useful for UG MBBS students

1. Dr.SUMITHA.A MBBS.,MD
ASSISTANT PROFESSOR
PHAMACOLOGY

2.  Cough is a protective reflex.
 Due to stimulation of mechano or chemoreceptors in
throat,respiratory passages
 Stretch receptors in lungs.

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The most common causes of cough
Acute cough (<3 weeks): URTIs (especially the common
cold, acute bacterial sinusitis, and pertussis), pneumonia,
pulmonary embolus, and congestive heart failure.
Sub-acute cough (3-8 weeks): post-infectious
Chronic cough (>8 weeks):
In a smoker: chronic obstructive lung disease or
bronchogenic carcinoma.
In a nonsmoker: postnasal drip ,GERD

5. • Non-productive (dry): No useful purpose, increases
discomfort to the patient needs suppression
• Productive (tenacious): Presence of excessive
sputum suppression not desired needs
coughing/clearing out of the sputum

7. • Sooth the throat and reduce afferent impulses from the
inflamed/irritated pharyngeal mucosa.
• E.g: Lozenges, cough drops, linctuses containing syrup,
Glycerine, Liquorice

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• These act
– in CNS to raise the threshold of cough center
–peripherally in Respiratory tract to reduce tussal impulse
Should be used only for dry unproductive cough
E.g:
Opioids: Codein, Pholcodein
Non-opioids: Noscapine, Dextromethorphan
Antihistaminics: Chlorpheniramine, Diphenhydramine,
Promethazine

9. Semi synthetic opioid analgesic
Less potent than morphine
More selective for cough centre
Potent cough suppressant action at low dose :15 mgtablet
;15mg/5ml linctus
Anti tussive action –blocked by Naloxone
S/E
Constipation ,Drowsiness, Respiratory depression
OPIOIDS Codeine

10. Pholcodeine
Antitussive efficacy similar to codeine
No analgesic/addictive effect
Longer acting
Dose 10-15mg .

11. NON- OPIOIDS Dextromethorphan
D-isomer of methorphan
Raise threshold for cough centre
M.O.A
NMDA receptor antagonist
Least addiction and constipation Ascoril –D:
dextromethorphan,CPM,phenylephrine
Uses
Use along with antihistamine and bronchodilator as suppressant
S/E
Nausea, vomiting, ataxia
Dose- 10mg TDS

12. Noscapine
Opium alkaloids belongs to benzyl isoquinoline group
No addictive, analgesic & constipating properties
Do not interfere with mucocilliary movement
Release histamine – produce bronchoconstiction in asthmatics.
S/E
Nausea,headache,tremor
Dose 15 mg-30 mg

13.  PRENOXDIAZINE
- desensitises pulmonary stretch receptors and
reduces tussal impulses originating in the lungs.
 It has moderate antitussive action
Orally 100-200mg TDS
 Anti histamines:
 Chlorpheniramine -2 to 5
mg,Promethazine 25 mg
Sedative,anticholinergic property

14.  Bronchial secretion enhancers
 Ammonium chloride, Sodium citrate or potassium citrate,
Guaiphenesin,vasaka and Tolu balsam
 stimulate the flow of respiratory tract secretions by stimulating
the bronchial secretory cells (to increase the volume) and
ciliary movements (to facilitate their removal)

15. Sodium & potassium citrate
M.O.A
Increase Bronchial secretion by salt action
Guaifenesin
Expectorant drug
M.O.A
Increase airway secretion and mucocilliary activity
Dose 100-200mg BD
Ammonium chloride,Ipecac
Reflexly increase respiratory secretion
Gastric irritant

16. Bromhexine
Synthetic derivative of vasicine (Vasaka)
M.O.A
Depolymerization of muco polysaccharide
Increasing lysosomal enzyme activity
↑ volume & ↓ viscosity of sputum
S/E
GIT upset, rhinorrhea,lacrimation
Dose 8 mgTDS
MUCOLYTICS

17. Ambroxol
Metabolite of bromhexine
Similar properties
Dose 15-30 mg TDS MUCOLITE 30 MG TAB
Dornase alfa
Human recombinant DNAse
Cleaves DNA
Useful in Cystic fibrosis
Given by inhalation
Dose 2.5mg OD

18. Acetyl cysteine
M.O.A
Reduce viscosity of sputum by opening disulfide bond of
mucoprotein
S/E
Nausea,vomiting,stomatitis,bronchospasm,rhinorrhea
Dose 200mg
Administer directly to respiratory tract

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ASCORIL-C: Codeine, Chlorpheniramine.
Ascoril –LS: levosalbutamol,Ambroxol,
Guaiphenesin
Ascoril –D:
dextromethorphan,CPM,phenylephrine
BENADRYL: Diphenhydramine, Ammonium chloride,
Sodium citrate, Menthol.
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21. THANK YOU