1. P H R M A C O L O G Y - NOTE 1 - Treatment of Cough
• It clears the excess secretions
& inhaled foreign matters.
Productive Cough
• Expectorants are used.
Common causes of Cough: • Dry cough has no useful
Non-Productive function.
• 1) Acute Respiratory Infection. Cough • Anti-tussives are used.
• Upper respiratory infection.
• Pneumonia.
• Bronchitis
• They should be used for dry cough.
• 2) Chronic Respiratory Infection. • because it suppress cough reflex, it should not be used in
• TB. Anti-tussive the presence of bronchial secretions.
• Postnasal drip.
• 3) Airway Diseases.
• It reduces the sensitivity of periphral cough receptors to it's
• Asthma. Locally anti- activators which include irritants & autacoids (Bradykinine).
• COPD. tussive
• 4) Irritants.
• Cigarettes smoking. • They clear airway from mucus secretion by:
• ability to expectorate sputum.
• Inhaled foreign bodies. Mucoactive
Agents • mucus hyper secretion.
• 5) Drug Induced.
• Inhaled drugs (aerosols).
• ACE-inhibitors (anti-hypertensive).
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2. P H R M A C O L O G Y - NOTE 1 - Treatment of Cough
DRUDS FOR COUGH
Anti-tussives Mucoactive
Drugs Agents
Centrally Peripherally Expectorants Mucolytics
Opioid Hyperosmolar Classic
Anti-histamins Above Larynx Below Larynx Na citrate mucolytic
Dervatives saline
Diphenhydram steam with or without Na NAS
Codeine Lozenge K citrate
ine (menthol & benzoin bicarbonate
tincture)
Ammonium Peptide
Pholcodeine Syrup Na Iodide mucolytic
Nebulized Cloride
Lignocaine
Dextrome- Dornase alpha
K Iodide Guaifenesin
thorphan Nebulized
Benzocaine
Noscapine Creosote Guaicolate others
Centrally & Bromhexine
Periphrally
Benzonatate Ambroxol
Mucoregulatory
Anti- Macrolide Anti-
cholinergic Antibiotics inflammatory
Ipratropium Azithromycin Indomethacin Corticosteroids
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Atropine
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3. P H R M A C O L O G Y - NOTE 1 - Treatment of Cough
Anti-Tussives (cough suppressent)
DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
Codeine They suppress cough reflex by Nausea.
Derict inhibition of Cough Center in the Dizziness.
Dervative
Pholcode
Opioid
Acting Centarlly
Dextromethorphan medulla. Urenary retention.
Constipation.(vi)
Noscapine
Diphenhydramine It depresses CNS including Cough Center. Sedation.
Histamine
Drowsiness.
Anti-
Dizziness.
Lozenges They are demulcents. They form gelatious coat that protects the Used for cough of
Larynx
Above
Syrup (honey) inflammed skin Sore throat.
Pharyngitis.
Acting Periphrally
Steam Without tooking, Taken with or Promote secretion of dilute mucus,
it taken by without (menthol To protect inflammed mucosa
& benzoin
inhalation .
tincture)
Larynx
Below
Nebulized Ligocaine 1) Local anesthesia. During fiber optic bronchoscopy.
2) Blooking mucosal cough receptors. intractable cough in bronchial carcinoma.
Nebulized
Benzocaine
Acting both Benzonatate Chemichally, it is related to 1) In lungs, acting on
Centrally tetracaine (local ansthesia). Stretch & cough receptors.
&Periphrally 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
Hyperosmolar Saline (10 ml of 6% saline). Used in fibross & bronchiectasis.
Inhaled by ultrasonic nebulisation.
Na citrate 1) Stimulate secretion of low viscosity watery Used in early dry stage of acute bronchitis.
K citrate mucus & sissolve it.
To make it thinner less sticky.
Na bicarbonate
2) elasticity of bronchi.
To easily expectorate the mucus.
Expectorants
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 Chronic respiratory disease.
K Iodide 2) has mucolytic action. Chronic asthma.
Guaifenesin 1) respiratory secretion.
2) adhesiveness & surface tension of viscid sputum
Creosote 1) sputum. Lung absess.
2) has mild antiseptic & deodrant action. Chronic bronchitis. 6
Guaicolate Bronchiectasis.
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4. P H R M A C O L O G Y - NOTE 1 - Treatment of Cough
Muocoactive Agentgs (Mucolytic)
o They viscosity & of elasticity airway secretion & mucociliary & cough clearance.
DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
N-acetulcysteine (NAC) Taken orally or by inhalation. 1) Hydrolyse disulfid bond of mucin. In condition associated with viscous mucus Bronchospasm.
It is a precursor of intracellular
cysteine & glutathione.
So, mucus loss it’s viscosity & elasticity.
secretion:
Chronic bronchitis, emphysema,
Prevent by
β2-agonist.
2) Act as antioxidant.
brochiectasis & cystic fibrosis. Disagreeable odor.
So, it prevent pulmonary injury in patient
Classic Mucolytic
(ARD): bronchitis, pneumonia & asthma. Sulfur odor &
with COPD or lung cancer. Post-operative & post-traumatic taste.
pulmonary complications. GI irritation.
Care of tracheostomy. Nausea.
Act as antidote for paracetamol overdose. Vomiting.
Stomatitis.
Dornase alpha Taken by nebulisation. For cystic fibrosis. Allergic reaction.
Mucolytic
Pharyngitis.
Peptide
Laryngitis.
Voice alteration.
Bromhexine It is an expectorant & mucolytic 1) Liquefy mucus. Acute bronchitis. Rhinorrhea.
drug.
Taken orally, parentral or by
By viscosity of bronchial secretion.
Chronic bronchitits.
COPD.
Lacrimation.
Gastric irritant.
2) Enhance expectoration.
inhalation. Avoid with
Others
Ambroxol Taken orally.
By the rate of microciliary. antacid.
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
Indomethacine inflammation which leading to mucus hyper Panbronchiolits
nflammatory
secretion.
Anti-i
Corticosteroid
Ipratropium mucus volume that secreted in chronic
bronchitis.
Anticholinergic
Atropine mucus hypersecrtion. used pre-anesthetically for endotracheal
intubation.
Azithromycin Taken orally for long term
antibiotics
Macrolide
administion.
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