Respiratory drugs

1. RESPIRATORY DRUGS

2. ANTI-ASTHMATIC DRUGS
• Classified as:
1. Bronchodilators( 2 types : adrenergic agonist
and metylxanthines)
2. Anticholinergic.
3. Mast cell stabilizers
4. Corticosteroids.
5. Anti-histamines.

3. 1. Bronchodilators: adrenergic
agonists
• Mechanism of action:
• They causes widening of the airway by relaxing bronchial
smooth muscles by stimulating beta receptors

4. • Drug examples & Doses
S. No. Drugs Doses
1 Salbutamol 2-4 mg orally
2 Terbutaline 5mg orally.
3 Formoterol 80 mcg B.D. orally
4 Albuterol 200-400 mcg inhaled
every 6 hrly.

5. Indications/uses
• Relieving the distress of
asthma.
• Bronchospasm
• broncho-
constriction
 Adverse Effects
• Nervousness.
• Anxiety.
• Tremor.
• Headache.
• Palpitations.
• Tachycardia.
• Arrhythmias
Contraindications/
Precautions.
• Patient with
uncontrolled
arrhythmias.
• Prolonged use of albuterol
may cause hypokalemia

6. Bronchodilators: Methylxanthine
• Mechanism of action: These drugs are weak CNS
stimulants that are powerful smooth muscle
relaxants thus they relax the smooth muscle of bronchi and
helps in bronchodilation and can help in relieving
breathlessness. They also have diuretic effect.

7. • Drug examples & Doses
S. No. Drugs Doses
1 Theophylline 200-400 mg TDS
orally.
2 Etiophylline 250 mg TDS IV/IM
3 Aminophylline 250-500mg TDS IV
slow.

8. Indication/Uses
• Totreat and prevent bronchospasm.
• asthma
• Bronchitis
• emphysema
Contraindications/ Precautions
• Hypersensitivity to any
xanthine.
• Infection or irritation of
rectum or lower portion.
• Give cautiously in neonates, in
elderly patients, heart disorders
hepatic disorders

9. • Adverse effects
• Headache.
• Anxiety.
• Nausea.
• Seizures.
• Abdominal Cramping.
• Diarrhea.
• Respiratory arrest.
• Irritability.
• Insomnia.
• Vomiting.
• Peptic ulcer.
• Epigastric pain.
• Tachycardia

10. 2. Mast cell Stabilizers
• Mast cell stabilizers works to prevent allergy cells called mast
cell from breaking open and releasing chemicals that help to
cause inflammation.
• They are not effective once the allergic reaction has occurred
and mediators are released from mast cells. So they are useless
during asthmatic attack. They are used in the prophylaxis of
asthma.
 Mechanism of action-
• They inhibit mast cell activity, thus prevent
the release of allergic mediators like histamine,
serotonin, prostaglandins, cytokines. These chemical are
essential for an inflammation and allergic reactions

11. • Drug examples and Doses
S. No. Drug Doses
1 Cromolyn
sodium
20mg 4times a
day
(Nebulization
solution)

12. Indication / uses
• Prevent asthma symptoms
from occurring or
prophylaxis to asthmatic
attack.
• To decrease inflammation or
bronchospasm.
• To decrease allergic reactions.
• Rhinitis/conjunctivitis.
Contraindications/ precautions
• Hypersensitivity.
• To be used
carefully
with
renal dysfunction, hepatic
dysfunction.
• Lactation, Cardiac
arrhythmias

13. 3. Anti-Inflammatory Drugs (Cortico-steroids)
• These drugs have anti- inflammatory as well as
anti- allergic actions thus they are effective in bronchial
asthma
 Mechanism of action-
• They prevent the release of or counteract the bronchial
mediators (Kinins, serotonin, Histamine) that cause tissue
inflammation responsible for edema and airway narrowing

14. • Drug example and dose
S. No Drugs Doses
1 Prednisolone 5-60mg per day in divided
dose.
2 Beclomethasone
Dipropionate
100μgm
(microgram)
6hrly by
aerosol
inhalation.

15. Indication/uses
• Chronic bronchitis.
• Allergic Rhinitis.
• Respiratory inflammatory
disorders.
• Bronchial asthma.
• Prophylaxis in exercise
induced asthma.
• Allergic reaction.
Contraindications/precautions
• Acute bronchospasm.
• Use cautiously in patients
who are
immunosuppressed and in
those taking prednisone or
other corticosteroids.
• Use very cautiously in patients
with viral respiratory infections

16. • Adverse effects
• Hoarseness.
• Candidac infections.
• Oropharyngeal irritation.
• Bronchospasmafter inhalation of dry powder

17. 4. Antihistamines
Antihistamines are the drugs used in the
treatment of allergic disorders and some other
conditions.
Mechanism of action:
• These drugs block the effect of histamine and its
receptors. They also provide some sort of sedation.
There are four types of antihistamines drugs.
1. Highly sedatives.
2. Moderate sedatives.
3. Mild sedatives.
4. Non sedatives.

18. Drug Example & Doses
S.
No
Drugs Doses
Highly Sedative
1 Diphenhydramine 25-50mg
2 Promethazine 25-50mg
3 Hydroxyzine 25-50mg
Moderate Sedatives
4 Medizine 25-50mg
5 Buclizine 25-50mg
6 Phenivamine 25-50mg
7 Cyproheptadine 4mg

19. S.
No.
Drugs Doses
Mild Sedatives
8 Chlorpheniramine 2-4mg
9 Cyclizine 50mg
10 Triprolidine 2.5-5mg
Non Sedatives
11 Astemizole 10mg
12 Cetrizine 10mg
13 Lovatadine 10mg
14 Fexofenadine 120-180mg

20. Indications/Uses
• Allergic reactions (Hay fever,
Vasomotor rhinitis urticaria,
asthma,Anaphylaxis).
• Because of their
anticholinergic actions they
are used as antiemetics and
useful in motion sickness.
• As hypnotics, Mild
sedative/anxiolytics.
• Parkinsonism
Contraindications/precautions
• Hypersensitivity.
• Lactation.
• Hypokalemia.
• Neonate.
• Coma.
• Special precautions in acute
asthma and pregnancy,
elderly, epilepsy.

21. Adverse effects
Due to
anticholinergic effect
• Drowsiness in
common.
• Dryness of mouth.
• Blurring of vision.
• Urinary retention.
• Constipation.
• Delirium.
• Convulsions.
• Severe toxicity may causes death to cardiac and
respiratory failure.

22. MUCOLYTICS (SPUTUM CLEARANCE)
 These drugs reducethe viscosity of sputum that helps to easily
expel the sputum.
 Mechanism of action:
• Decrease mucous viscosity by breaking or altering
mucoproteins present in sputum.

23. Drug example & Doses
S No. Drugs Doses
1 Acetylcysteine 2.5 ml of 10-20% solution
given by inhalation or
nebulization
2 Bromhexine 8-16 mg TDS.

24. Indications/uses
• To treat abnormal viscous, or
thick and hard mucus.
• As an antidote for
acetaminophen overdose
(acetylcysteine).
 Adverse effects
• Stomatitis.
• Drowsiness.
• Bronchospasm.
• Nausea/vomiting.
• Severe rhinorrhea
Contraindications/precautions
• Hypersensitivity to these
drugs.
• Cautiously in elderly,
pregnant or breast
feeding mothers.

25. DECONGESTANTS
 ADecongestant drugs used to relieve nasal congestion in
upper respiratory tracts.
 Mechanism of action
• Decongestants are sympathomimetic drugs that act by
stimulating the α (alpha) – adrenergic receptors. The
decongestant effect due to vasoconstriction of the blood vessel
in the nose sinuses etc. the vasoconstriction effect reduces
swelling or inflammation and mucous formation in the nasal
passage and make it easier to breath.

26. Drug examples and doses
S. No. Drugs Doses
1 Oxymetazoline
hydrochloride
0.05% solution or nasal spray.
2 Phenylephrine
hydrochloride
10 mg
3 Pseudoephedrine
hydrochloride
60 mg.

27. Indications /uses
• For temporary relief of nasal
congestion due to common
cold.
• Hay fever.
• Sinusitis.
• Upper respiratory tract
allergens.
• To promote nasal and sinus
drainage.
Contraindications/precautions
• Hypersensitivity to these drugs.
• MAO (Monoamine oxidase)
inhibiters drugs therapy.
• Use cautiously in older age
patient they are more likely to
experience adverse reaction.
• Nasal contestant should not
be used for more than three
days, and oral decongestant
should not used more than
7days because prolonged
use will result in rebound
congestion.

28.  Adverse Effects
• Arrhythmias.
• Tachycardia.
• Insomnia.
• Palpitation.
• Hypertension.
• Drowsiness.
• Hypersensitivity reactions including rash, urticaria

29. DRUGS FOR COUGH
• The drug which used in cough are:
1. Antitussive.
2. Expectorants.
3. Bronchodilators.

30. 1. Antitussives (Cough center
suppressant)
a) Opioids – Codeine, pholcodine.
b) Non opioids – Noscapine,
dextromethorphan.
c) Antihistamine – Chlorpheniramine
diphenhydramine

31. 2. Expectorants
a) Bronchial secretion enhances – sodium or
potassium citrate, potassium iodide,
ammonium chloride.
b) Mucolytes – bromhexine ambroxol,
acetylcysteine.

32. 3. Bronchodilators – already
explained
• Salbutamol, Terbutaline

33. ANTITUSSIVES
• They are used to suppress dry cough mostly because their
aim to control rather than eliminate cough. These are also
called cough center suppressants.
 Mechanism of action
• These are the drugs that act in the CNS to increase threshold
of cough center

34. Drug example & Doses
S.
No
Drugs Doses
1 Codeine (Opioids) 15-60mg up to every 4 hrs
2 Noscapine (Non opioids) PO 15-30 mg itramin maleate
3 Dextromethorphan (Non opioids) 10-30mg PO 4-8hrs max.
120/day
4 Chlorpheniramine
(Antihistamine)
4 mg PO 4-6 hrly
5 Diphenhydramine
(Antihistamine)
25 mg PO 4hrly not to exceed 150 mg
/ day.

35. Indications/uses
• Dry & unproductive cough.
• Allergic cough.
• Spasmodic cough
Adverse Effects
• Constipation.
• Drowsiness.
• Dryness of mouth.
• Irritability.
• Ataxia.
• Respiratory depression in
higher doses.
• Addiction.
• Vertigo.
• Nausea, Headache
Contraindication/precautio
ns
• Respiratory
Depression.
• Asthmatics.
• Convulsion
disorder.
• Contraindicate while driving.
• Obstructive
airway disease.

36. EXPECTORANTS
• These drugs help in removal of secretions of
respiratory tract and mucolytic agents
produce liquification of mucous making
expectoration easier.
Mechanism of action
• They increase bronchial secretions or reduce its
viscosity, sodium and potassium citrate
increase bronchial secretion by salt action also
these drugs stimulate gastric mucosa or directly
acting on mucous membrane of lungs to increase
the secretion ofmucous.

37. Indications/uses
• Chronic productive cough.
• Thick mucous production.
• Combinations with
antitussives drugs for
relieving cough.
Adverse effect
• Allergic reactions /
hypersensitivity.
• Rhinorrhea.
• Lacrimation.
• Gastric irritation.
Contraindication/precautions
• History of peptic ulceration.
• Asthmatic
patients.
• Severe hepatic or renal
function.

38. Thank you