-
Etiology of cough
- upper respiratory infection
- sinusitis
- rhinitis
- asthma/COPD
- GERD
- CHF
- drug-induced
-
Pathophysiology of cough
A cough is an important defense mechanism to rid the airways of mucus and foreign bodies.
A cough may be acute (<3 weeks) or chronic (> 3 weeks)
-
The GOLD standard treatment of cough
codeine
-
Three (3) antitussives & cough suppressants
- codeine
- dextromethorphan
- diphenhydramine (Benadryl)
-
MOA of antitussives
centrally mediated suppression of cough
-
Which agent is the only narcotic agent used for cough as antitussive?
codeine
-
MAX dose of codein
10-20mg q4-6 hr (120mg/d)
-
Role in therapy for codeine
primarily for night cough
-
SE of codeine
sedation, nausea, & constipation
-
Which agent is the only category I OTC non-narcotic antitussive?
dextromethorphan
-
MAX dose for dextromethorphan
10-30 mg q 4-8hr (120mg/d)
-
Role in Therapy for dextromethorphan
nonproductive cough
-
SE of dextromethorphan
- drowsiness
- GI effects (N/V, bloating, etc.)
-
DI with dextromethorphan
MAOI
-
A category II antitussive
diphenhydramine (Benadryl)
-
The only antitussive that has both centrally mediated suppression of cough center AND anticholinergic
diphenhydramine (Benadryl)
-
MAX dose of diphenhydramine (Benadryl)
25mg q 4hr (75mg/d MAX)
-
Trade/Brand names (2) for dextromethorphan
- Benylin - for liquid
- Delsym - for suspension
-
The only category I OTC expectorant
guaifenesin (Robutussin, Mucinex, Humibid)
-
MOA of expectorant
thinning of mucus to enhance clearance
-
MAX dose of guaifenesin (Robitussin, Mucinex, Humibid)
MAX is 2,400 mg/d, regardless if immediate or extended release
-
Name the immediately release & extended release guaifenesin products
- Immediate release: Robitussin syrup
- Extended release: Mucinex & Humibid sprinkle
-
Role in therapy for expectorant
productive cough
-
SE of expectorant
GI discomfort
-
Patient education for expectorant
increase fluid intake
-
Two (2) FDA approved topical antitussive
camphor & menthol
-
MOA for topical antitussive
local anesthetic effect in nasal mucosa
-
Three (3) products availavility for topical antitussive
- 1. lozenges
- 2. ointment
- 3. steam inhalation
-
Patient education on topical antitussive
ointment & solution are toxic if ingested
-
Five (5) sore throat remedies
- 1. saline gargle
- 2. benzocaine
- 3. dyclonine
- 4. phenol
- 5. menthol
-
Combination expectorant & cough suppressant
guaifenesin & dextromethorphan (Robitussin DM)
-
Combination expectorant & decongestant
guaifenesin & pseudoephedrine (Robitussin PE)
|
|
