Expectorants and Antitussives
Demulcents
Definition:
Demulcents are soothing agents that coat and protect mucous
membranes in the throat. These substances are particularly useful for
providing relief from irritation and inflammation, especially in
conditions that lead to a dry cough.
Common Examples:
Lozenges, cough drops, linctuses containing syrup, glycerine, or
liquorice.
Mechanism of Action:
• Soothing Effect: Demulcents relieve the irritative sensations in the
throat by forming a protective film over the mucous membranes.
This barrier reduces the effects of irritants and can help calm the
cough reflex.
• Symptomatic Relief: By reducing afferent impulses from
inflamed or irritated pharyngeal mucosa, demulcents provide
symptomatic relief in instances of dry cough that arise from throat
irritation .
Expectorants
Definition:
Expectorants are substances that help increase the production of
bronchial secretions and facilitate the removal of mucus from the
respiratory tract. They are particularly beneficial for patients with
productive coughs, aiding in clearing the airways.
Common Examples:
Guaiphenesin, potassium iodide, and ammonium chloride.
Mechanism of Action:
1. Increase in Bronchial Secretions: Expectorants enhance the
secretion of mucus from the bronchial glands, leading to increased
bronchial secretions. This is often facilitated through salt action (as
seen with sodium or potassium citrate) that helps draw water into
the mucus.
2. Reduced Viscosity of Mucus: Certain expectorants help reduce
the viscosity of mucus, making it easier to cough up. For example:
a. Guaiphenesin works by reducing surface tension, which
allows mucus to become thinner and less sticky.
b. Mucolytic Agents (such as acetylcysteine, bromhexine) can
also play a role in breaking down the mucus structure, thus
lowering its viscosity.
3. Facilitation of Coughing: By loosening the mucus and increasing
its volume, expectorants help facilitate its removal through
coughing, which aids in clearing the airways of secretions and
irritants .
Conclusion
In summary, demulcents soothe and protect irritated mucous
membranes, providing relief from dry cough, while expectorants
enhance mucus production and clearance, making them effective in
managing productive coughs. Both play critical roles in respiratory care
and symptom management .
explain what are mucolytics along with examples, doses and side effects
Mucolytics are medications that help to break down and thin mucus in
the respiratory tract, making it less viscous and easier to expel. This is
particularly useful in conditions where thick mucus production is a
problem, such as chronic bronchitis, cystic fibrosis, and other respiratory
syncytial viruses.
Mechanism of Action
Mucolytics work by disrupting the molecular structure of mucus. They
typically open disulfide bonds in the mucoproteins present in sputum,
reducing the thickness and viscosity of the mucus. This action facilitates
mucus clearance from the airways through coughing.
Common Mucolytics
1. Acetylcysteine
a. Dose: Typically administered via inhalation or orally.
Common dosages range from 600 mg orally to 1200 mg per
day, or 3 to 5 mL of a 10% to 20% solution for inhalation,
depending on the severity of the condition and the patient's
needs.
b. Side Effects: Potential side effects include gastrointestinal
discomfort, nausea, vomiting, and, less frequently, allergic
reactions such as rash or bronchospasm .
2. Ambroxol
a. Dose: Generally administered in the range of 30 mg to 120
mg per day, divided into two to three doses.
b. Side Effects: Common side effects may include
gastrointestinal disturbances, headache, dizziness, and in rare
cases, allergic reactions .
3. Bromhexine
a. Dose: The typical dosage is 8 mg to 32 mg per day, often
divided into two or three doses.
b. Side Effects: Side effects can include gastrointestinal
discomfort, nausea, and allergic reactions .
4. Carbocisteine
a. Dose: Generally, the dosage ranges from 250 mg to 750 mg
taken three times daily (TDS).
b. Side Effects: Side effects may include gastric discomfort,
rashes, and it is contraindicated in patients with peptic ulcers
due to its potential to break the gastric mucosal barrier
Antitussives
Antitussives are medications used to suppress or relieve cough. They can
be particularly useful for addressing dry, nonproductive coughs that do
not serve a useful physiological purpose, such as those associated with
irritation or inflammation in the airways.
Mechanism of Action
Antitussives act by inhibiting the cough reflex, which is typically
initiated by stimulation of cough receptors in the respiratory tract.
Depending on their action mechanism, antitussives can be classified into
two main categories:
1. Central Acting Antitussives: These medications work directly on
the cough center in the brain (the medulla) to raise the threshold
for coughing.
2. Peripheral Acting Antitussives: These medications work by
targeting receptors in the airways to reduce the urge to cough.
Types of Antitussives
1. Opioid Antitussives
a. Examples:
i. Codeine: A common strong antitussive with sedative
effects.
ii. Ethylmorphine
iii. Pholcodeine
b. Dose:
i. Codeine: Typically, 10-20 mg every 4-6 hours as
needed, not exceeding 120 mg per day in adults.
c. Side Effects: Potential side effects include drowsiness,
constipation, nausea, and the risk of respiratory depression,
especially in overdose situations.
2. Non-opioid Antitussives
a. Examples:
i. Dextromethorphan: Widely used in over-the-counter
cough preparations.
ii. Chlophedianol
b. Dose:
i. Dextromethorphan: Generally, 10-20 mg every 4
hours, not exceeding 120 mg per day for adults.
c. Side Effects: Side effects can include dizziness, drowsiness,
gastrointestinal disturbances, and in some rarer cases, allergic
reactions.
3. Antihistamines
a. Examples:
i. Chlorpheniramine
ii. Diphenhydramine
iii. Promethazine
b. Dose:
i. Diphenhydramine: Usually prescribed at 25-50 mg
every 4-6 hours, not to exceed 300 mg per day.
c. Side Effects: Common side effects are sedation, dry mouth,
dizziness, and potential anticholinergic effects (such as
urinary retention and constipation).
4. Peripherally Acting Antitussives
a. Example:
i. Prenoxdiazine
b. Dose: Dosage varies, and it is typically prescribed based on
specific formulations.
c. Side Effects: Side effects can include gastrointestinal
discomfort and allergic reactions.
Indications for Use
Antitussives are typically indicated for:
• Dry coughs that are persistent or disruptive.
• Coughs related to conditions that do not produce beneficial mucus
clearance, such as viral infections and irritants.
Contraindications
Antitussives are generally not recommended for productive coughs, as
suppressing the cough reflex in these situations can lead to mucus
accumulation in the airways, potentially worsening respiratory
conditions
Bronchodilators
Bronchodilators are a class of medications that relax the smooth muscles
of the airways, resulting in the widening (dilation) of the bronchial
passages. This provides relief from symptoms associated with
respiratory conditions that involve bronchoconstriction (narrowing of the
airways), such as asthma and chronic obstructive pulmonary disease
(COPD).
Mechanism of Action
Bronchodilators work by stimulating specific receptors in the bronchial
walls, leading to muscle relaxation and dilation of the airways.
Depending on their mechanism, bronchodilators can be categorized into
three major classes:
1. Beta-Adrenergic Agonists:
a. These drugs stimulate beta-2 adrenergic receptors on the
smooth muscle of the airways, leading to relaxation and
bronchodilation.
b. Short-Acting Beta Agonists (SABAs): Provide quick relief
of bronchospasm.
i. Examples: Albuterol (Salbutamol), Levalbuterol.
ii. Onset: Typically work within 5-15 minutes and last for
about 4-6 hours.
c. Long-Acting Beta Agonists (LABAs): Used for longer-term
control of asthma and COPD.
i. Examples: Salmeterol, Formoterol.
ii. Onset: 30 minutes to 1 hour, lasting up to 12 hours.
2. Anticholinergics:
a. These medications block the action of acetylcholine on
muscarinic receptors in the airway smooth muscle, reducing
bronchoconstriction.
b. Short-Acting Anticholinergics: Ipratropium bromide.
c. Long-Acting Anticholinergics: Tiotropium, Aclidinium.
d. Onset: Ipratropium begins to work within 30 minutes,
whereas tiotropium has a longer onset and background effect
lasting 24 hours.
3. Methylxanthines:
a. These are a class of bronchodilators that inhibit
phosphodiesterase, leading to an increase in cAMP levels and
subsequent bronchodilation.
b. Example: Theophylline.
c. Use: Less commonly used now due to side effects and the
complexity of dosing; often used as an add-on therapy.
d. Onset: Variable, with effects lasting several hours.
Indications for Use
Bronchodilators are indicated for:
• Asthma: To relieve acute bronchospasm and manage chronic
bronchial inflammation.
• COPD: For both immediate relief and long-term control of
symptoms.
• Other Conditions: Such as bronchitis and emphysema.
Side Effects
While generally well-tolerated, bronchodilators can have side effects
that vary by class:
1. Beta-Agonists:
a. Common side effects include tremors, palpitations, increased
heart rate (tachycardia), anxiety, and headache.
b. Overuse can lead to decreased effectiveness over time and
worsening of bronchial hyperreactivity.
2. Anticholinergics:
a. May cause dry mouth, urinary retention, constipation, and
blurred vision.
b. Rarely linked to cardiovascular effects but are generally well-
tolerated.
3. Methylxanthines:
a. Can produce several side effects, including gastrointestinal
upset, insomnia, irritability, and toxicity leading to
arrhythmias and seizures.
