroid
A
n
t
i
c
h
o
l
i
n
e
r
g
i
c


Ipratropium
mucus volume that secreted in chronic
bronchitis.

Atropine
mucus hypersecrtion. used pre-anesthetically for endotracheal
intubation.

M
a
c
r
o
l
i
d
e

a
n
t
i
b
i
o
t
i
c
s

Azithromycin
Taken orally for long term
administion.