P H R M A C O L O G Y - NOTE 1 - Treatment of Cough

• It clears the excess secretions

& inhaled foreign matters.
Productive Cough
• Expectorants are used.

Common causes of Cough: • Dry cough has no useful

Non-Productive function.
• 1) Acute Respiratory Infection. Cough • Anti-tussives are used.

• Upper respiratory infection.

• Pneumonia.
• Bronchitis
• They should be used for dry cough.
• 2) Chronic Respiratory Infection. • because it suppress cough reflex, it should not be used in
• TB. Anti-tussive the presence of bronchial secretions.
• Postnasal drip.
• 3) Airway Diseases.
• It reduces the sensitivity of periphral cough receptors to it's
• Asthma. Locally anti- activators which include irritants & autacoids (Bradykinine).
• COPD. tussive
• 4) Irritants.
• Cigarettes smoking. • They clear airway from mucus secretion by:
•  ability to expectorate sputum.
• Inhaled foreign bodies. Mucoactive
Agents •  mucus hyper secretion.
• 5) Drug Induced.
• Inhaled drugs (aerosols).
• ACE-inhibitors (anti-hypertensive).
4

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 P H R M A C O L O G Y - NOTE 1 - Treatment of Cough
DRUDS FOR COUGH

Anti-tussives Mucoactive
Drugs Agents

Centrally Peripherally Expectorants Mucolytics

Opioid Hyperosmolar Classic

Anti-histamins Above Larynx Below Larynx Na citrate mucolytic
Dervatives saline

Diphenhydram steam with or without Na NAS

Codeine Lozenge K citrate
ine (menthol & benzoin bicarbonate
tincture)

Ammonium Peptide
Pholcodeine Syrup Na Iodide mucolytic
Nebulized Cloride
Lignocaine

Dextrome- Dornase alpha

K Iodide Guaifenesin
thorphan Nebulized
Benzocaine

Noscapine Creosote Guaicolate others

Centrally & Bromhexine

Periphrally

Benzonatate Ambroxol

Mucoregulatory

Anti- Macrolide Anti-

cholinergic Antibiotics inflammatory

Ipratropium Azithromycin Indomethacin Corticosteroids

5
Atropine

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 P H R M A C O L O G Y - NOTE 1 - Treatment of Cough

 Anti-Tussives (cough suppressent)

DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
Codeine  They suppress cough reflex by  Nausea.
 Derict inhibition of Cough Center in the  Dizziness.
Dervative

Pholcode
Opioid
Acting Centarlly

Dextromethorphan medulla.  Urenary retention.

 Constipation.(vi)
Noscapine
Diphenhydramine  It depresses CNS including Cough Center.  Sedation.
Histamine

 Drowsiness.
Anti-

 Dizziness.

Lozenges  They are demulcents.  They form gelatious coat that protects the  Used for cough of
Larynx
Above

Syrup (honey) inflammed skin  Sore throat.

 Pharyngitis.
Acting Periphrally

Steam  Without tooking, Taken with or  Promote secretion of dilute mucus,

it taken by without (menthol  To protect inflammed mucosa
& benzoin
inhalation .
tincture)
Larynx
Below

Nebulized Ligocaine 1) Local anesthesia.  During fiber optic bronchoscopy.

2) Blooking mucosal cough receptors.  intractable cough in bronchial carcinoma.
Nebulized
Benzocaine
Acting both Benzonatate  Chemichally, it is related to 1) In lungs, acting on
Centrally tetracaine (local ansthesia).  Stretch & cough receptors.
&Periphrally 2) Act on CNS
 Mucoactive Agents (Expectorants)
o They  volume or hydration of airway secretion.
o They improve expectoration of respiratory mucus secretion.
DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
Hyperosmolar Saline  (10 ml of 6% saline).  Used in fibross & bronchiectasis.
 Inhaled by ultrasonic nebulisation.
Na citrate 1) Stimulate secretion of low viscosity watery  Used in early dry stage of acute bronchitis.
K citrate mucus & sissolve it.
 To make it thinner less sticky.
Na bicarbonate
2) elasticity of bronchi.
 To easily expectorate the mucus.
Expectorants

Ammonium Cloride  Stimulate secretion of low viscosity watery mucus

 By stimulation of sensory nerve ending in
the stomach.
Na Iodide 1) Stimulate secretion of low viscosity watery mucus  Chronic respiratory disease.
K Iodide 2) has mucolytic action.  Chronic asthma.
Guaifenesin 1) respiratory secretion.
2) adhesiveness & surface tension of viscid sputum
Creosote 1) sputum.  Lung absess.
2) has mild antiseptic & deodrant action.  Chronic bronchitis. 6
Guaicolate  Bronchiectasis.

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 P H R M A C O L O G Y - NOTE 1 - Treatment of Cough

 Muocoactive Agentgs (Mucolytic)

o They  viscosity & of elasticity airway secretion &  mucociliary & cough clearance.
DRUGS
N-acetulcysteine (NAC)
Classic Mucolytic
PHARMACOKINETIC
 Taken orally or by inhalation.
 It is a precursor of intracellular
cysteine & glutathione.
ACTION & ITS MECHANISM USES SIDE EFFECT
1) Hydrolyse disulfid bond of mucin.  In condition associated with viscous mucus  Bronchospasm.
 So, mucus loss it’s viscosity & elasticity.
secretion:
 Chronic bronchitis, emphysema,
 Prevent by
β2-agonist.
2) Act as antioxidant.
brochiectasis & cystic fibrosis.  Disagreeable odor.
 So, it prevent pulmonary injury in patient

 (ARD): bronchitis, pneumonia & asthma.  Sulfur odor &

with COPD or lung cancer.  Post-operative & post-traumatic taste.
pulmonary complications.  GI irritation.
 Care of tracheostomy.  Nausea.
 Act as antidote for paracetamol overdose.  Vomiting.
 Stomatitis.
Dornase alpha  Taken by nebulisation.  For cystic fibrosis.  Allergic reaction.
Mucolytic

 Pharyngitis.
Peptide

 Laryngitis.
 Voice alteration.
Bromhexine  It is an expectorant & mucolytic 1) Liquefy mucus.  Acute bronchitis.  Rhinorrhea.
drug.
 Taken orally, parentral or by

By viscosity of bronchial secretion.
 Chronic bronchitits.
 COPD.
 Lacrimation.
 Gastric irritant.
2) Enhance expectoration.
inhalation.  Avoid with
Others

Ambroxol  Taken orally. 

By the rate of microciliary. antacid.
 has less GI irritant.
 Mucoactive Agents (Mucoregulatory Agents)
o They  airway mucus hyper secretion which caused by goblet cells & submucosal gland.
DRUGS PHARMACOKINETIC ACTION & ITS MECHANISM USES SIDE EFFECT
Indomethacine  inflammation which leading to mucus hyper  Panbronchiolits
nflammatory

secretion.
Anti-i

Corticosteroid

Ipratropium  mucus volume that secreted in chronic

bronchitis.
Anticholinergic

Atropine  mucus hypersecrtion.  used pre-anesthetically for endotracheal

intubation.

Azithromycin  Taken orally for long term

antibiotics
Macrolide

administion.