PHARMACOLOGY

DRUG THERAPY FOR COUGH AND ASTHMA

Cough Suppressants/ Antitussives
lessen the cough by blunting the cough reflex
Dextromethorphan
Function Acts on nucleus tractus solitarius (cough center, loc. Brainstem)
Disadvantage Low bioavailability d/t extensive first pass metabolism
Dosage 0.5mg/kg; max. 30 mg given 3-4x/ day
Population specifics jPx with hepatic and renal impairment, geriatric no dose adjustment
kPregnant category c
lbreastfeeding (+) low active metabolite
mpediatric patientnot recmmended
Contraindications & jHypersensitivity Nausea, GI discomfort, drowsiness/dizziness,
Adverse Effects kMAOI use  if MAOI stopped, wait for 2 weeks Euphoria, visual hallucinations, delusions(>4mg/kg)
before giving.
Expectorants
 Reduce thickness of mucus= easier expectoration
Guafenesin
Function Thins the mucus in the bronchial passage; well absorbed by oral admin
Contraindications & Hypersensitivity to the agent Nausea, vomiting, allergic reaction
Adverse Effects Same population specifics as CS
Dosage SABA LABA
jAdults: 200-400 mg every 4 hrs jAdults: 600 -1200mg every 12 hrs
kChildren (6-12): 100-200 mg every 4 hours kChildren (6-12): 600mg every 12 hrs
lChildren (4-5): 50-100 mg every 4 hours lChildren <6 y/o: not recommended
mInfants & children <4 y/o: not recommended
ASTHMA
Goals of Therapy jLong term control
kPrevention of Acute Exacerbation
l intensity & frequency of symptoms
mlimited activity related to asthma symptoms
B2 Adrenergic Agonists
directly relaxes airway smooth muscles
AE: Hyperglycemia, tachycardia, tremors, hypokalemia, hypomagnesemia
SABA jGiven via inhalation to treat acute bronchospasm
kBronchodilation is maximal w/i 15 ms and lasts up to 4 hrs
lNo anti-inflammatory effects, ergo not to be used as monotherapy for persistent asthma
LABA jLong duration of 12 hrs minimum
kContraindicated as monotherapy and should only be used as combo with an asthma controller medication
lAdjunct to ICS (for moderate to severe asthma)
Inhaled Corticosteroids DOC for persistent asthma
Can cause oropharyngeal candidiasis d/t local immunosuppression
Alternative Drugs jLeukotriene Modifiersfor exercise induced spasm
kCromolyninhibits mast cell degranulation & histamine release
lTheophylline bronchodilator