P H R M A C O L O G Y.. Treatment of Cough

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

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• 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.


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DRUDS FOR COUGH

Anti-tussives Drugs

Centrally

Opioid Dervatives

Codeine

Pholcodeine

Dextrome-thorphan

Noscapine

Anti-histamins

Diphenhydramine

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 citrateNa

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


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Anti-Tussives (cough suppressent) DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT

A

ctin

g C

enta

rlly

Op

ioid

Der

vati

ve

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

medulla.

Nausea.

Dizziness.

Urenary retention.

Constipation.(vi)

Pholcode

Dextromethorphan

Noscapine

An

ti-

His

tam

ine

Diphenhydramine

It depresses CNS including Cough Center. Sedation.

Drowsiness.

Dizziness.

Act

ing

Per

iph

rally

Ab

ove

Lar

ynx

Lozenges They are demulcents. They form gelatious coat that protects the inflammed skin

Used for cough of Sore throat. Pharyngitis.

Syrup (honey)

Bel

ow

Lary

nx

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

Exp

ecto

ran

ts

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


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


Cla

ssic

Mu

coly

tic

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 it’s 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

β2-agonist.

Disagreeable odor. Sulfur odor &

taste.

GI irritation.

Nausea.

Vomiting.

Stomatitis.

Pep

tid

e

Mu

coly

tic Dornase alpha Taken by nebulisation. For cystic fibrosis. Allergic reaction.

Pharyngitis.

Laryngitis.

Voice alteration.

Oth

ers

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.


An

ti-i

nfl

am

ma

tory

Indomethacine inflammation which leading to mucus hyper secretion.

Panbronchiolits

Corticosteroid

An

tich

olin

erg

ic

Ipratropium mucus volume that secreted in chronic bronchitis.

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

Ma

cro

lide

an

tib

ioti

cs Azithromycin Taken orally for long term

administion.

Education

P H R M A C O L O G Y.. Treatment of Cough