Antitussives,+Expectorants+and+Mucolytics

=**Antitussives, Expectorants and Mucolytics**= These are any large group of drugs that act on the central and peripheral nervous systems to suppress the cough reflex. These kind of substances promote the ejection of mucus or other exudates from the lung, bronchi and trachea, they promote expectoration by reducing the viscosity of pulmonary secretons or by decreasing the tenacity with which exudates adhere to the lower respiratory tract. Because the cough reflex is necessary for clearing the upper respiratory tract of obstructive secretions, antitussives should not be used with a productive cough. These are administered orally, usually in a syrup with a mucolytic or expectorant and alcohol, or, sometimes in a capsule with an antihistaminic and a mild analgesic.

__[[image:cough.jpg width="214" height="188" align="left"]]Cough__
A cough in medicine, is a sudden and often repetitively occurring defense reflex which helps to clear the large breathing passages from excess secretions, irritants, foreign particles and microbes. The cough reflex consists of three phases: an inhalation, a forced exhalation against a closed glottis, and a violent release of air from the lungs following opening of the glottis, usually accompanied by a distinctive sound. Coughing can happen voluntarily as well as involuntarily, though for the most part it is involuntarily. Frequent or severe coughing usually indicates the presence of a disease. Many viruses and bacteria benefit by causing theirhost to cough, which helps to spread the disease to new hosts. Coughing is classified as acute(of sudden onset) if it is present less than three weeks, subacute if it is present between three and eight weeks, and chronic when lasting longer than eight weeks. A cough can be dry or productive, depending on whether sputum is coughed up. Most of the time, coughing is acute and caused by a respiratory tract infection. Coughing can be triggered by food entering the windpipe rather than the esophagus due to a failure of the epiglottis in patients who have difficulties swallowing. Smoking and air pollution are common causes of coughing. Provided the patient is a non-smoker and has a normal chest X-ray, the three most common causes of chronic cough are asthma, gastroesophageal reflux disease and post-nasal drip. Other causes of chronic cough include chronic bronchitis, heart failure and medications such as ACE inhibitors.

Acute viral rhinopharyngitis, or acute coryza, known as an upper respiratory virus, or commonly called the cold, is a contagious, viral infectious disease of the upper respiratory system, primarily caused by rhinoviruses, ( picornaviruses) or coronaviruses. It is the most common infectious disease in humans; there is no known cure, but it is very rarely fatal. Common symptoms are cough, sore throat, runny nose, blocked nose, and sneezing; sometimes accompanied by 'pink eye', muscle aches, fatigue, malaise, headaches, muscle weakness, uncontrollable shivering, loss of appetite, and rarely extreme exhaustion. Fever is more commonly a symptom of influenza, another viral upper respiratory tract infection (URTI) whose symptoms broadly overlap with the cold but are more severe. Symptoms may be more severe in infants and young children (due to their immune system not being fully developed) as well as the elderly (due to their immune system often being weakened). Various cold medicines exist which claim to help relieve symptoms. They include antitussives, antihistamines and decongestants. They are not recommended for use in children.



Tiny, hair-like structures called cilia help move mucus across sinus membranes and toward an exit. All of your sinus cavities connect to your nose to allow a free exchange of air and mucus. Infections or allergies make sinus tissues inflamed, red, and swollen. That's called sinusitis. Sinusitis causes many symptoms. Most people have a stuffy nose and pain or pressure in several locations around the face or teeth. There's usually a nasal discharge that may be yellow, green, or clear. Other symptoms may include fatigue, decreased sense of smell and/or taste, cough, sore throat, bad breath, headache, pain on bending forward, and fever. There are various medicines that exist which claim to help relieve symptoms. They include antitussives, antihistamines and decongestants.
 * Sinuses: Air Spaces in Your Head **

** Emphysema is a lung disease, ** characterized by an abnormal, permanent enlargement of air spaces distal to the terminal bronchioles. The disease is coupled with the destruction of walls, but without obvious fibrosis. It is often caused by exposure to toxic chemicals, including long-term exposure to tobacco smoke.Emphysema is characterized by loss of elasticity (increased pulmonary compliance) of the lung tissue caused by destruction of structures feeding the alveoli, in some cases owing to the action of alpha 1-antitrypsin deficiency. This causes the small airways to collapse during forced exhalation, as alveolar collapsibility has decreased. As a result, airflow is impeded and air becomes trapped in the lungs, in the same way as other obstructive lung diseases. Symptoms include shortness of breath on exertion, and an expanded chest. However, the constriction of air passages isn't always immediately deadly, and treatment is available. Signs of emphysema include pursed-lipped breathing, central cyanosis and finger clubbing. The chest has hyper resonant percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. There may be decreased breath sounds and audible expiratory wheeze. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. The face has a ruddy complexion if there is a secondary polycythemia. Sufferers who retain carbon dioxide have asterixis (metabolic flap) at the wrist. A type of mucolytic is Acetylcysteine which is use to treat abnormally thick mucus secretions in chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis (chronic dilation of the airways), pneumonia, bronchitis, tacheobronchitis, cystic fibrosis, and other conditions involving excess mucus accumulation in the lung that is significant enough to affect breathing.



**Tuberculosis** (abbreviated TB for tubercle bacillus or Tuberculosis) is a common and often deadly infectious disease caused by mycobacteria. In humans, Mycobacterium tuberculosis is the primary causative bacterium although other mycobacteria such as Mycobacterium bovis, Mycobacterium africanum, Mycobacterium canetti, and Mycobacterium microti are also causes.[1] Tuberculosis usually attacks the lungs (as pulmonary TB) but can also affect the central nervous system, the lymphatic system, the circulatory system, the genitourinary system, the gastrointestinal system, bones, joints, and even the skin.Tuberculosis is spread through the air, when people who have the disease cough, sneeze, or spit. Most infections in human beings will result in asymptomatic, latent infection, and about one in ten latent infections will eventually progress to active disease, which, if left untreated, kills more than half of its victims. The classic symptoms of tuberculosis are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms.



** Acetylcysteine // Medica Korea( International Apex) C://** Acetylcysteine
 * I :** Mucolytic in respiratory disorders associated with cough. Amp Antidote in paracetamol poisoning.
 * D:** Cap Adult 200mg tid. Children up to 2 yrs old 200mg once a daily: 2-7 yrs old 200mg bid. Amp Treatment of Paracetamol poisoning Initially 150mg/kg body wt. in 200mL glucose 5% by IV infusion over 15mins, followed by 50mg/kg wt. in 5% over the next 4 hours& then next 16 hour. NaCl 0.9% may also be used where glucose 5% is unsuitable.

HTN : flushing nausea vomitting,fever syncope,sweating.
 * AR:** Hypersensitivity reactions including bronchospasm, angioedema,rashes and pruritus:

**//Precautions://** **Prolonged use:** Safety and effectiveness of daily administration of dornase alfa for longer than 12 months have not been established. **Pregnancy:** There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.
 * Do not use in the following situations: ** Allergy to acetylcysteine, dornase alfa, Chinese hamster ovary cell products(dornase alfa only), or any other ingredients within the drug.
 * Breastfeeding: ** It is not known if acetylcysteine or dornase alfa appear in breast milk. Consult your doctor before you begin breastfeeding.

Dornase alfa: To reduce frequency of respiratory infections requiring parenteral (injectable) antibiotics and to improve pulmonary function in conjunction with standard therapies for patients with cystic fibrosis.

**//Precautions://** **Prolonged use:** Safety and effectiveness of daily administration of dornase alfa for longer than 12 months have not been established. Consult your doctor before you begin breastfeeding.
 * Do not use in the following situations: ** Allergy to acetylcysteine, dornase alfa, Chinese hamster ovary cell products (dornase alfa only), or any other ingredients within the drug.
 * Pregnancy: ** There are no adequate or well-controlled studies in pregnant women. Use only if clearly needed and the potential benefits to the mother outweigh the possible hazards to the fetus.
 * Breastfeeding: **It is not known if acetylcysteine or dornase alfa appear in breast milk.
 * Children: **Safety and effectiveness of dornase alfa in children younger than 5 years of age have not been established.

Every drug is capable of producing side effects. Many mucolytic users experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy, and individual susceptibility. Possible side effects include:
 * Respiratory System: **Increased mucus; runny nose; sore throat; voice changes; voice loss; cough; difficulty breathing; bronchitis; bronchspasm (spasm of the air tubes); chest tightness.
 * Digestive Tract: **Nausea; vomiting; stomach pain; mouth inflammation.
 * Other: **Fever; rash; drowsiness; eye inflammation; clamminess.

Benadryl Expectorant® ** __Guaifenesin__ ** **Class:** Guaifenesin (w/ 2% alcohol sup)
 * // Brand Names: //** Benadryl Expectorant (Johnson & Johnson[Zuellig]), Robitussin, Eurocof

** Side Effects : ** nausea, vomiting, dizziness, headache, rash (including urticaria) **Contraindications:** persistent cough, asthma, emphysema
 * Indication: ** relief of upper chest congestion as may occur w/ common cold or inhaled irritants; loosens with phlegm (sputum) & thins bronchial secretions to rid bronchial passageway of bothersome mucus
 * Dosage forms: ** adult & children=>12, 2-4 tsp; children 2-6, 1/2-1 tsp; 6 mth-2 yr, 1/4-1/2 tsp to be taken w/ meals
 * P/P: ** syr 100mg/5mL x 60mL
 * Pregnancy Category: ** C

** Salbutamol ** //** Brand Names: **// Ventolin Volmax, Astagen, Asmalin Pulmocap, Asbunyl Plus IAE

**Dosage:** adult, tab tid-qid - if adequate bronchodilation is not obtained dose may be increased; children> 12 yr - 1-2 tab, 6-12 yr - 1/2-1 tab, 2-6 yr - 1/2-1 tab. all doses must be taken qid-tid a compensatory small increase in heart rate, headache, transient muscle cramps, tachycardia, mouth and throat irritation (inhalers), palpitation P/P: tab 2mg x 100's, 500's / inhaler 100 mcg inhalation x 200 doses / sugar free syrup (orange flavored) 2 mg/5 mL x 60 mL
 * Indication: ** treatment & prevention of bronchial asthma, bronchitis, emphysema w/ associated reversible airway obstruction
 * Contraindications: ** threatened abortion during 1st or 2nd trimesters of pregnancy; toxaemia of pregnancy
 * Side Effects: **fine tremor of skeletal muscle, feelings of tension, peripheral vasodilation,
 * Pregnancy Category: ** C

Carbocisteine //**Brand Names:**// Afilem/Aflem Forte, Bromycil, Broncocent, Disoflem

as in acute and chronic bronchitis, bronchiectasis & emphysema & fever. P/P: cap 500 mg x 100's / susp 100mg/5mL x 60mL / drops 50 mg/mL x 15mL
 * Indication **: cough icluding those associated w/ excessive & tenacious bronchial secretions
 * Dosage: ** cap: 1 cap tid-qid - children 8-12: 10-15 mL tid, 4-7:7.5-10 mL tid
 * Side Effects: ** bronchospasms, nausea, vomiting, stomatitis & rhinorrhea occassionally chills

**Bromhexine HCl** //** Brand Names: **// Bisolvon, Bisolvex, Muconix, Mucolyptus

P/P: syr 4mg/5ml x 60mL; Forte cap 16mg x 10's, 200's; tab 8mg x 10's, 200's; adult syr 8mg x 60mL, 120mL; ped syr 4mg(strawberry flavor) x 60mL, 120mL; soution 2mg/mL x 20mL
 * Indication: ** secretolytic therapy in acute & chronic bronchopulmonary disease associated w/ abnormal mucus secretion & impaired mucus transport; treatment of respiratory conditions with difficulty
 * Dosage: ** adult/cap tid; tab adult children>12 yrs Habtid, 7-12 yr 1/2 tabtid, 2-6 yr 1/2 tabbid, adult syr adult & children>12 yr 5 mL tid
 * Special Precautions: ** GI ulceration
 * Pregnancy Category: **

//**Brand Names:**// Bromace, Atrivex, Bromacef
 * [[image:ambroxol.jpg width="186" height="186" align="left"]]Ambroxol HCl **

**Indication:** acute & chronic respiratory tract disorders associated w/ abnormal secretions in bronchitis, bronchial asthma & bronchiectasis; ease elimination of phlegm during nasopharyngeal inflammation
 * Dosage: ** adult: tab 30-120mg in 2-3 divided doses daily; 0 yr adult & children>12 yr 10mL bid; children 6-12 yr 5mL bid-tid; 2-6 yr 2-5mL tid; <2 yr 2.5mL bid
 * Special Precautions **: GI ulceration, pregnancy & lactation, history of peptic ulcer, 1st trimester of pregnancy

//** Brand Names: **// Neozep, No-Drowse Decolgen, Disudrin
 * [[image:neozep.jpg width="190" height="120" align="left"]]Phenylpropanolamine **

**Indication:** relief of runny nose, headache, fever, generalized malaise, muscle and joint pains P/P: caplet 100's; 500mg x 10's; syr 100mg 15mL x 60mL
 * Dosage: ** 1 caplet 6hrly; syr children 7-12 yr 1 tsp; 2-6 yr 1/2tsp; drops children 1-2 yr 1mL --all to be taken 6hrly
 * Special Precautions **: glaucoma, prostatic enlargement, hyperthyroidism, hypertension, CV disorders, diabetes mellitus, chronic nasal congestion upon withdrawal (prolonged use)

** Pentoxyverine Citrate ** //** Brand Name: **// TOCLASE

**Indication:** symptomatic treatment of irritating & unproductive cough; rhinopharyngitis, laryngitis, tracheobronchitis, coughs following emphysematous lesions or pleural irritations; smoker's spasmodic coughs, incoercible cough of bacilloses, pulmonary neoplasiabrachioectasis
 * Special Precautions **: renal impairment, asthmatic cough or cough accompanied by significant hypersecretion; pregnancy; elderly; diabetes
 * Adverse Reaction: ** somnolence, dry mouth, nausea, vomiting, stomach ache, skin reaction, diarrhea

 Ferrer, Marie Fatima Geli, Karissa Mae C. Gumangan, Lea Pangonilo, Mae Regine//** 9:30- 10:30 MWF
 * //Submitted by:

Good work anyway! =)
 * 84/100 = nice and very colorful, but some lack brand names and some medications included are not under the category**.