‎Treatment of cough

‎irritant --afferent--> center-<-efferent-- cough center

‎Dry cough (non-productive) ‎Productive cough (wet) Mucolytics + Expectorants

‎Treat with cough suppressant ‎Mucolytics ‎Expectorants

‎Antitussives •‎ These are agents that reduce viscosity (liquefaction) of ‎ hese are drugs that increase the amount
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‎respiratory tract secretions without increasing their amount. ‎and liquefy bronchial secretions.

‎these drugs reduce the frequency or

‎intensity of coughing. my date in brome ‎Bromhexine ‎Ambroxol ‎Acetylcysteine ‎1. Na+ or K+ citr/ate and acet/ate: ‎2. Nauseant expectorants ‎3. Iodides: (Na+ & K+ iodide): last line ‫مهم‬ ‎Guaifenesin ‎5. Stimulant (aromatic) expectorants: ‎6-Water vapor

‎Classification I‎ t reduces the viscosity of bronchial secretion ‎: it is metabolite of bromhexine –‎ It has free sulfhydryl (-SH) groups, that •‎ They increase bronchial ‎• Ipecacuanha & Ammonium salts 1‎ -Expectorant effect: iodides I‎ t increases bronchial secretions and ‎Creosote –‎ Inhalation of water vapor is excellent expectorant.
‎by fragmenting its glycoproteins so mucus ‎and less gastric irritant ‎break disulfide bonds in mucous and ‎secretion by salt action, ‎accumulates in the bronchial glands ‎facilitates its expectoration ‎– It liquefies respiratory secretion rapidly.
‎becomes less viscid and easily to expel. ‎reduce its viscosity. ‎– Also adequate intake of water is useful in lowering
‎A. Peripheral antitussives : ‎B. Central antitussives: ‫مهم‬ ‎C. Central and peripheral antitussives ‫مهم‬ ‎ hey stimulate sensory nerve
T ‎sputum viscosity.
•‎ Stimulate healing of inflamed respiratory
‎They ↓ afferent ‫غير مهم‬ s‎ ecretion become less ‎endings in the stomach ‎2-stimulate secretion of low ‎mucosa & decrease the amount of sputum.
•‎ Uses: ‎– It could be given orally or by inhalation. ‎sticky and easy to expel. ‎viscosity watery mucous ‎• Also has mild antiseptic
‎They inhibit cough center in the ‎Benzonatate ‎– Respiratory diseases e.g. bronchiectasis ‎• Used in the treatment of lung abscess,
‎1. Demulcents (e.g. liquorice lozenges): ‎2-Steam inhalation of menthol: ‎medulla ‎– Post-operative and post-traumatic l‎eading to reflex ‎chronic bronchitis and bronchiectasis.
‎pulmonary complications. ‎They are used in the early ‎ stimulation of excess ‎ ucolytic effect: iodides also potentiate
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‎• Depress peripheral cough receptors at the ‎– Chronic sinusitis. ‎dry stage of acute bronchitis ‎bronchial secretion ‎the effect of proteolytic enzymes in the
‎– They form gelatinous protective coat on ‎They are added to boiling water and the ‎I. Narcotic antitussives: ‎II. Non-narcotic (non-addictive) antitussives: ‎lung by its local anesthetic effect, so it ‎sputum and liquefying it.
‎the inflamed mucous membranes ‎warm steam is inhaled to stimulate ‎inhibit transmission of afferent impulses to
‎secretion of mucus that forms a protective ‎cough center,

‎They are used when the cough arises from

‎coat on the inflamed mucous membranes. ‎Codeine ‎Pholcodeine (more favorable) ‎• Dextromethorphan: (drug of choice) Remote procedure call ‎Adverse effects: MIIT not A

•‎ Metallic taste. ulceration of mucous membrane.

‎above the ‎• Also have central antitussive effect.
‎•irritation of gastric mucosa
‎larynx i.e. pharyngitis. ‎– They can be used when the cough arises ‎where 1-It is a natural derivative of ‎It is less addictive than codeine ‎– Is a synthetic derivative of morphine that
‎•Irritation of lachrymal, nasal and salivary glands (painful salivary swelling)& increase their secretion.
‎from above or below the larynx. ‎morphine. ‎suppresses the response of the central cough center
‎•Thyroid dysfunction (hypothyroidism).
‎• Allergic reactions

‎How 2-It causes direct inhibition of the ‎– It has no analgesic effect, has low addictive
‎cough center in the medulla. ‎profile, but may cause dysphoria at higher doses

‎3-It has weak analgesic action. ‎– Has significantly better side effect profile
t‎ han codeine and has been demonstrated
‎to be equally effective for cough suppression
‎4-Adverse effect 3D

‎–Drowsiness, nausea, vomiting and constipation .

‎–Dryness of mucosa and thickening of sputum difficult to expel.
‎–Dependence. Depression of respiratory center