Antitussives , expectorants and mucolytics

1. Drug therapy for cough Dr. Gyanendra Raj Joshi PharmD , RPh

2. Cough Productive cough Unproductive cough

3. Sites of action for treatment Peripheral sites Afferent side Efferent side Central nervous system Medullary paths Cerebral cortex Subcortical paths

4. Antitussives acting peripherally Demulcents Linctus containing syrup, glycerine , liquorice Cough drops Water aerosol inhalation Steam inhalation Compound benzoin tincture Local anesthetics Nebulised lidocaine

5. Antitussives that act centrally (cough centre suppressants) Opiods D ethadone , codeine Non opioids D extromethorphan , pholcodine , noscapine Antihistamines C hlorpheniramine , diphenhydramine , promethazine

6. Expectorants( Mucokinetics ) Mucolytics : Carbocysteine , mecysteine Water inhalation via an aerosol Bromhexine Ambroxol Dornase α Bronchial secretion enhancers : Direct acting : Reflexly acting :

7. Nasal decongestants α adrenergic receptor agonist Mechanism Examples Adverse effects

8. Cold remedies Benign self limited syndrome Viral Combination of drugs Drugs Intranasal ipratropium Cromolyn sodium Antihistamines Antitussives Expectorants Decongestants Intranasal glucocorticoids Leukotriene receptor antagonists Zinc

9. Vitamins and herbal remedies Antiviral therapy Antibiotic therapy NSAIDS Exercise Face mask Gargling Hydration Warm fluids