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46 Cards in this Set
- Front
- Back
Children under what age should not have decongestants?
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2
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Children younger than what age should not have antihistamines?
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6
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Decongestants
vaso-______ resulting in mucosal drying |
constriction
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Antitussives
work to suppress ______ |
coughing
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Antitussives Suppress the cough CENTER in the _______
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Medulla
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Antitussives Suppress the cough receptors in the ______
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throat, lungs
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______ is the most common ingredient in OTC suppressing agents
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Dextromethorphan (DXM)
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OTC cough suppressing agents
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Robitussin products, Tylenol cold products, and NyQuil medications.
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narcotic antitussives
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Codeine or hydrocodone
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Physician can prescribe a narcotic antitussive.
Duration of the prescription does not exceed how long? |
1 week
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Non-narcotics Antitussives
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Benzonatate [Tessalon]
dextromethorphan (but Wannamaker says something different about DXM) |
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Two Basic Types of Cough
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Productive and Non-Productive Cough
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Should you use a antitussive if
Productive cough congested cough removes excessive secretions |
no
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Should you use a antitussive if
non-productive cough dry cough “self-feed” |
yes
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narcotic antitussives directly
suppress cough reflex in where? _____ |
medulla of the brain
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dextromethorphan directly
suppress cough reflex in where? |
medulla of the brain
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benzonatate MOA to stop coughing
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anesthetizes or
numbs the cough reflex |
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Side Effects of Benzonatate
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dizziness, headache, & sedation
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Side Effects of Narcotic-Type
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sedation, nausea, & constipation
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side effects of Dextromethorphan
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dizziness, drowsiness, & nausea
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The active ingredient or one of the active ingredients in cough medicines which causes the “high”
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Dextromethorphan (DEX)
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The most widely used cough suppressant in the U.S.;
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DXM
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Some of Products with DXM
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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 |
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“Code names” for DXM or Specific Products
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“Dex, DXM, Robo, Skittles, Syrup, Tussin;”
“Triple-C or CCC” refers to a cold and cough remedy, which has potent doses of DXM. |
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Describe the The “High” assoc with DXM
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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 |
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Describe The “Lows” of DXM
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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 |
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Of Major Concern is Combining DXM With…
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Non-drowsy antihistamines
SSRI anti-depressants MAOI inhibitors |
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A Normal Dose of Cough Medicine is ____ Milligrams
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15-30
Mind-altering effects can occur at doses as low as 100 milligrams |
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Isomer of DXM
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Levorphanol
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Dextromethorphan + CYP 2D6
= |
Dextrorphan (active metabolite)
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Dextromethorphan; Dextrorphan
Inhibits _____ Receptor |
NMDA
(N-methyl-d-aspartate receptor) Same site of action as ketamine, phencyclidine Dissociative hallucinogens |
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Dextromethorphan; Dextrorphan Inhibits reuptake of _____
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serotonin
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DXM substrate for and inhibitor of ______
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CYP2D6
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Who is More likely to abuse DXM?
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Extensive metabolizers (EMs)
(Produce more Dextrorphan) |
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"Plateaus" of DXM
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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 |
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Nasal Decongestants:Classifications (3)
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Adrenergics (sympathomimetics)
Anticholinergics (parasympatholytics) Corticosteroids (topical) |
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Oral Decongestants:
exclusively adrenergics alpha-adrenergic activity 3 examples: |
pseudoephrine [Afrin & Sudafed]
phenylpropanolamine phenylephrine |
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Topical Decongestants (5)
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phenylephrine [Neo-Synephrine]
oxymetazoline [Sinex LA] ephedrine [Vicks] – direct & indirect acting beclomethasone [Beconase & Vancenase] flunisolide [Nasolide] |
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Direct acting adrenergic receptor agonists:
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Phenylephrine (Neosynephrine)
Alpha 1 & 2 Oxymetazoline (Afrin, Dristan 12 hour) |
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Oxymetazoline Reduces _______-Dependent Protein Kinase Activity
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cAMP-
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side effects of adrenergic decongestants
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nervousness
insomnia palpitations tremor |
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side effects of steroid decongestants
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local mucosal
irritation & dryness |
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1 mucolytic
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Acetylcysteine (Mucomyst)
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Mucolytics Also used for _____ overdose... given orally
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Tylenol
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Expectorants are available in two forms:
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Mucolytic
Stimulant |
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Guaifenesin side effects
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(cough syrups: Robitussin, Glytuss)
Dizziness Headache Nausea |