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Respiratory system Ppt


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Respiratory system Ppt

  1. 1. The respiratory system Dhruvit Kalathiya Vishal Mangukiya Suvik Patel Ruchit Parmar Sunil Prasad
  2. 2. The respiratory system
  3. 3. Learning objectives What we will learn in this presentation: The structures of the respiratory system and their functions The mechanisms of breathing How gases are exchanged during breathing The composition of inhaled and exhaled air The different measurements of lung capacity and breathing The effects of exercise on the respiratory system What is meant by aerobic and anaerobic respiration
  4. 4. The nasal passages and lungs Air is drawn into the body via the nose or mouth. There are advantages to breathing through your nose: the air is warmed so that it is closer to body temperature tiny hairs and mucus in the nose filter the air, preventing larger dust and pollen particles reaching the alveoli mucus moistens the air, making it easier for the alveoli to absorb. Air then travels through the larynx, trachea (windpipe), bronchi (one bronchus to each lung) and bronchioles to the alveoli, where oxygen passes into the bloodstream.
  5. 5. Pharynx      Common space used by both the respiratory and digestive systems. Commonly called the throat. Originates posterior to the nasal and oral cavities and extends inferiorly near the level of the bifurcation of the larynx and esophagus. Walls are lined by a mucosa and contain skeletal muscles that are primarily used for swallowing. Partitioned into three adjoining regions: nasopharynx oropharynx laryngopharynx
  6. 6. Larynx Voice box is a short, somewhat cylindrical airway ends in the trachea.  Prevents swallowed materials from entering the lower respiratory tract.  Conducts air into the lower respiratory tract.  Produces sounds.   Muscular walls aid in voice production and the swallowing reflex  Glottis – the superior opening of the larynx  Epiglottis – prevents food and drink from entering airway when swallowing  pseudostratified ciliated columnar epithelium
  7. 7. Mechanisms of breathing – inspiration When you breathe in: Intercostal muscles pull ribs up and out intercostal muscles between the ribs contract, pulling the chest walls up and out the diaphragm muscle below the lungs contracts and flattens, increasing the size of the chest the lungs increase in size, so the pressure inside them falls. This causes air to rush in through the nose or mouth. Diaphragm contracts and moves down
  8. 8. Mechanisms of breathing – inspiration
  9. 9. Mechanisms of breathing – expiration When you breathe out: Ribs move in and down Intercostal muscles between the ribs relax so that the chest walls move in and down. The diaphragm muscle below the lungs relaxes and bulges up, reducing the size of the chest. The lungs decrease in size, so the pressure inside increases and air is pushed up the trachea and out through the nose or mouth. Diaphragm relaxes and bulges up
  10. 10. Mechanisms of breathing – expiration
  11. 11. Gas exchange at the alveoli The alveoli are bunches of tiny air sacks inside the lungs. Each individual sack is called an alveolus. When you breathe in, they fill with air. The alveoli are covered in tiny capillaries (blood vessels). Gases can pass through the thin walls of each alveolus and capillary, and into the blood stream. Gases can also pass from the blood stream, into the alveolus.
  12. 12. Gas exchange at the alveoli
  13. 13. Composition of inhaled and exhaled air Gas Oxygen Carbon dioxide Nitrogen Water vapour Amount in inhaled air 21% Very small amount 79% Small amount Amount in exhaled air 17% 17% 3% 79% Large amount
  14. 14. Measuring breathing Tidal volume is the amount you breathe in and out in one normal breath. Respiratory rate is how many breaths you take per minute. Minute volume is the volume of air you breathe in one minute. Vital capacity is the maximum volume of air you can breathe out after breathing in as much as you can. Residual volume is the amount of air left in your lungs after you have breathed out as hard as you can.
  15. 15. Breathing during exercise During exercise the muscle cells use up more oxygen and produce increased amounts of carbon dioxide. Your lungs and heart have to work harder to supply the extra oxygen and remove the carbon dioxide. Your breathing rate increases and you breathe more deeply. Heart rate also increases in order to transport the oxygenated blood to the muscles.
  16. 16. Breathing during exercise Muscle cell respiration increases – more oxygen is used up and levels of CO2 rise. The brain detects increasing levels of CO2 – a signal is sent to the lungs to increase breathing. Breathing rate and the volume of air in each breath increase. This means that more gaseous exchange takes place. The brain also tells the heart to beat faster so that more blood is pumped to the lungs for gaseous exchange. More oxygenated blood gets to the muscles and more CO2 is removed.
  17. 17. Breathing changes during exercise Look at these statistics for a 16 year-old athlete: During rest Respiratory rate Volume per breath During exercise 14 breaths/ minute 32 breaths/ minute 0.4 litres 2.4 litres
  18. 18. Respiration Respiration is the process that takes place in living cells which releases energy from food molecules. Glucose from food is used to fuel exercise. Oxygen is required to ‘break down’ the glucose to produce energy. This energy is used to make muscles contract. Waste products, including carbon dioxide, are produced as a result of the chemical reactions. These must be removed and excreted. respiration glucose oxygen energy
  19. 19. Aerobic respiration There are two different types of respiration. When you exercise at a steady, comfortable rate, the cardiovascular system is able to supply the muscles with all the oxygen they need. Under these conditions, aerobic respiration takes place. glucose + oxygen energy + carbon dioxide + water Aerobic exercise can be maintained for long periods without the performer getting breathless or suffering muscle cramps. Moderate activities like walking, jogging, cycling and swimming use aerobic respiration.
  20. 20. Anaerobic respiration When you exercise at a high intensity, the cardiovascular system cannot supply enough oxygen to the muscles. Under these conditions, anaerobic respiration takes place. glucose energy + lactic acid With no oxygen available, glucose is burned to produce energy and lactic acid. Lactic acid is a mild poison. As it builds up, it causes muscle pain and eventually cramp. Short, intense activities like sprinting, weightlifting, jumping and throwing use anaerobic respiration.
  21. 21. you might want to think twice about smoking…. 21
  22. 22. Respiratory diseases
  23. 23. Objectives 1. 2. 3. 4. 5. Antihistamines Decongestants Antitussives Expectorants Bronchodilators
  24. 24. Decongestants
  25. 25. Nasal Congestion Excessive Inflamed Primary nasal secretions and swollen nasal mucosa causes ◦ Allergies ◦ Upper respiratory infections (common cold)
  26. 26. Decongestants: Types (cont’d) Two dosage forms Oral Inhaled/topically applied to the nasal membranes
  27. 27. Oral Decongestants Prolonged decongestant effects, but delayed onset Effect less potent than topical No rebound congestion Exclusively adrenergics Example: pseudoephedrine, Sinutab, Dristan, Tylenol cold, Sudafed
  28. 28. Topical Nasal Decongestants Topical adrenergics ◦ Prompt onset ◦ Potent ◦ Sustained use over several days causes rebound congestion, making the condition worse ◦ Eg:
  29. 29. Topical Nasal Decongestants (cont’d) Adrenergics ◦ desoxyephedrine ◦ phenylephrine Intranasal steroids ◦ beclomethasone dipropionate ◦ flunisolide ◦ fluticasone
  30. 30. Nasal Decongestants: Mechanism of Action Site of action: blood vessels surrounding nasal sinuses  Adrenergics ◦ Constrict small blood vessels that supply URI structures ◦ As a result these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain ◦ Nasal stuffiness is relieved
  31. 31. Nasal Decongestants: Mechanism of Action (cont’d) Site of action: blood vessels surrounding nasal sinuses  Nasal steroids ◦ Anti-inflammatory effect ◦ Work to turn off the immune system cells involved in the inflammatory response ◦ Decreased inflammation results in decreased congestion ◦ Nasal stuffiness is relieved
  32. 32. Nasal Decongestants: Indications Relief of nasal congestion associated with:  Acute or chronic rhinitis  Common cold  Sinusitis  Hay fever  Other allergies
  33. 33. Nasal Decongestants: Indications (cont’d) May also be used to reduce swelling of the nasal passage and facilitate visualization of the nasal/pharyngeal membranes before surgery or diagnostic procedures
  34. 34. Nasal Decongestants: Side Effects Adrenergics Steroids Nervousness Local mucosal dryness Insomnia and irritation Palpitations Tremors (systemic effects due to adrenergic stimulation of the heart, blood vessels, and CNS)
  35. 35. Antitussives
  36. 36. Antitussives: Definition Drugs used to stop or reduce coughing Opioid and nonopioid (narcotic and nonnarcotic) Used only for nonproductive coughs!
  37. 37. Antitussives: Mechanism of Action Opioids Suppress the cough reflex by direct action on the cough centre in the medulla Examples: ◦ codeine ◦ hydrocodone
  38. 38. Antitussives: Mechanism of Action (cont’d) Nonopioids Suppress the cough reflex by numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulated Examples: ◦ Dextromethorphan, Nyquil, Robitussin
  39. 39. Antitussives: Indications Used to stop the cough reflex when the cough is nonproductive and/or harmful
  40. 40. Antitussives: Side Effects Dextromethorphan Dizziness, drowsiness, nausea Opioids Sedation, nausea, vomiting, lightheadedness, constipation
  41. 41. Expectorants
  42. 42. Expectorants: Definition Drugs that aid in the expectoration (removal) of mucus Reduce the viscosity of secretions Disintegrate and thin secretions
  43. 43. Expectorants: Mechanisms of Action Direct stimulation Reflex stimulation Final result: thinner mucus that is easier to remove
  44. 44. Expectorants: Mechanism of Action (cont’d) Reflex stimulation  Agent causes irritation of the GI tract  Loosening and thinning of respiratory tract secretions occur in response to this irritation ◦ Example: guaifenesin
  45. 45. Expectorants: Mechanism of Action (cont’d) Direct stimulation  The secretory glands are stimulated directly to increase their production of respiratory tract fluids ◦ Examples: iodine-containing products such as iodinated glycerol and potassium iodide
  46. 46. Expectorants: Indications Used for the relief of nonproductive coughs associated with: Common cold Pertussis Bronchitis Influenza Laryngitis Measles Pharyngitis Coughs caused by chronic paranasal sinusitis
  47. 47. Bronchial Asthma Recurrent and reversible shortness of breath that occurs when the bronchi and bronchioles become narrow as a result of bronchospasm, inflammation, and edema of the bronchial mucosa, and the production of viscid (sticky) mucous. Symptoms • wheezing, • shortness of breath, • chest tightness, • coughing. Asthma is caused by inflammation in the airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by.
  48. 48. Asthma May be triggered by viruses Irritants Allergens Can develop at any age Seen more often in children who are exposed to airway irritants during infancy
  49. 49. Asthma Bronchoconstriction Inflammation Mucosal edema Excessive mucous
  50. 50. Classification 1.Bronchodilators A . β2 Sympathomimetics : Salbutamol,Terbutaline,Bambuterol,Salmetrol,For moterol,Ephedrine. B . Methylxanthines : Theophylline, Aminophylline, Choline theophyllinate, Hydroxyethyl theophylline, Theophylline ethanolate of piperazine,Doxophylline C . Anticholinergics : Ipratropium bromide, Tiotropium bromide.
  51. 51. Classification 2.Leukotriene antagonists : Montelukast, Zafirlukast. 3.Mast cell stabilizers Sodium cromoglycate, Ketotifen 4.Corticosteroids a.Systemic : Hydrocortisone,Prednisolone and others. b.Inhalational : Beclomethasone dipropionate, Budesonide, Fluticasone propionate, Flunisolide, Ciclesonide. 5.anti-IgE antibody Omalizumab
  52. 52. Salbutamol(β2 sympathomimetics) Machanism of action : A highly selective β2 agonist Cause bronchodilation through β2 receptor stimulation Increased cAMP formation in bronchial muscle cell Ralaxation In addition,increased cAMP in the mast cells and other inflammatory cells decreases mediator release
  53. 53. Sulbutamol Selectivity is further incresed by inhaling the drug Inhaled salbutamol produces bronchodilation within 5 min and action lasts for 2-4 hours… therefor it is used to abort and terminate attacks of asthma,but not suitable for the round the clock prophylaxis.
  54. 54. Side effect Muscle tremors Palpitation Restlessness Nervousness Throat irritation Ankle edema Dose 2-4 mg oral,0.25-0.5 mg i.m./s.c., 100200 µg by inhalation
  55. 55. Theophylline(methylxanthines) Mechanism of action : Increase levels of energy-producing cAMP* This is done competitively inhibiting phosphodiesterase (PDE), the enzyme that breaks down cAMP Result: smooth muscle relaxation, bronchodilation, and increased airflow *cAMP = cyclic adenosine monophosphate
  56. 56. Side effect Nausea, vomiting, anorexia Gastroesophageal reflux during sleep Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias Transient increased urination Dose 100-300 mg TDS (15 mg/kg/day)
  57. 57. Anticholinergics: Mechanism of Action Acetylcholine (ACh) causes bronchial constriction and narrowing of the airways. Anticholinergics bind to the ACh receptors, preventing ACh from binding. Result: bronchoconstriction is prevented, airways dilate.
  58. 58. Side Effects Dry mouth or throat Gastrointestinal distress Headache Coughing Anxiety
  59. 59. Antileukotrienes Currently available agents: montelukast (Singulair) zafirlukast (Accolate) zileuton (Zyflo)
  60. 60. Antileukotrienes: Mechanism of Action Leukotrienes are substances released when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body. Leukotrienes cause inflammation, bronchoconstriction, and mucus production. Result: coughing, wheezing, shortness of breath
  61. 61. Antileukotriene agents prevent leukotrienes from attaching to receptors on cells in the lungs and in circulation. Inflammation in the lungs is blocked, and asthma symptoms are relieved. Side Effects Headache Dyspepsia Nausea Dizziness Insomnia Liver dysfunction Diarrhea
  62. 62. Corticosteroids: Mechanism of Action Stabilize membranes of cells that release harmful bronchoconstricting substances. These cells are leukocytes, or white blood cells. Also increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation.
  63. 63. Inhaled Corticosteroids beclomethasone dipropionate (Beclovent, Vanceril) triamcinolone acetonide (Azmacort) dexamethasone sodium phosphate (Decadron Phosphate Respihaler) flunisolide (AeroBid)
  64. 64. Side Effects Pharyngeal irritation Coughing Dry mouth Oral fungal infections
  65. 65. Mucolytics Agents which breakdown the mucus. Examples:- Ambroxol, Bromhexine
  66. 66. Ambroxol Bromhexine  Amcold  Ascoril (Brand Name)  Cipla Ltd (Company Name) (Brand Name)  Glenmark Ltd (Company Name)
  67. 67. Expectorant Drugs Which helps in expelling out mucus. Examples:- Guaifenesin, Potassium Iodide
  68. 68. Guainfenesin Potassium Iodide  Barkeit  Betadine (Brand Name)  Unisankyo Ltd (Company Name) (Brand Name)  Win Medicare Ltd (Company Name)
  69. 69. Cough Suppressant Drugs used to suppress the cough specially used in dry cough. Examples:- Codeine phosphate, Dextromethorphan
  70. 70. Codeine Dextromethorphan  Corex  Alex (Brand Name)  Pfizer Ltd (Company Name) Lozenge (Brand Name)  Glenmark Ltd (Company Name)
  71. 71. Guided By: Mr. Prashant Pandey Reference: Medical Pharmacology by K.D.Tripathi Edition 6th.