Komiskey 10-2-07 Antitussives

Front 1

Children under what age should not have decongestants?

Back 1

2

Front 2

Children younger than what age should not have antihistamines?

Back 2

6

Front 3

Decongestants
vaso-______ resulting in mucosal drying

Back 3

constriction

Front 4

Antitussives
work to suppress ______

Back 4

coughing

Front 5

Antitussives Suppress the cough CENTER in the _______

Back 5

Medulla

Front 6

Antitussives Suppress the cough receptors in the ______

Back 6

throat, lungs

Front 7

______ is the most common ingredient in OTC suppressing agents

Back 7

Dextromethorphan (DXM)

Front 8

OTC cough suppressing agents

Back 8

Robitussin products, Tylenol cold products, and NyQuil medications.

Front 9

narcotic antitussives

Back 9

Codeine or hydrocodone

Front 10

Physician can prescribe a narcotic antitussive.

Duration of the prescription does not exceed how long?

Back 10

1 week

Front 11

Non-narcotics Antitussives

Back 11

Benzonatate [Tessalon]

dextromethorphan (but Wannamaker says something different about DXM)

Front 12

Two Basic Types of Cough

Back 12

Productive and Non-Productive Cough

Front 13

Should you use a antitussive if

Productive cough
congested cough
removes excessive secretions

Back 13

no

Front 14

Should you use a antitussive if

non-productive cough
dry cough
“self-feed”

Back 14

yes

Front 15

narcotic antitussives directly
suppress cough reflex in where?
_____

Back 15

medulla of the brain

Front 16

dextromethorphan directly
suppress cough reflex in
where?

Back 16

medulla of the brain

Front 17

benzonatate MOA to stop coughing

Back 17

anesthetizes or
numbs the cough reflex

Front 18

Side Effects of Benzonatate

Back 18

dizziness, headache, & sedation

Front 19

Side Effects of Narcotic-Type

Back 19

sedation, nausea, & constipation

Front 20

side effects of Dextromethorphan

Back 20

dizziness, drowsiness, & nausea

Front 21

The active ingredient or one of the active ingredients in cough medicines which causes the “high”

Back 21

Dextromethorphan (DEX)

Front 22

The most widely used cough suppressant in the U.S.;

Back 22

DXM

Front 23

Some of Products with DXM

Back 23

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

Front 24

“Code names” for DXM or Specific Products

Back 24

“Dex, DXM, Robo, Skittles, Syrup, Tussin;”
“Triple-C or CCC” refers to a cold and cough remedy, which has potent doses of DXM.

Front 25

Describe the The “High” assoc with DXM

Back 25

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

Front 26

Describe The “Lows” of DXM

Back 26

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

Front 27

Of Major Concern is Combining DXM With…

Back 27

Non-drowsy antihistamines
SSRI anti-depressants
MAOI inhibitors

Front 28

A Normal Dose of Cough Medicine is ____ Milligrams

Back 28

15-30

Mind-altering effects can occur at doses as low as 100 milligrams

Front 29

Isomer of DXM

Back 29

Levorphanol

Front 30

Dextromethorphan + CYP 2D6
=

Back 30

Dextrorphan (active metabolite)

Front 31

Dextromethorphan; Dextrorphan
Inhibits _____ Receptor

Back 31

NMDA


(N-methyl-d-aspartate receptor)
Same site of action as ketamine, phencyclidine
Dissociative hallucinogens

Front 32

Dextromethorphan; Dextrorphan Inhibits reuptake of _____

Back 32

serotonin

Front 33

DXM substrate for and inhibitor of ______

Back 33

CYP2D6

Front 34

Who is More likely to abuse DXM?

Back 34

Extensive metabolizers (EMs)


(Produce more Dextrorphan)

Front 35

"Plateaus" of DXM

Back 35

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

Front 36

Nasal Decongestants:Classifications (3)

Back 36

Adrenergics (sympathomimetics)
Anticholinergics (parasympatholytics)
Corticosteroids (topical)

Front 37

Oral Decongestants:
exclusively adrenergics
alpha-adrenergic activity
3 examples:

Back 37

pseudoephrine [Afrin & Sudafed]
phenylpropanolamine
phenylephrine

Front 38

Topical Decongestants (5)

Back 38

phenylephrine [Neo-Synephrine]
oxymetazoline [Sinex LA]
ephedrine [Vicks] – direct & indirect acting
beclomethasone [Beconase & Vancenase]
flunisolide [Nasolide]

Front 39

Direct acting adrenergic receptor agonists:

Back 39

Phenylephrine (Neosynephrine)
Alpha 1 & 2 Oxymetazoline (Afrin, Dristan 12 hour)

Front 40

Oxymetazoline Reduces _______-Dependent Protein Kinase Activity

Back 40

cAMP-

Front 41

side effects of adrenergic decongestants

Back 41

nervousness
insomnia
palpitations
tremor

Front 42

side effects of steroid decongestants

Back 42

local mucosal
irritation & dryness

Front 43

1 mucolytic

Back 43

Acetylcysteine (Mucomyst)

Front 44

Mucolytics Also used for _____ overdose... given orally

Back 44

Tylenol

Front 45

Expectorants are available in two forms:

Back 45

Mucolytic
Stimulant

Front 46

Guaifenesin side effects

Back 46

(cough syrups: Robitussin, Glytuss)
Dizziness
Headache
Nausea