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Anti inflammatory agents used in asthma and cough suppressants

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Anti inflammatory agents used in asthma and cough suppressants

  1. ANTI-INFLAMMATORY AGENTS USED IN ASTHMA AND COUGH SUPPRESSANTS ANKIT GILANI DEPT OF PHARMACOLOGY AND TOXICOLOGY NIPERA1113PC03 (sem-1) SUBJECT – PC-620
  2. ASTHMA  An inflammatory condition in which there is recurrent reversible airways obstruction in response to irritant stimuli that are too weak to affect non-asthmatic subjects. symptoms shortness of wheezing breath ( especially cough. in breathing out)
  3. PATHOGENESIS
  4. characterised by:  inflammation of the airways  bronchial hyper-reactivity  reversible airways obstruction
  5. TREATMENT BRONCHODILATORS ANTI-INFLAMMATORY β-Adrenoceptor agonists, AGENTS Xanthine drugs , Glucocorticoids , Muscarinic receptor Cromoglicate and antagonists, nedocromil , Cysteinyl leukotriene Anti-IgE treatment . receptor antagonists, Histamine H1-receptor antagonists.
  6. ANTI-INFLAMMATORY AGENTS  Mainly glucocorticoids  Cromoglicate and nedocromil (weak anti- inflammatory and short duration , now hardly used for asthma)  Omalizumab (humanised monoclonal anti-IgE antibody)
  7. Mechanism of glucocorticoids
  8.  decrease formation of cytokines, in particular the Th2 cytokines that recruit and activate eosinophils and are responsible for promoting the production of IgE and the expression of IgE receptors.  Glucocorticoids also inhibit the generation of the vasodilators PGE2 and PGI2, by inhibiting induction of COX-2  By inducing annexin 1, they could inhibit production of leukotrienes and platelet- activating factor.
  9.  Corticosteroids inhibit the allergen-induced influx of eosinophils into the lung.  Glucocorticoids up-regulate β2 adrenoceptors, decrease microvascular permeability, and indirectly reduce mediator release from eosinophils by inhibiting the production of cytokines (e.g. IL-5 and granulocyte-macrophage colony- stimulating factor) that activate eosinophils.
  10. EXAMPLES : 1) Systemic ( given orally) :  Prednisone  Prednisolone  Methylprednisolone 2) Inhaled :  Beclometasone  Budenoside  Fluticasone  Mometasone  Ciclesonide
  11. Unwanted effects Systemic : Thinning of the skin, Tendency to bruise, Osteoporosis, Muscle Weakness, Infections ,Hypertension, etc. inhaled : Oropharyngeal candidiasis (thrush) sore throat and croaky voice [ use of 'spacing' devices, reduces these problems ]
  12. DRUGS FOR COUGH COUGH : a protective reflex that removes foreign material and secretions from the bronchi and bronchioles. It can be triggered by inflammation in the respiratory tract, for example by undiagnosed asthma or chronic reflux with aspiration, or by neoplasia. In these cases, cough suppressant (antitussant) drugs are useful.
  13. DRUGS FOR COUGH Pharyngeal demulcents Expectorants (mucokinetics) Antitussives (cough centre suppressants) Adjuvant antitussives (bronchodilators)
  14. MECHANISM OF COUGH SUPPRESSION  Antitussive drugs act by an ill-defined effect in the brain stem, depressing the 'cough centre'.  All opioid narcotic analgesics have antitussive actions in doses below those required for pain relief.  Those used as cough suppressants are members of the group with minimal analgesic actions and addictive properties.  New opioid analogues that suppress cough by inhibiting release of excitatory neuropeptides through an action on μ receptors on sensory nerves in the bronchi are being assessed.
  15. EXAMPLES  Codeine (methylmorphine) is a weak opioid with considerably less addiction liability than the main opioids, and is a mild cough suppressant.  It decreases secretions in the bronchioles, which thickens sputum, and inhibits ciliary activity. Constipation is common.  Dextromethorphan and pholcodine are believed to have fewer adverse effects.

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