Cough and Could Agents are a specific type of medications that can be administered when a patient is sick. As a Respiratory Therapist, this is a topic that you should be familiar with and it’s one that is covered in Pharmacology courses during school.

This study guide contains practice questions on this topic that can help you learn everything that you need to know. So, if you’re ready, let’s get started.

Cold and Cough Agents Practice Questions:

1. What is the common cold?
It is a viral (non-bacterial) upper respiratory infection and lasts 7-10 days. Non-bacterial upper respiratory tract infection with symptoms of general malaise, runny and stuffy nose, sneezing, cough, possible sore throat, and some chest discomfort.

2. What is the flu?
Influenza, caused by a viral infection, rapid onset, and top 10 killers in the U.S. along with its complications.

3. What is the treatment for the flu?
Antivirals and the flu vaccine.

4. What are sympathomimetics used to treat?
Decongestion.

5. What are antihistamines used to treat?
Dry secretions.

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6. What are antitussives?
They suppress the cough reflex.

7. What are sympathomimetics mechanisms of action?
Alpha adrenergic stimulates vasoconstriction.

8. What are intranasal corticosteroids?
Nasal sprays, anti-inflammatory, and inhibit cytokine release from nasal epithelial cells.

9. What are the effects of antihistamines?
Cause drowsiness, Benadryl, H-1 and H-2 receptors are blocked.

10. What is the description of the production of histamine?
Non-specific stimuli to tissue, chemicals, injury/trauma, allergens, drugs, dust, and cigs.

11. Where is histamine stored?
Stored in tissue mast cells located below the respiratory tract mucosa and connective tissue.

12. Where is histamine released?
The autonomic nervous system via receptor sites on mast cells.

13. What is airway obstruction?
Mucosal edema, inflammatory cell infiltration with eosinophils, and influence release of local mediators.

14. What are the effects of histamine?
Increase airway resistance, decrease max expiration flow, decrease diffusion capacity, increase total lung capacity, increase mucous production, vasodilation, increase vascular permeability, and stimulates adenyl cyclase in mast cells.

15. What is the antihistamine mechanism of action?
Block action of H-1 receptors and prevent or inhibit mediator release from storage sites.

16. What are expectorants?
Expectorants are agents that facilitate removal of mucus from lower respiratory tract. They are drugs that increase stimulation of mucus. Best is water and avoid caffeinated or alcoholic beverages.

17. What are mucolytic expectorants?
Facilitate removal via lysing action. Agent that facilitates mucus removal by lysing or mucolytic action.

18. What are stimulant expectorants?
They are agents that increase the production and clearance of mucus secretions in the respiratory tract.

19. What is the anatomy of mucus?
It covers surface airways and 5-10 microns thick.

20. What is the composition of mucus?
95% water with 5% protein and lipid molecules.

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21. What is the function of mucus?
Shields epithelia from direct contact with toxic materials, prevents infection, and lubricates airway.

22. What is caused by dehydration?
Increased respiratory rate, increase the depth of breathing, fluid loss, and infections.

23. What disease caused increased mucus?
Bronchitis, asthma, cystic fibrosis, and pneumonia.

24. What is diuresis?
Excessive urination.

25. What can enhance diuresis?
Caffeine, tea, cola, beer, and alcohol.

26. What is the expectorants mechanism of action?
Increase vagal gastric reflex stimulation, absorption into respiratory glans, and topical stimulation.

27. What is the best expectorant?
Water.

28. What is a cough?
Stimulation of the vagal sensory endings.

29. What is the antitussive mechanism of action?
Depress cough center in the medulla.

30. What patients should not be given cough depressants?
Patients with thick retained secretions.

31. What are decongestants?
Adrenergic acts to vasoconstriction blood vessels and reduce inflammation of the nasal cavity and rebound congestion will occur with prolonged use.

32. What are antihistamines?
Drugs that reduce the effects mediated by histamine, reduces/dries secretions but cause drowsiness, and nocturnal use more indicated that around the clock use. Blocks increased capillary permeability and bronchial smooth muscle constriction.

33. What is the most common virus to cause a cold?
Rhinovirus.

34. What is the main difference between flu and cold?
A fever.

35. What virus causes flu?
Influenza.

36. How do adrenergic agents relieve nasal congestion?
The strong alpha effect causes vasoconstriction.

37. What are the examples of adrenergic decongestants?
Sudafed and Dimetapp (pseudoephedrine), Sudafed PE (phenylephrine), and Afrin (oxymetazoline).

38. What is the hazard of using topical adrenergic decongestants?
Repeated use increases secretions and nasal edema as drug’s effect fade. Can become addicting. This is known as “rebound congestion” or “rhinitis medicamentosa“.

39. After how many days can rebound congestion become a problem?
3-5 days.

40. What are the hazards of systemic adrenergic decongestants?
Increase in sympathetic side effects: increased blood pressure, tachycardia, anxiety, sleeplessness, tremors and increased concentrations in the bloodstream.

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41. What are the four classes of cough and cold drugs?
Adrenergic, antihistamines, expectorants, and antitussives.

42. What are the side effects of adrenergic decongestants?
Tremors, tachycardia, hypertension, and rebound effect.

43. What are the side effects of antihistamines?
Drowsiness, impaired responses, and mucosal drying.

44. What is an undesirable effect of expectorants?
Questionable efficacy.

45. What are the undesirable effects of antitussives?
Not recommended for productive coughs and the logic of combination expectorant-antitussives is questionable.

46. Should medication be used to suppress a cough when the cough is productive?
No, no it should not be used.

47. What should be noted when giving cold and cough medication?
Productive cough, fever, any cardiac/pulmonary side effects, vital signs (BP) should be known, remember to only treat symptoms and should only be used short term.

48. What receptor does cold medicine have an antagonist for?
H1 receptor.

49. What does the H1 receptor control?
Inflammation and allergic reaction.

50. What happens when the H1 receptor is stimulated?
Bronchoconstriction, mucus secretion, nasal congestion, wheal and flare reactions on skin.

51. What does the H2 receptor control?
Regulate gastric secretions.

52. What does the H3 receptor control?
Feedback control for histamines.
53. What is the indication for antihistamines?
Reduce/dry secretions in upper airway due to a common cold or allergic reaction.

54. What antihistamines are used as cold remedies (H1 antagonists)?
Diphenhydramine (Benadryl), Loratadine (Claritin), and Fexofenadine (Allegra).

55. What antihistamines are used to treat ulcers (H2 antagonists)?
Zantac and Tagamet.

56. What are antihistamines considered due to their effects?
Antihistaminic, sedative, and anticholinergic.

57. What is the effect of antihistaminic?
Blocks histamine-induced vascular permeability, pruritus, and bronchial smooth muscle constriction.

58. What does the anticholinergic effect cause?
Upper airway drying, cholinergic blockade, anxiety/nervousness, urinary retention, dilated pupils, and blurred vision.

59. What are the precautions for taking antihistamines?
Drying effect causes impaction of secretions and possible sinus blockage and also drowsiness.

60. What are the examples of mucolytic expectorants?
Mucomyst and pulmozyme.

61. What is an example of stimulant expectorants?
Guaifenesin (Robitussin/Mucinex).

62. What is the MOA for stimulant expectorants?
Vagal gastric reflex stimulation and production of mucus.

63. Why is water important with stimulant expectorants?
It helps preserve normal mucus viscosity.

64. What are examples of expectorants?
Guaifenesin/glycerol guaiacolate (Robitussin/Mucinex), iodinated glycerol (Iophen/Par Glycerol/R-Gen), and potassium iodide (SSKI, Pima).

65. What are the groups for antitussives?
Narcotic and non-narcotic.

66. What are the narcotic antitussives?
Codeine and hydrocodone.

67. What are the non-narcotic antitussives?
Dextromethorphan (DM/DXM), delsym, and benzonatate (Tessalon).

68. What is the indication for antitussives?
A dry, irritating, and hacking cough.

69. What are sympathomimetics (adrenergic)?
For decongestion and alpha stimulating property which leads to vasoconstriction.

70. Why use antihistamines?
To dry secretions.

71. Why use expectorants?
To increase mucus clearance.

72. What do antitussives do?
Suppress cough reflex.

73. What are cold symptoms?
Cough (hacking), mild fatigue, none to slight myalgia, nasal congestion, sneezing, and sore throat (common).

74. What are flu symptoms?
High fever (typical), chills (typical), nonproductive cough, prominent headache, severe fatigue, myalgia usual, nasal congestion, sneezing, and sore throat (occasional).

75. What are topical sympathomimetic decongestants?
Sprays or drops, faster results than oral applications but using theses a lot can cause a cycle of increased secretions, called rebound congestion, and addiction to use.

76. What happens in rebound congestion?
The nasal mucosa swells (congested) and there’s no vasoconstriction.

77. What is histamine?
Causes local inflammatory response such as smooth muscle contraction, dilation, itching, pain and increased capillary permeability. Important mediator of local inflammatory response that causes smooth muscle to contract, increase capillary permeability and dilation, itching, and pain.

78. What are antihistamines effects?
Sedatives (penetrate blood-brain barrier), anticholinergic (upper airway drying) and antihistaminic.

79. What are some brand name examples of antihistamine effects?
Benadryl causes drowsiness; and Claritin and Zyrtec that prevents.

80. What is a smoker’s cough?
Mucus is always irritating the throat because cilia are damaged.

81. What is a narcotic cough suppressant?
Depress the cough center in the medulla and sedates. Examples are codeine and hydrocodone.

82. What is an example of a nonnarcotic cough suppressant?
Dextromethorphan.

83. What is the use of a cough suppressant?
To suppress dry, hacking, and nonproductive cough.

84. What can be used for patients who are not responding to antihistamines?
Ipratropium Bromide because it is an anticholinergic.

85. What is influenza (flu)?
Non-bacterial infection with rapid onset of symptoms including fever, headache, and fatigue.

86. What is an adrenergic agent?
An agent that vasoconstricts and relieves nasal congestion.

87. What are adrenergic decongestants?
Useful for nasal clearing but rebound congestion can occur.

88. What does antihistamine agents do?
Dry secretions through an anticholinergic effect and by blockade of H1 receptors.

89. What is a cough suppressant useful for?
They are useful for the treatment of a nonproductive, irritating, dry, and hacking cough.

90. What is an indication for adrenergic agents?
Nasal congestion.

Final Thoughts

When it comes to pharmacology, learning the cough and cold agents is a topic that is often overlooked. Hopefully, this study guide can help make the process easier for you.

We have another guide on Mucus-Controlling Drugs that I think you will enjoy. Thanks for reading and as always, breathe easy my friend.

References

The following are the sources that were used while doing research for this article:

  • Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019. [Link]
  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
  • “Prevention and Treatment of the Common Cold: Making Sense of the Evidence.” PubMed Central (PMC), 18 Feb. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3928210.
  • “Cough Management: A Practical Approach.” PubMed Central (PMC), 23 July 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC3205006.

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