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Antitussive, expectorants, nasal decongestants
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- 2. TYPES OF COUGH COUGH PRODUCTIVENON PRODUCTIVE 2 types EXPECTORANTS ANTITUSSIVES Increase volume and decrease viscosity of secretions Out ward movement by ciliary activity USE USE Suppress the frequency and intensity of cough Not affecting secretion Darshan Vaghela
- 3. ANTITUSSIVES Centrally acting Centrally andPeripherally Acting They possess central antitussive activity by virtue of suppressing cough cemter that mediates the cough reflex They possess central antitussive activity by virtue of suppressing cough cemter that mediates the cough reflex Peripheral Acting cough reflex Some of them (not all) are pharmacologically inert, remaining agents act though peripheral receptors in lungs Darshan Vaghela
- 4. ANTITUSSIVES Morphine Severe side effects,seldom used except for relief of intractable cough in terminal illness. For the same lactulose is to use to minimize constipation Codaine: Dose: 10mg BD/TDS orally Dextromethaphan Dose: 10mg TDS orally Methyle transfer of detro-isomer levophanol, no analgesic activity, Leaset addiction and constipation Used with antihistamines and bronchodilators Centrally acting Dose: 10mg BD/TDS orally opioid anlgesic, potant cough suppressant lesser addiction liability and lesser constipatoin S/E: on overdose respiratory deppression, convulsion, hypotension, tachycardia Pholcodeine: Dose: 10mg BD orally Structurally resemble to codeine but better tolarated And longar acting Noscapine: Dose: 15mg TDS orally Naturally occurring opium alkaloid Devoid addiction and constipation and drowsiness Pipazethate Dose: 40mg TDS orally Negligible CNS depressant activity Darshan Vaghela
- 5. ANTITUSSIVES Prenoxdiazine: Inhibits pulmonatystreach receptor to relieve Bronchospasm Modrate antitussive action Benzonatate: 100-200mg TDS orally; Structurally recemble to local anesthetics (LA) tetracaine, acts centrally and also inhibit pulmonary stretch receptor. It having mild LA activity and causes vertigo at high dose Centrally and Peripherally Acting Demulcent Indirect peripheral cough suppressant Provide protection coating over sensory receptor on pharynx (honey, syrup tolu, liquorice, syrup vasaka) Local anesthetics (xylocaine and bopivocaine) applied to larynx and pharynx specially in bronchoscopy and patient who are refractory to other cough therapies Peripheral Acting Darshan Vaghela
- 6. ANTITUSSIVES Central nervous systemreactions Sedation; dizziness; lightheadedness Gastrointestinal reactions Nausea; vomiting; constipation Nonprescription cough medicines containing two or more ingredients produce few adverse Side Effect or more ingredients produce few adverse reactions when used as directed Interactions Central nervous system (CNS) depressants and alcohol may cause additive depressant effects when administered with antitussives containing codeine When dextromethorphan is administered with monoamine oxidase inhibitors, patients may experience hypotension, fever, nausea, jerking motions to the leg, coma Darshan Vaghela
- 7. ANTITUSSIVES Contraindicated in patientswith known hypersensitivity to drugs. Opioid antitussives are contraindicated in premature infants or during labor when delivery of premature infant is anticipated Used with caution in patients: With persistent or chronic cough; cough accompanied by excessive secretions; high fever; rash; Contraindication and precautions With persistent or chronic cough; cough accompanied by excessive secretions; high fever; rash; persistent headache or nausea or vomiting Antitussives containing codeine are used with caution during pregnancy and labor and in patients with COPD; acute asthmatic attack; pre-existing respiratory disorders; acute abdominal conditions It should not be used in cough associated with asthma or chronic bronchitis as they causes harmful retention and thickening of sputum Opioid Antitussives are used cautiously in patients with head injury and increased intracranial pressure; acute abdominal disorders; convulsive disorders; hepatic or renal impairment; prostatic hypertrophy; asthma or other respiratory conditions Darshan Vaghela
- 8. EXPECTORANTS Either increasing thevolume or decreasing viscosity or both of respiratory secretions. Act either by mucokinetic or by mucolytic action. mucokinetic activity – stimulate secretary cells, rise of secretions & volume mucolytic activity - reduce viscosity of respiratory secretions by direct action on mucus and Facilitate removal of secreted liquid by ciliary action and coughing. Darshan Vaghela
- 9. EXPECTORANTS Acetylecystaine, carbocystaine, bromhexine,ambroxol & dornase-alpha. Acetylecystaine Decrease the viscosity by splitting disulphide bond (-S-S-)of muco-proteins which is further facilitate by alkaline pH (7-9), while carbocystaine action is unclear. Used in Cystic fibrosis and chronic bronchitis (administered via inhalation)& in paracetamol poisoning. Mucolytic Expectorants Used in Cystic fibrosis and chronic bronchitis (administered via inhalation)& in paracetamol poisoning. Side effect: nausea, vomiting, stomatitis, bronchospasm. Bromhexine –alkaloide from vasaka plant. Ambroxol is metabolite of Bromhexine- It dipolamarise the mucopolysaccherides of mucus. Breakage of lysosomal enzyme activity that break fibre network tenacious sputum. Side effect: GIT upset, Rhinorrhoea. Dornase-alpha- Highly purified solution of recombinant human DNase; an enzyme selectively claves DNA and hydrolyses it.DNA that accumulate in sputum of patient of cystic fibrosis. Darshan Vaghela
- 10. EXPECTORANTS Acute bronchopulmonary disease Pulmonarycomplications of cystic fibrosis Pulmonary complications associated with surgery Other uses Pulmonary complications associated with surgery Post-traumatic chest conditions Atelectasis due to mucus obstruction Acetaminophen overdosage Darshan Vaghela
- 11. EXPECTORANTS Expectorants and mucolyticsare contraindicated in patients with known hypersensitivity Expectorant potassium iodide is contraindicated during pregnancy Expectorants are used cautiously during pregnancy and lactation and in patients with some Contra indication and Precautions Expectorants are used cautiously during pregnancy and lactation and in patients with some conditions as follow. Persistent cough; severe respiratory insufficiency or asthma; older adults or debilitated patients Patient may experience hypokalemia; cardiac arrhythmias; or cardiac arrest when potassium- containing medications and potassium-sparing diuretics are administered with iodine products Thyroid function tests may also be altered by iodine Contra indication and Precautions Darshan Vaghela
- 12. NASAL DECONGESTANTS Phenylephrine Naphazoline Xylometazoline Pseudoephedrine Oxymetazoline Phenyl propanolamine Action Adrenergicdrugs Alpha agonist Produces vaso-constriction Low beta activity (poor bronchodilating effect) Action Combined with antihistaminics, mucolytics, antitussives and analgesics, it is believed to afford symptomatic relief in common cold, hay fever; sinusitis, allergic rhinitis, blocked eustachian tubes and upper respiratory tract infections. Darshan Vaghela
- 13. NASAL DECONGESTANTS Tachycardia other cardiac arrhythmias Nervousness Restlessness Insomnia blurredvision Nausea vomiting Adverse Reactions patients with known hypersensitivity and patients taking monoamine oxidase inhibitors Sustained-released pseudoephedrine is contraindicated in children below 12 years of age contraindications Darshan Vaghela
- 14. NASAL DECONGESTANTS interactions Interactant drugEffect of interaction MAOIs Severe headache, hypertension and possibly hypertensive crisis Beta-adrenergic blocking drugs Initial hypertension episode followed by Beta-adrenergic blocking drugs Initial hypertension episode followed by bradycardia Dec Dcongestants are used cautiously in patients with: Thyroid disease Cardiovascular disease Prostatic hypertrophy Diabetes mellitus Coronary artery disease Peripheral vascular disease Hypertension glaucoma Pregnant women should consult with their primary health care provider before using these drugs precautions Darshan Vaghela
- 15. Thank youThank you DarshanVaghela