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  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 two types COUGH Non Productive (Dry) Productive (Tenacious)
  4. 4. • Non productive:- cough is considered as serving no useful purpose., rather it increased discomfort to the patient. • For treatment antitussive agents are useful. • Productive cough:-It is characterized by presence of excessive sputum and may be associated with conditions such as chronic bronchitis and bronchiectasis. • In this condition expectorants are useful.
  5. 5. • Ideal antitussive should suppress the frequency as well as intensity of coughing with out affecting the normal elimination of excessive secretions from the respiratory tract. • Expectorants:- Increase decrease the viscosity enhance the propulsion upward and outward by and coughing. the volume and of secretions to of the secretion ciliary movement
  6. 6. Classification of drugs Peripherally acting Pharyngeal demulcents Peripherally& centrally Centrally acting Opioids Expectorants Mucokinetics Mucolytic Non Opioids
  7. 7. Peripherally acting Pharyngeal demulcents – – – – – Prenoxdiazine Glycerin Liquo rice Lozenges Linctus containing syrup. Expectorants:1.Mucokinetics – – – – – Ammonium chloride Sodium citrate Potassium Iodide Guaifenesin Ipecacuanha 2.Mucolytic – – – – – Vasaka Bromhexine Ambroxal Dornase alfa Acetyl cysteine
  8. 8. Centrally acting • Opioids – Codeine – Pholcodeine – Morphine – Ethylmorphine • Non Opioids – Noscapine – Dexomethorphan – Pipazethate – Chlophedinol – Oxeladin Centrally and peripherally acting • Benzonatate
  9. 9. Demulcents:- 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
  10. 10. 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.
  11. 11. Essential oils:- Provide only mild expectoration by directly stimulating the bronchial secretory cells. • 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 it can produce metabolic acidosis.
  12. 12. • 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. ADE:-It is dangerous in patients sensitive to iodine and interfere with thyroid function. • Prolong use can induce goiter and hypothyroidism • Less popular now because of hazards
  13. 13. • Guaiacol and Guaifenesin are 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. • It is administered orally 100-200mg BD
  14. 14. Mucolytic Mucolytics alter the chemical characteristics of mucus to decrease its viscosity and facilitate its removal by ciliary action Commonly used mucolytics include acetyl cysteine, carbocysteine, bromhexine, ambroxol and dornase-alfa.
  15. 15. Bromhexine:- It is an alkaloid from vaska plant . • It depolymerises mucopolysaccharides of mucus and also increase lysosomal enzyme activity that break the fiber network of tenacious sputum . • Oral dose is 8-16mg TDS • Side effects:- GIT upset and rhinorrhoea (Water release from nose).
  16. 16. • Ambroxol:-Metabolite of bromhexine and has a similar mode of action • Oral dose 30mg BD/TDS
  17. 17. Acetylcyseteine :- It is a mucolytic that decrease the viscosity of mucus by splitting the disulfide –S -- S- bonds of mucoproteins. • Action facilitated by alkaline pH(7-9) • Administratation is done by nebulisation (3-5ml of 20%solution),also oral 200mg TDS but efficacy is much less. • Side effects :- Nausea, vomiting, 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 patients of cystic fibrosis
  19. 19. Other 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 • Drugs that 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 unproductive 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. • Administered orally (10mg BD or TDS) • Abuse liability is low at these dose. • Side effects:- 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 drowsiness than codeine. • More suited for long term use • Orally 10-15mg BD and
  23. 23. Dextromethorphan:-It is methyl dextroisomer of levorphanol. ester of the • It has less addition liability, no analgesic action, least constipating effect and 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 • Side effect: At high doses may produce nausea, headache and tremors.
  25. 25. Pipazethate:- Phenothiazine group antitussive. Occasionally used. • Given by orally 40mg TDS Chlophedianol:- It is less effective • Rarely used • Dose 20mg BD orally • High doses cause excitatory tremors. of effects,
  26. 26. Centrally & peripherally acting antitussives Benzonatate:- It is structurally related to local anesthetic 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 Orally Side effects: Drowsiness, nausea, headache • High doses cause vertigo.