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DRUG THERAPY OF
COUGH
Cough is physiologically useful protective reflex
that

clears

the

respiratory

tract

of

the

accumulated mucus and fo...
Types of cough
Cough is 2 types
COUGH

Non Productive (Dry)

Productive (Tenacious)
Cough phases
Mechanism of cough
Stimulation of mechano or chemoreceptors
(throat, respiratory passages or stretch receptors in
lungs)
A...
Most common causes of cough
•
•
•
•
•
•
•
•
•
•
•
•

Common cold,
Upper/lower respiratory tract infection
Allergic rhiniti...
Classification of drugs
Peripherally acting

Peripherally& centrally
Benzonatate

Pharyngeal
demulcents

Expectorants

Muc...
Peripherally acting
Expectorants:Pharyngeal demulcents
1.Mucokinetics
– Prenoxdiazine
– Ammonium chloride
– Glycerin
– Sod...
Centrally acting
• Opioids
– Codeine
– Pholcodeine
– Morphine
– Ethylmorphine

• Non Opioids
– Noscapine
– Dexomethorphan
...
Demulcents:- These are indirect peripherally
acting cough suppressants.
• They provide a protective coat over
sensory rece...
Expectorants
• Mucokinetics:- These expectorants
stimulate the flow of respiratory tract
secretions by stimulating bronchi...
• Essential oils:- Provide only mild expectoration
by directly stimulating the bronchial secretory
cells.
• Syrup of Ipeca...
KI:- (0.2-0.3g) It is secreted by bronchial
glands and in this process irritates them,
increasing the volume of secretions...
• Guaiacol and Guaifenesin - obtained from
creosote wood but nowadays are prepared
synthetically.
• These safe expectorant...
Mucolytic
• Mucolytics alter the chemical
characteristics of mucus to ↓ its viscosity
and facilitate its removal by ciliar...
Bromhexine:- Alkaloid from vasaka plant .
• It depolymerises mucopolysaccharides of
mucus directly and also by ↑ lysosomal...
Acetylcyseteine :- It is a mucolytic that ↓
viscosity of mucus by splitting the
disulfide –S-S- bonds of mucoproteins.
• I...
Dornase-alfa:- It is highly purified solution of
recombinant human deoxyribonuclease
(DNase). These enzyme that selectivel...
• Drinking warm water, inhaling warm moist
air or menthol vapours, surfactants such
as tyloxapol, proteolytic enzymes such...
Centrally acting
• Act in the CNS to raise the threshold of
cough centre to reduce tussal impulses
• Main aim to control r...
Codeine:- An opium alkaloid (Semi
synthetic opioid), qualitatively similar to but
less potent then morphine.
• It is more ...
Pholcodeine:- It is structurally related to
codeine but it is slightly more potent,
longer acting and better tolerated tha...
Dextromethorphan:-It is methyl ester of the
dextroisomer of levorphanol.
• Less addition liability, no analgesic action,
l...
Noscapine:- It is naturally occurring opium
alkaloid belonging to benzylisoquinoline
group.
• Popular cough suppressant
• ...
Pipazethate:- Phenothiazine group of
antitussive .Occasionally used in cough
mixtures.
• Given orally 40mg TDS
Chlophedian...
Centrally as well as peripherally
acting antitussives
Benzonatate:- It is structurally related to LA
tetracaine.
• It not ...
Specific treatment approach to
cough
Etiology of cough
1) Upper/lower respiratory
tract infections
2) Smoking/chronic bron...
Cough (VK)
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Cough (VK)

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Cough (VK)

  1. 1. DRUG THERAPY OF COUGH
  2. 2. Cough is physiologically useful protective reflex that clears the respiratory tract of the accumulated mucus and foreign substances. It occurs due to stimulation of mechano / chemo receptors in throat, respiratory passage or stretch receptors in the lung.
  3. 3. Types of cough Cough is 2 types COUGH Non Productive (Dry) Productive (Tenacious)
  4. 4. Cough phases
  5. 5. Mechanism of cough Stimulation of mechano or chemoreceptors (throat, respiratory passages or stretch receptors in lungs) Afferent impulses to cough centre (medulla) Efferent impulses via parasympathetic & motor nerves to diaphragm, intercostal muscles & lung Increased contraction of diaghramatic, abdominal & intercostal (ribs) muscles ⇒noisy expiration (cough)
  6. 6. Most common causes of cough • • • • • • • • • • • • Common cold, Upper/lower respiratory tract infection Allergic rhinitis Smoking Chronic bronchitis Pulmonary tuberculosis Asthma Gastroesophageal reflux Pneumonia Congestive heart failure Bronchiectasis Use of drugs (e.g.:ACEI)
  7. 7. Classification of drugs Peripherally acting Peripherally& centrally Benzonatate Pharyngeal demulcents Expectorants Mucokinetics Mucolytic Centrally acting Opioids Non Opioids
  8. 8. Peripherally acting Expectorants:Pharyngeal demulcents 1.Mucokinetics – Prenoxdiazine – Ammonium chloride – Glycerin – Sodium citrate – Liquo rice – Potassium Iodide – Lozenges – Guaifenesin – Linctus containing – Ipecacuanha 2.Mucolytic syrup. – – – – – Vasaka Bromhexine Ambroxal Dornase alfa Acetyl cysteine
  9. 9. Centrally acting • Opioids – Codeine – Pholcodeine – Morphine – Ethylmorphine • Non Opioids – Noscapine – Dexomethorphan – Pipazethate – Chlophedinol – Oxeladin Centrally and peripherally acting • Benzonatate
  10. 10. Demulcents:- These are indirect peripherally acting cough suppressants. • They provide a protective coat over sensory receptors on pharynx and reduce afferent impulses from the inflamed / irritated mucosa. • They provide relief in dry cough arising from throat. • Ex:- Honey, liquorice
  11. 11. Expectorants • Mucokinetics:- These expectorants stimulate the flow of respiratory tract secretions by stimulating bronchial secretory cells( to inc. volume) and the ciliary movement (to facilitate their removal) Ex:- Volatile oils, certain emetics in sub emetic doses, ammonium chloride, Na citrate, guaiacol and guaifenesin.
  12. 12. • Essential oils:- Provide only mild expectoration by directly stimulating the bronchial secretory cells. • Syrup of Ipecacuanha know its use has declined. • Sodium and potassium citrate:- (0.3-1g) After absorption citrates get converted to bicarbonates in vivo and mucus becomes less viscous in alkaline pH. • Ammonium chloride:- It is a gastric irritant which reflexly enhances bronchial secretions. • Large doses-produce metabolic acidosis.
  13. 13. KI:- (0.2-0.3g) It is secreted by bronchial glands and in this process irritates them, increasing the volume of secretions. • It also gastric irritant acts reflexly as well. A/E:-It is dangerous in pts sensitive to iodine, and interfere with thyroid function. • Prolong use - induce goiter and hypothyroidism • Less popular now because of these potential hazards
  14. 14. • Guaiacol and Guaifenesin - obtained from creosote wood but nowadays are prepared synthetically. • These safe expectorants with proven efficacy. • Guaifenesin is less irritating derivate of guaiacol. • After absorption, guaifenesin is secreted through bronchial glands to increase airway secretion and mucosal ciliary activity. • Admi orally 100-200mg BD
  15. 15. Mucolytic • Mucolytics alter the chemical characteristics of mucus to ↓ its viscosity and facilitate its removal by ciliary action • Commonly used mucolytics include acetyl cysteine, carbocysteine,bromhexine, ambroxol and dornase-alfa.
  16. 16. Bromhexine:- Alkaloid from vasaka plant . • It depolymerises mucopolysaccharides of mucus directly and also by ↑ lysosomal enzyme activity that break the fiber network of tenacious sputum . • Oral dose is 8-16mg TDS S/E:- GIT upset and rhinorrhoea • Ambroxol:-Metabolite of bromhexine and has a similar mode of action • Oral dose 30mg BD/TDS
  17. 17. Acetylcyseteine :- It is a mucolytic that ↓ viscosity of mucus by splitting the disulfide –S-S- bonds of mucoproteins. • It’s action facilitated by alkaline pH(7-9) • Admi is done by nebulisation (3-5ml of 20%solution),also oral 200mg TDS but efficacy is much less. • S/E :- N, V, stomatitis and bronchospasam
  18. 18. Dornase-alfa:- It is highly purified solution of recombinant human deoxyribonuclease (DNase). These enzyme that selectively cleaves DNA. • Purulent (Pus) pulmonary secretions in cystic fibrosis contain very high amounts of extra cellular DNA. • Dornase alfa inhalation (2.5mg once daily) hydrolysis this accumulated DNA in the sputum of the pts of cystic fibrosis
  19. 19. • Drinking warm water, inhaling warm moist air or menthol vapours, surfactants such as tyloxapol, proteolytic enzymes such as chymotrypsin or trypsin are also used for their hydrating and mucolytic action.
  20. 20. Centrally acting • Act in the CNS to raise the threshold of cough centre to reduce tussal impulses • Main aim to control rather then eliminate cough • These are mainly useful for dry cough or if cough is disturbs sleep or is hazardous.
  21. 21. Codeine:- An opium alkaloid (Semi synthetic opioid), qualitatively similar to but less potent then morphine. • It is more selective for cough centre and it is treated as standard antitussive. • It suppress cough center for 6hr. • Admi orally (10mg BD or TDS) • Abuse liability is low at these dose. S/E:- High dose cause respiratory depression, convulsions, postural hypotension, constipation.
  22. 22. Pholcodeine:- It is structurally related to codeine but it is slightly more potent, longer acting and better tolerated than codeine. • It cause lesser constipation and drowsiness than codeine. • More suited for long term use • Orally 10-15mg BD
  23. 23. Dextromethorphan:-It is methyl ester of the dextroisomer of levorphanol. • Less addition liability, no analgesic action, least constipating effect, minimal drowsiness . • It is as potent as codeine and given orally 10mg TDS • Most popular cough suppressant • Combination available with antihistamines and bronchodilators in cough mixtures.
  24. 24. Noscapine:- It is naturally occurring opium alkaloid belonging to benzylisoquinoline group. • Popular cough suppressant • Given orally 15mg TDS. • Less addiction liability, drowsiness, analgesic activity S/E: At high doses may produce N, H and tremors.
  25. 25. Pipazethate:- Phenothiazine group of antitussive .Occasionally used in cough mixtures. • Given orally 40mg TDS Chlophedianol:- It is less effective • Rarely used • Dose 20mg BD orally • High doses cause excitatory effects, tremors.
  26. 26. Centrally as well as peripherally acting antitussives Benzonatate:- It is structurally related to LA tetracaine. • It not only inhibits the afferent cough impulses to suppress the central cough center, but also inhibits the pulmonary stretch receptors and also posses local anaesthetic action • Administered orally 100-200mg S/E: D, N, H • High doses cause vertigo.
  27. 27. Specific treatment approach to cough Etiology of cough 1) Upper/lower respiratory tract infections 2) Smoking/chronic bronchitis Treatment Appropriate antibiotics Cessation of smoking 3) Pulmonary tuberculosis Antibiotics 4) Asthmatic cough Inhaled β2-agonists/ipratropium/corticosteroid 5) Postnasal drip (sinusitis) Antibiotics, nasal decongestants, antihistamines

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