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46 Cards in this Set

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Children under what age should not have decongestants?
2
Children younger than what age should not have antihistamines?
6
Decongestants
vaso-______ resulting in mucosal drying
constriction
Antitussives
work to suppress ______
coughing
Antitussives Suppress the cough CENTER in the _______
Medulla
Antitussives Suppress the cough receptors in the ______
throat, lungs
______ is the most common ingredient in OTC suppressing agents
Dextromethorphan (DXM)
OTC cough suppressing agents
Robitussin products, Tylenol cold products, and NyQuil medications.
narcotic antitussives
Codeine or hydrocodone
Physician can prescribe a narcotic antitussive.

Duration of the prescription does not exceed how long?
1 week
Non-narcotics Antitussives
Benzonatate [Tessalon]

dextromethorphan (but Wannamaker says something different about DXM)
Two Basic Types of Cough
Productive and Non-Productive Cough
Should you use a antitussive if

Productive cough
congested cough
removes excessive secretions
no
Should you use a antitussive if

non-productive cough
dry cough
“self-feed”
yes
narcotic antitussives directly
suppress cough reflex in where?
_____
medulla of the brain
dextromethorphan directly
suppress cough reflex in
where?
medulla of the brain
benzonatate MOA to stop coughing
anesthetizes or
numbs the cough reflex
Side Effects of Benzonatate
dizziness, headache, & sedation
Side Effects of Narcotic-Type
sedation, nausea, & constipation
side effects of Dextromethorphan
dizziness, drowsiness, & nausea
The active ingredient or one of the active ingredients in cough medicines which causes the “high”
Dextromethorphan (DEX)
The most widely used cough suppressant in the U.S.;
DXM
Some of Products with DXM
Alka-Seltzer Plus Cold & Cough Medicine
Coricidin HBP Cough and Cold
Dayquil LiquiCaps
Dimetapp DM
Robitussin cough products
Sudafed cough products
Triaminic cough syrups
Tylenol Cold products
Vicks 44 Cough Relief products
Vicks NyQuil LiquiCaps
Generic/store brands
“Code names” for DXM or Specific Products
“Dex, DXM, Robo, Skittles, Syrup, Tussin;”
“Triple-C or CCC” refers to a cold and cough remedy, which has potent doses of DXM.
Describe the The “High” assoc with DXM
Similar to an ecstasy-like high
Experience mild distortions of color and sound
Strong visual hallucinations
“Out-of-body" sensations
Confusion
Slurred speech
Loss of motor control
Describe The “Lows” of DXM
Dehydration
Delusions
Panic attacks
Memory problems
Blurred vision
Stomach pain, nausea, Numbness of fingers and toes
Drowsiness and dizziness
Fever and headaches
Rashes and itchy skin
Loss of consciousness
and vomiting
High blood pressure and rapid heart beat
Of Major Concern is Combining DXM With…
Non-drowsy antihistamines
SSRI anti-depressants
MAOI inhibitors
A Normal Dose of Cough Medicine is ____ Milligrams
15-30

Mind-altering effects can occur at doses as low as 100 milligrams
Isomer of DXM
Levorphanol
Dextromethorphan + CYP 2D6
=
Dextrorphan (active metabolite)
Dextromethorphan; Dextrorphan
Inhibits _____ Receptor
NMDA


(N-methyl-d-aspartate receptor)
Same site of action as ketamine, phencyclidine
Dissociative hallucinogens
Dextromethorphan; Dextrorphan Inhibits reuptake of _____
serotonin
DXM substrate for and inhibitor of ______
CYP2D6
Who is More likely to abuse DXM?
Extensive metabolizers (EMs)


(Produce more Dextrorphan)
"Plateaus" of DXM
1st Plateau: 1.5-2.5mg/kg
Mild alcohol-marijuana-like intoxication, GI
2nd Plateau: 2.5-7.5mg/kg
Lethargy or agitation, ataxia, nystagmus, tachycardia
3rd Plateau: 7.5-15mg/kg
Variable, often dysphoric, psychosis, disorientation, altered judgment may be severe
4th Plateau: > 15-30mg/kg
Fully dissociative, seizures, hyperthermia, aspiration
Nasal Decongestants: Classifications (3)
Adrenergics (sympathomimetics)
Anticholinergics (parasympatholytics)
Corticosteroids (topical)
Oral Decongestants:
exclusively adrenergics
alpha-adrenergic activity
3 examples:
pseudoephrine [Afrin & Sudafed]
phenylpropanolamine
phenylephrine
Topical Decongestants (5)
phenylephrine [Neo-Synephrine]
oxymetazoline [Sinex LA]
ephedrine [Vicks] – direct & indirect acting
beclomethasone [Beconase & Vancenase]
flunisolide [Nasolide]
Direct acting adrenergic receptor agonists:
Phenylephrine (Neosynephrine)
Alpha 1 & 2 Oxymetazoline (Afrin, Dristan 12 hour)
Oxymetazoline Reduces _______-Dependent Protein Kinase Activity
cAMP-
side effects of adrenergic decongestants
nervousness
insomnia
palpitations
tremor
side effects of steroid decongestants
local mucosal
irritation & dryness
1 mucolytic
Acetylcysteine (Mucomyst)
Mucolytics Also used for _____ overdose... given orally
Tylenol
Expectorants are available in two forms:
Mucolytic
Stimulant
Guaifenesin side effects
(cough syrups: Robitussin, Glytuss)
Dizziness
Headache
Nausea