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PREPARED BY:
BIKRAM ADHIKARI (3)
HUMAN BIOLOGY 7TH
BATCH
Drugs used for Cough
1
Introduction to Cough
 Cough is the protective reflex, its purpose being expulsion
of respiratory secretions or foreign particles from lungs or
upper airway passages
 Cough may be:
 Useful (productive):
 Sputum is coughed up/drain the airway)
 Useless(nonproductive/dry)
2
Introduction to Cough
Types of cough
 Classified based on duration, characters, quality and timing
Acute: Sudden onset/less than 3 weeks
Sub-acute: 3-8 weeks
Chronic: Longer than eight weeks
3
Mechanism of cough
4
Drugs for cough
Cough can be treated :
 By Nonspecific therapy
 With specific remedies(antibiotics,etc)
5
Nonspecific therapy
1) Pharyngeal demulcents :
Lozenges, Cough drops, Linctuses containing syrup, glycerine,
liquorice
2) Expectorants (Mucokinetics)
(a)Bronchial secretion enhancers:
Sodium or Potassium citrate, Potassium iodide, Guaiphenesin (Glyceryl
guaiacolate), Balsum of Tolu, Vasaka,Ammonium chloride.
(b) Mucolytics:
Bromhexine, Ambroxol, Acetyl cysteine, Carbocisteine
6
Nonspecific therapy
3) Antitussives (Cough centre suppressants)
(a) Opioids: Codeine, Ethylmorphine, Pholcodeine
(b) Nonopioids: Noscapine, Dextromethorphan, Chlophedianol.
(c) Antihistamines: Chlorpheniramine, Diphenhydramine, Promethazine
(d) Peripherally acting: Prenoxdiazine.
2) Adjuvant antitussives
Bronchodilators: Salbutamol, Terbutalin.
7
Demulcents and expectorants
Pharyngeal demulcents
sooth throat
 reduce afferent impulses from the inflamed/irritated
mucosa
symptomatic relief in dry cough arising from throat
Lozenges
Cough drops
Linctuses containing syrup
Glycerine
Liquorice
8
Demulcents and expectorants contd…
Expectorant
 Mucokinetics
 Increase bronchial secretion or reduce viscosity removal by
coughing
Two category:
 Bronchial secretion enhancer
 Mukolytics
9
Demulcents and expectorants contd…
Bronchial secretion enhancer
 Sodium or Potassium citrate
 Potassium iodide
 Guaiphenesin(Glyceryl guaiacolate)
 Balsum of Tolu
 Vasaka
 Ammonium chloride
10
Demulcents and expectorants contd…
Bronchial secretion enhancer
 Sodium or Potassium citrate salt action
 Potassium iodide
 Secreted by bronchial glands
 Irritate airways mucosa
 Prolonged usedisturb thyroid function iodism
 Not used now
11
Demulcents and expectorants contd…
Bronchial secretion enhancer
 Guaiphenesin, Balsum of Tolu, Vasaka
 Plant products
 Enhance bronchial secretion
 Promotes Mucocilliary function secreted by tracheobronchial
glands
 Ammonium chloride
 Ammonium salts
 Increase respiratory secretions
12
Demulcents and expectorants contd…
 Expectorant formulations + antitussive / antihistaminics
 US-FDA stopped marketing except Guaiphenesin
 Steam inhalation & proper hydration  clearing airways
Nonconclusive efficacy
13
Demulcents and expectorants contd…
Mucolytics
 Bromhexine
 Ambroxol
 Acetyl cysteine
 Carbocisteine
14
Demulcents and expectorants contd…
Mucolytics
 Bromhexine:
 Derivative of vasicine obtained from Adhatoda vasica
 Potent mucolytic and mucokinetic  induce thin copious
bronchial secretion
 Depolymerises mucopolysaccharide directly or by lysosomal
enzyme
 Dose: adult 8mg TDS side effects
15
Demulcents and expectorants contd…
Mucolytics
 Ambroxol:
 A metabolite of bromohexine
 Dose: 15-30 mg TDS
 Mucolytic action, uses and side effects similar to bromhexine
 Acetylcysteine
 Derivative of cysteine
 Opens disulfide bonds on mucoproteins present in sputum
 Also act as antioxidants reduce airway inflammation
16
Demulcents and expectorants contd…
Mucolytics
 Carbocysteine:
 Liquefies viscid sputum
 Administered orally (250-750 mg TDS)
 May break gastric mucosal barrier  contraindicated in peptic
ulcer
 Side effects:
17
Antitussives
 Acts on CNS  raise threshold of cough center
 Act peripherally in respiratory tract  reduce tussal response
or both the action
 Aimed to control the cough rather than eliminate
 Used only for dry, unproductive cough or if cough is unduly
tiring, disturbs sleep /hazardous
18
Antitussives (contd..)
Ophoids:
Codeine
 Opium alkaloid Less potent than morphine
 more selective for cough center
 standard antitussive: suppress cough for 6 hours
 Side effects:
Abuse
Constipation is main drawback
At high dose, respiratory depression and drowsiness
19
Antitussives (contd..)
 Contraindications:
 Asthamatics
Patients with diminished respiratory reserve
Should be avoided in children
 Dose: adult 10-30mg frequently used as syrup codeine
phos. 4-8 ml
20
Antitussives (contd..)
Ophoids:
Ethylmorphine
 Closely related to codeine which is methylmorphine
 Has antitussive, respiratory depressant properties like codeine
 Believed to be less constipating
 Dose: 10-30 mg TDS
Pholcodeine
 Similar in efficacy as antitussive to codeine
 Long acting codeine (12h)
 Dose: 10-15 mg.
21
Antitussives (contd..)
Nonopioids:
Noscapine
 Opium alkaloid of benzoisoquinoline
 Depresses cough but lacks narcotic, analgesic or
dependence inducing properties
 Equipotent antitussive as codeine
 Useful in spasmodic cough
 Dose: 15-30 mg
 Side effect:
Headache and nausea
Can produce bronchoconstriction by stimulating histamine
release
22
Antitussives (contd..)
Nonopioids:
Dextromethorphan
 A synthetic central NMDA (N-methyl D-aspartate) receptor
antagonist
 d-isomer has antitussive action while l-isomer is analgesic.
 Effective as codeine
 Does not depress mucociliary function of the airway mucosa
 Dose: 10–20 mg
 Side effect:
Dizziness, nausea, drowsiness
 At high doses hallucinations and ataxia may occur.
23
Antitussives (contd..)
Nonopioids:
Chlophedianol
 A centrally acting antitussive
 Slow onset and longer duration of action.
 Dose: 20–40 mg
 Side effect:
Dryness of mouth
Vertigo
Irritability
24
Antitussives (contd..)
Antihistamines:
H1 blockers are added to antitussive/expectorants
Afford relief in cough due to their sedative and
anticholinergic action
Lack selectivity for cough center
Have no expectorant property
25
Antitussives (contd..)
Specially promoted for cough in respiratory allergic
states
Commonly used antihistanines:
Chlorpheniramine (2-5mg)
Diphenhydramine (15-25mg )
Promethazine (15-25mg)
Second generation antihistamines like Terfenadine,
Loratadine are ineffective
26
Antitussives (contd..)
Peripherally acting antitussives:
Prenoxdiazine :
 Desensitize the pulmonary stretch receptors and reduce
tussal impulses originating in the lungs
 Indicated in cough of bronchial origin
 Efficacy is not impressive
 Dosage: 100-200 mgs TID-QID
27
Adjuvant Antitussives
Bronchodilators:
 Bronchospasm can induce or aggravate cough
 Pulmonary receptor stimulation can induce both cough and
bronchoconstriction in individual with bronchial
hyperreactivity
 Relieve cough and clear secretions by increasing surface
velocity of airflow during cough
 Not used routinely
28
Specific treatment approach to cough
Etiology of cough Treatment approach
Upper /lower respiratory tract
infection
Appropriate antibiotics
Smoking/chronic bronchitis Smoke cessation
Pulmonary tuberculosis Anti tubercular drugs
Asthmatic cough Inhalation of beta2 agonist,
ipratropium bromide
29
References
Essentials of Medical Pharmacology,7th
editon, KD
Tripathi
30
31

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Drugs used for cough

  • 1. PREPARED BY: BIKRAM ADHIKARI (3) HUMAN BIOLOGY 7TH BATCH Drugs used for Cough 1
  • 2. Introduction to Cough  Cough is the protective reflex, its purpose being expulsion of respiratory secretions or foreign particles from lungs or upper airway passages  Cough may be:  Useful (productive):  Sputum is coughed up/drain the airway)  Useless(nonproductive/dry) 2
  • 3. Introduction to Cough Types of cough  Classified based on duration, characters, quality and timing Acute: Sudden onset/less than 3 weeks Sub-acute: 3-8 weeks Chronic: Longer than eight weeks 3
  • 5. Drugs for cough Cough can be treated :  By Nonspecific therapy  With specific remedies(antibiotics,etc) 5
  • 6. Nonspecific therapy 1) Pharyngeal demulcents : Lozenges, Cough drops, Linctuses containing syrup, glycerine, liquorice 2) Expectorants (Mucokinetics) (a)Bronchial secretion enhancers: Sodium or Potassium citrate, Potassium iodide, Guaiphenesin (Glyceryl guaiacolate), Balsum of Tolu, Vasaka,Ammonium chloride. (b) Mucolytics: Bromhexine, Ambroxol, Acetyl cysteine, Carbocisteine 6
  • 7. Nonspecific therapy 3) Antitussives (Cough centre suppressants) (a) Opioids: Codeine, Ethylmorphine, Pholcodeine (b) Nonopioids: Noscapine, Dextromethorphan, Chlophedianol. (c) Antihistamines: Chlorpheniramine, Diphenhydramine, Promethazine (d) Peripherally acting: Prenoxdiazine. 2) Adjuvant antitussives Bronchodilators: Salbutamol, Terbutalin. 7
  • 8. Demulcents and expectorants Pharyngeal demulcents sooth throat  reduce afferent impulses from the inflamed/irritated mucosa symptomatic relief in dry cough arising from throat Lozenges Cough drops Linctuses containing syrup Glycerine Liquorice 8
  • 9. Demulcents and expectorants contd… Expectorant  Mucokinetics  Increase bronchial secretion or reduce viscosity removal by coughing Two category:  Bronchial secretion enhancer  Mukolytics 9
  • 10. Demulcents and expectorants contd… Bronchial secretion enhancer  Sodium or Potassium citrate  Potassium iodide  Guaiphenesin(Glyceryl guaiacolate)  Balsum of Tolu  Vasaka  Ammonium chloride 10
  • 11. Demulcents and expectorants contd… Bronchial secretion enhancer  Sodium or Potassium citrate salt action  Potassium iodide  Secreted by bronchial glands  Irritate airways mucosa  Prolonged usedisturb thyroid function iodism  Not used now 11
  • 12. Demulcents and expectorants contd… Bronchial secretion enhancer  Guaiphenesin, Balsum of Tolu, Vasaka  Plant products  Enhance bronchial secretion  Promotes Mucocilliary function secreted by tracheobronchial glands  Ammonium chloride  Ammonium salts  Increase respiratory secretions 12
  • 13. Demulcents and expectorants contd…  Expectorant formulations + antitussive / antihistaminics  US-FDA stopped marketing except Guaiphenesin  Steam inhalation & proper hydration  clearing airways Nonconclusive efficacy 13
  • 14. Demulcents and expectorants contd… Mucolytics  Bromhexine  Ambroxol  Acetyl cysteine  Carbocisteine 14
  • 15. Demulcents and expectorants contd… Mucolytics  Bromhexine:  Derivative of vasicine obtained from Adhatoda vasica  Potent mucolytic and mucokinetic  induce thin copious bronchial secretion  Depolymerises mucopolysaccharide directly or by lysosomal enzyme  Dose: adult 8mg TDS side effects 15
  • 16. Demulcents and expectorants contd… Mucolytics  Ambroxol:  A metabolite of bromohexine  Dose: 15-30 mg TDS  Mucolytic action, uses and side effects similar to bromhexine  Acetylcysteine  Derivative of cysteine  Opens disulfide bonds on mucoproteins present in sputum  Also act as antioxidants reduce airway inflammation 16
  • 17. Demulcents and expectorants contd… Mucolytics  Carbocysteine:  Liquefies viscid sputum  Administered orally (250-750 mg TDS)  May break gastric mucosal barrier  contraindicated in peptic ulcer  Side effects: 17
  • 18. Antitussives  Acts on CNS  raise threshold of cough center  Act peripherally in respiratory tract  reduce tussal response or both the action  Aimed to control the cough rather than eliminate  Used only for dry, unproductive cough or if cough is unduly tiring, disturbs sleep /hazardous 18
  • 19. Antitussives (contd..) Ophoids: Codeine  Opium alkaloid Less potent than morphine  more selective for cough center  standard antitussive: suppress cough for 6 hours  Side effects: Abuse Constipation is main drawback At high dose, respiratory depression and drowsiness 19
  • 20. Antitussives (contd..)  Contraindications:  Asthamatics Patients with diminished respiratory reserve Should be avoided in children  Dose: adult 10-30mg frequently used as syrup codeine phos. 4-8 ml 20
  • 21. Antitussives (contd..) Ophoids: Ethylmorphine  Closely related to codeine which is methylmorphine  Has antitussive, respiratory depressant properties like codeine  Believed to be less constipating  Dose: 10-30 mg TDS Pholcodeine  Similar in efficacy as antitussive to codeine  Long acting codeine (12h)  Dose: 10-15 mg. 21
  • 22. Antitussives (contd..) Nonopioids: Noscapine  Opium alkaloid of benzoisoquinoline  Depresses cough but lacks narcotic, analgesic or dependence inducing properties  Equipotent antitussive as codeine  Useful in spasmodic cough  Dose: 15-30 mg  Side effect: Headache and nausea Can produce bronchoconstriction by stimulating histamine release 22
  • 23. Antitussives (contd..) Nonopioids: Dextromethorphan  A synthetic central NMDA (N-methyl D-aspartate) receptor antagonist  d-isomer has antitussive action while l-isomer is analgesic.  Effective as codeine  Does not depress mucociliary function of the airway mucosa  Dose: 10–20 mg  Side effect: Dizziness, nausea, drowsiness  At high doses hallucinations and ataxia may occur. 23
  • 24. Antitussives (contd..) Nonopioids: Chlophedianol  A centrally acting antitussive  Slow onset and longer duration of action.  Dose: 20–40 mg  Side effect: Dryness of mouth Vertigo Irritability 24
  • 25. Antitussives (contd..) Antihistamines: H1 blockers are added to antitussive/expectorants Afford relief in cough due to their sedative and anticholinergic action Lack selectivity for cough center Have no expectorant property 25
  • 26. Antitussives (contd..) Specially promoted for cough in respiratory allergic states Commonly used antihistanines: Chlorpheniramine (2-5mg) Diphenhydramine (15-25mg ) Promethazine (15-25mg) Second generation antihistamines like Terfenadine, Loratadine are ineffective 26
  • 27. Antitussives (contd..) Peripherally acting antitussives: Prenoxdiazine :  Desensitize the pulmonary stretch receptors and reduce tussal impulses originating in the lungs  Indicated in cough of bronchial origin  Efficacy is not impressive  Dosage: 100-200 mgs TID-QID 27
  • 28. Adjuvant Antitussives Bronchodilators:  Bronchospasm can induce or aggravate cough  Pulmonary receptor stimulation can induce both cough and bronchoconstriction in individual with bronchial hyperreactivity  Relieve cough and clear secretions by increasing surface velocity of airflow during cough  Not used routinely 28
  • 29. Specific treatment approach to cough Etiology of cough Treatment approach Upper /lower respiratory tract infection Appropriate antibiotics Smoking/chronic bronchitis Smoke cessation Pulmonary tuberculosis Anti tubercular drugs Asthmatic cough Inhalation of beta2 agonist, ipratropium bromide 29
  • 30. References Essentials of Medical Pharmacology,7th editon, KD Tripathi 30
  • 31. 31

Editor's Notes

  1. Opium: dark brown resinous material in poppy plant