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COUGH - Coggle Diagram

- - - - Codeine
        
        第二个最dominant der opium alkaloid（鸦片碱性）
        
        Natural isomer of methylated morphine
        
        少止痛功能，，可以控制咳嗽
        
        Suppress cough centre as agonist at central mu(u) opioid peptide receptor
        
        Semi-synthetic opioid derived from codeine :dihydrocodeine and hydrocodone
        
        Pharmacokinetic
        
        Oral bioavailability -90%
        
        Methylation of morphine at carbon-3 decrease hepatic pass effect
        
        Cytochrome P450 2D6 convert codeine to morphine
        
        Cytochrome P450 3A4 convert codeine to norcodeine
        
        Uridine diphosphate glucuranosyl transferase (UDPGT) conjugates codeine, norcodeine and morphine to 3- and 6-glucuronides
        
        Adverse Effect
        
        会上瘾，less than morphine
        
        Common :晕，便秘
        
        Less common : 上瘾，dependence，hype,痒，恶心，呕，嘴巴干，miosis，hypotension，depression
        
        Codeine is metabolised to morphine ,pass through breast milk
        
        depressing the respiration of a breastfed baby
        
        Withdrawal symptoms:
        
        drug craving
        
        Runny nose
        
        Yawning
        
        Drug interaction
        
        Medication that is inhibit CYP450 会减少、完全block codeine 去 morphine 的转换
        
        Medication that induce CYP450 (rifampicin, dexamathasone 会增加 conversion rate，有更多morphine
        
        Poor metaboliser 会convert 不到去morphine 咯，减少morphine effect 和side effect
      - Morphine
      - Pholcodine
      - Ethylmorphine
    - - Dextromethorphan
        
        Stereoisomer of a methylated derivative of levophanol
        
        Suppress cough center at central and peripheral sigma opioid peptide receptor and antagonist at NMDA receptor
        
        Also act as nonselective serotonin reuptake inhibitor
        
        Half as potent as codeine as antitussive
        
        Phamacokinetic
        
        O-demethylation
        
        Dextrorphan by CYP3A4
        
        N-demethylation to 3-methoxymorphinan by CYP 3A4
        
        Partial conjugation with glucuronic acid and sulfate ions
        
        没有变的drug 可以 Detectable in urine
        
        Poor metabolizer will experience high effect, duration and side effect
        
        Adverse effect
        
        正常的剂量
        
        恶心
        
        有点晕
        
        晕
        
        Recreational dose
        
        Euphoria
        
        Hype
        
        confusion
        
        Acute overdose
        
        幻想
        
        impair judgement and memory
        
        Trigger histamin release
        
        Allergic reaction
        
        Potentiates activity of MAOIs and SSRIs
        
        Hypotension and infrequently coma
      - Noscapine
        
        Alkaloid from plant of Papaveraceae family
        
        No significant analgesic properties :!!:
        
        Suppress cough center as agonist at central and peripheral sigma opioid peptide receptor and antagonist at B2 receptor
        
        Primarily used for anti-tussive effect :!!:
        
        Increase effect of centrally sedating substance such as alcohol and hypotics
        
        Increase effect of warfarin
      - Pipazetate
      - Chlophedinol
      - Menthol
        
        Organic product derived from peppermint plant
        
        Soothing（舒缓） properties
        
        Anti-irritant and anaesthetic
        
        Cooling sensation produces by chemically triggering cold receptor
        
        Astringent (皮肤紧绷）and antibacterial properties -help treat bad breath
        
        oral
        
        Sore throat medication
        
        Suppress cough reflex and maybe prescribe as menthol crystal or proprietary capsule
        
        Cough suppress is acute and short lived
      - NMDCP
        你们的臭屁
    - - Aim to control rather than eliminate cough
    - - Suppress cough centre in medulla ( both central and peripheral effects),increase threshold
        
        Let epithelial tissues heal themselves
  - - - Guaifenesin
        
        OTC drug
        
        从 guaiac tree 来的
        
        MoA: increase volume and decrease viscosity of secretions in trachea, bronchi and stimulate the flow of respiratory tract secretions
        
        Allow ciliary movement to carry the loosened secretions upward toward the pharynx
        
        Pharmacokinetics
        
        Rapidly metabolised and excreted in urine
        
        Undergoes oxidation to B-(2-methoxyphenoxy)-lactic acid
        
        Approximately 40% of a dose is excreted as this metabolite in the urine within 3 hours
        
        Adverse effect
        
        Nausea ,vomiting ,formation of kidney stone ,diarrhea ,constipation
        
        Nausea and 呕吐可以减少by taking meal
        
        Risk of kidney stone formation 可以减少by maintaining good hydration and increase urine pH
        
        嘴巴干
        
        Drug interaction
        
        Increase absorption and analgesic effect of paracetamol and aspirin
        
        Increase sedative effect of alcohol ,transquilisers, sleep-pills and total anesthetics
        
        Effect increased by lithium and magnesium
        
        Increase dehydration effect of diuretics and laxative
      - Potassium lodide
      - Ammonium chloride
        
        Electrolyte 来的
        
        EXP: Diphenhydramine expectorant syrup
        
        MoA: irritate bronchial mucosa
        
        Production of excess respiratory tract fluid
        
        Side effect
        
        Irritant to gastric mucosa
        
        Induce nausea and vomiting
      - Sodium citrate
      - Ipecacuanha
      - PASIG
        怕sig（sick）-so 要expect 谁都有dz
  - - - Acetylcysteine
        
        L-cysteine amino acid
        
        MoA: contain reactive suphydryl grouop
        
        Reduce mucus viscosity
        
        Making it easier to cough up
        
        Used in asthma ,emphysema, bronchitis, pneumonia, cystic fibrosis and respiratory complication after surgery
        
        Side effect: Stomatitis ,nausea, vomit and rhinorhea, bronchospasm
      - Bromhexine
        
        Synthetic derivative of vasicine
        
        MoA: act at formative stages of mucus formation in gland within mucus secreting cells by disrupting the structure of acid mucopolysaccharide fibers
        
        Ez to expectorate
        
        Use
        
        Acute and chronic bronchitis
        
        Bronchial asthma
        
        Adverse effect
        
        CNS
        
        Headache
        
        Tinnitus
        
        GIT
        
        Gastric iritation
        
        GI disturbance
      - Carbocysteine
      - Ambroxol
        
        Synthesis from paracetamol and dibromobenzaldehyde
        
        MoA: stimulate release of surfactant by type 2 pneumocyte
        
        Promote mucus clearance
        
        ez to cough up
        
        Side effect
        
        GI effect
      - Methylcysteine
      - ABCAM
    - - Acethylcysteine
      - Tyloxapol
  - - - Relieving minor pain and inflammation
    - - Throat lozenges
        
        Strepsil
        
        Contain benzocaine or dextromethorphan
        
        Lubricating and soothing effect on irritated tissue of throat
    - - Pectin
      - Glycerin
      - Propylene
      - Glycol
      - Methyl cellulose
      - PPGGM？
        怕怕鬼鬼吗
        （so 我要protect你）
  - - - Relieve cough in patient with bronchial hyper reactivity
  - - - Local anaesthetic
    - - Headache
      - DZ
      - Pruritis (痒）
      - Nasal congestion
      - Burning og eyes
      - Tightness of chest
- - - - less than 3 weeks
        
        Result from cold ,or other upper respi tract infection such as flu ,pneumonia or whooping cough
    - - 3-8 weeks , usually is residual cough after an illness
    - - Longer than 8 weeks
  - - - Phlegm or sputum produced
        
        From lung and nasal sinuses
        
        Viral illness, bact infection
        
        Postnasal drip
        
        Tobacco use
        
        Reflux of stomach acid
    - - No sputum
        
        Result of residual effects of a viral illness or bacterial infection , bronchospasm, allergies ,med ,exposure of irritant ,asthma ,airway blockage
    - - Only at night
- - - - stimulation of mechano or chemoreceptor
    - - Generate volume for effective cough
    - - Closure of glottis combined with contraction of ms of chest wall, diaphragm and abdominal wall
        
        Rapid rise in intrathoracic pressure
    - - Violent release of air from lung
  - - - Mechano or chemoreceptor of pharynx ,trachea ,bronchi and bronchiole
    - - transfer to cough center thru vagus nerve
    - - in Medulla
    - - Transfer via parasympathetic motor nerve (vagus, Phrenic and spinal nerves) to diaphragm ,intercostal ms and lung
    - - Increased contraction of inspiratory and expiratory ms
  - - - Sensory nerve fibers located in ciliated epithelium of upper airway, cardiac and esophagus branches from diaphragm
    - - Located in upper brain stem and pon
    - - From cough center via vagus ,phrenic and spinal motor nerves to diaphragm
      - Nucleus retroambigualis sends impulse to inspiratory and expiratory ms
      - Nucleus ambiguus send impulse to larynx