Which of the following is/are true regarding antitussive medications? (select all that apply)
Used to suppress coughing
May be used long-term
Better for dry (non-productive) cough
Not very effective at current OTC doses
Contraindicated in children < 6 years old
Why would antitussives be contraindicated?
They cause gastrointestinal symptoms if used over 7 days.
Coughing is a defense mechanism which we don't want to suppress.
Patient has a productive cough.
Patient is < 2 years old
All of the above
All but A
What is the mechanism of action of Codeine and what is it's brand name?
Inhibits cough through direct effect on brainstem cough center. Also might inhibit peripheral afferent neurons that initiate coughing.
Competes for H1 receptor sites on respiratory tract to reduce secretion and stop coughing
Robitussin AC
Robitussin DM
Delsym
What is the mechanism of Dextromethorphan and what is/are it's brand names?
Soothing to the airway through vaporization.
Inhibits cough reflex by a similar mechanism to Codeine (inhibits cough through direct effect on brainstem cough center) but is a non-narcotic.
Inhibits cough reflex by a similar mechanism to Codeine (inhibits cough through direct effect on brainstem cough center) but is a narcotic and provides stronger action.
Vicks Vaposteam
Which two medications are sold as Vicks?
Menthol
Carnauba
Camphor
Lanolin
What are some common adverse effects of Codeine?
Fatigue
Abdominal pain
Drowsiness
Dizziness
Ataxia
What are some common side effects of Dextromethorphan?
Confusion
Irritability
Nervousness
Excitement
What is the primary side effect of Benadryl?
Shortness of Breath
Vomiting
Insomnia
Which drug do the young whippersnappers Robo Trip with?
Robaxin
Diphenhydramine
Dextromethorphan
Tylenol
What are some therapeutic benefits of Expectorants?
Compete for H1 receptor sites on respiratory tract to reduce secretion and stop coughing.
Facilitate production and ejection of mucus.
May increase pulmonary function
Prevents respiratory passages from being clogged by thick, viscous secretions.
Reduce secretions from upper airway so as to prevent drainage into the lower respiratory tract.
Which of the following are Adverse Effects of Decongestants?
Headache
Hypertension
Palpitations
Seizures
Nausea
Which of the following are characteristics of decongestants.
Binds to receptors located on blood vessels of nasal mucosa and stimulate vasoconstriction and resulting in drying up of mucosal vasculature and decreased local congestion
Usually beta-2 adrenergic agonists.
Usually beta-1 adrenergic agonists.
Usually alpha-1 adrenergic agonists.
Almost exclusively systemic medications.
May be systemic or local medications.
Almost exclusively local medications
Can cause CNS depression, avoid excessive use
Can cause CNS excitation, avoid excessive use
Which oral decongestant rocks and which one sucks?
Phenylephrine
Pseudoephedrine
When is the best time to take an oral decongestant?
In the morning to reduce the negative consequences of CNS excitation.
In the evening to reduce the negative consequences of CNS depression.
Any time of day as CNS effects are not often seen in decongestants.
In the evening to help congested patients sleep.
What is the chief concern with Afrin administration and what is its generic name?
Nasal polyps
Rebound congestion
Epistaxis
Oxymetazoline
Xylometazoline
Choose the correct statements regarding Phenylephrine and Pseudoephedrine. (if you get something incorrect, try flipping the statements)
Phenylephrine is more bioavailable (90%) than Pseudoephedrine (38%)
Phenylephrine: a1 adrenergic, weak B adrenergic Pseudoephedrine: a1 and B adrenergic
Phenylephrine has CNS effects, Pseudoephedrine does not.
Pseudoephedrine has more efficacy data than Phenylephrine.
Patients with heart conditions, asthma, and COPD need to be more cautious with Pseudoephedrine and less so with Phenylephrine
Which of these is NOT a condition in which we should be cautious when prescribing oral decongestants?
Hyperthyroidism
Diabetes
Coronary heart disease
Diverticulitis
Elevated intraocular pressure
Prostatic hypertrophy
MAOIs
Which Histamine mediates allergic response and is therefore what our antihistamine drugs target?
H1
H2
H3
H4
Arrange these antihistamine medications in terms of their ability to cross the blood brain barrier, from most crossing to least.
Diphenhydramine, Loratidine, Fexofenadine, Cetirizine
Diphenhydramine, Fexofenadine, Loratidine, Cetirizine
Diphenhydramine, Cetirizine, Loratidine, Fexofenadine
Fexofenadine, Diphenhydramine, Cetirizine, Loratidine
Loratidine, Cetirizine, Fexofenadine, Diphenhydramine
Which of the following medications are First Generation Antihistamines?
Brompheniramine (Dimetapp)
Chlorpheniramine (Chlor-Trimeton)
Clemastine (Tavist)
Hydroxyzine (Atarax)
Levocetirizine (Xyzal)
Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl)
Desloratidine (Clarinex)
Which of the following are Second Generation Antihistamines?
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratidine (Claritin)
While antihistamines are generally used more for allergic rhinitis and congestion, one medication has some efficacy in treating cold related rhinorrhea. Which is it?
What are some precautions and warnings to consider when prescribing antihistamines to patients?
Emphysema
Chronic Bronchitis
Narrow Angle Glaucoma
Cardiovascular disease
Enlarged Prostate Gland
Increased risk of CVA
Decrease in milk supply in nursing mothers.
What are some special considerations to make in elderly and children before prescribing Antihistamines?
Elderly patients having a paradoxical hyperactivity.
Children having a paradoxical hyperactivity.
Long half life in elderly, causing extended effect and increased fall risk.
Long half life in children, causing poor performance in school and social dysfunction.
When a combination product advertises itself as a Nighttime/PM medication, what is likely in the combination?
Pseudoephedrine, Phenylephrine (decongestant) but no antihistamine
Pseudoephedrine, Phenylephrine (decongestant) and/or an analgesic
Diphenhydramine, Chlorpheniramine, or Doxylamine
Antihistamine
When a combination product advertises itself as a Nondrowsy/AM/Daytime medication, what is likely in the combination?
When a combination product advertises itself as a Sinus medication, what is likely in the combination?
When a combination product advertises itself as a Cough medication, what is likely in the combination?
When a combination product advertises itself as an Allergy medication, what is likely in the combination?
