This document discusses the pharmacotherapy of cough and bronchial asthma. It begins by describing the etiology and types of cough, as well as the cough reflex process. It then covers the types of drugs used to treat cough, including expectorants, mucolytics, antitussives, and pharyngeal demulcents. The mechanisms and examples of each drug type are provided. The document also discusses the pathophysiology and classification of drugs used to treat bronchial asthma, including bronchodilators, leukotriene receptor antagonists, glucocorticoids, and monoclonal antibodies. The mechanisms and examples of the major drug classes used for asthma treatment are summarized.
Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting gastric acid secretion. This effect enables healing of peptic ulcers, gastroesophageal reflux disease (GERD), Barrett's esophagus, and Zollinger-Ellison syndrome, as well as the eradication of Helicobacter pylori as part of combination regimens.Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase proton pump.[1]
They are the most potent inhibitors of acid secretion available.[2] Proton-pump inhibitors have largely superseded the H2-receptor antagonists, a group of medications with similar effects but a different mode of action, and antacids.[3]
PPIs are among the most widely sold medications in the world. The class of proton-pump inhibitor medications is on the World Health Organization's List of Essential Medicines.[4][5] Omeprazole is the specific listed example.[4][5]
Mechanism of action
The activation of PPIs
Proton pump inhibitors act by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, or, more commonly, the gastric proton pump) of the gastric parietal cells.[71] The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen, making it an ideal target for inhibiting acid secretion.[citation needed]Because the H,K-ATPase is the final step of acid secretion, an inhibitor of this enzyme is more effective than receptor antagonists in suppressing gastric acid secretion.[72] All of these drugs inhibit the gastric H,K-ATPase by covalent binding, so the duration of their effect is longer than expected from their levels in the blood.[73]
Targeting the terminal step in acid production, as well as the irreversible nature of the inhibition, results in a class of medications that are significantly more effective than H2 antagonists and reduce gastric acid secretion by up to 99%.[2
Asthma is characterized by airway hyperresponsiveness and inflammation. Common symptoms include wheezing, coughing, and shortness of breath. Treatment approaches include preventing antigen exposure, reducing inflammation, blocking mediators, and dilating airways. Main drug classes used are bronchodilators like beta-2 agonists, methylxanthines, anticholinergics; leukotriene antagonists; mast cell stabilizers; inhaled and systemic corticosteroids; and anti-IgE antibodies for severe cases. Medications work by various mechanisms like increasing cAMP, blocking receptors, or inhibiting inflammatory pathways. Choice of treatment depends on severity and goals of management.
Bronchial asthma is a chronic disease characterized by recurrent episodes of coughing, wheezing and shortness of breath. It has various etiologies and types based on clinical features. The document discusses the pathophysiology and classification of drugs used to treat asthma including bronchodilators, corticosteroids, leukotriene antagonists, mast cell stabilizers and anti-IgE antibody. Treatment approaches for acute severe asthma involving nebulized bronchodilators, systemic corticosteroids and monitoring are also outlined.
This document discusses drugs for cough. It begins by describing the mechanism and causes of cough. Cough can be voluntary or reflexive, and has afferent and efferent pathways involving various nerves. Causes include upper respiratory infections, pneumonia, and other conditions. The document then classifies drugs for cough into four main categories: pharyngeal demulcents to soothe the throat; expectorants to increase or thin mucus; antitussives to suppress coughing; and bronchodilators to relieve cough caused by bronchospasm. Specific drugs and combinations are provided as examples for each category. The document concludes by describing specific treatments for cough based on its underlying cause.
The document discusses expectorants and antitussives. It defines expectorants as drugs that increase bronchial secretion or reduce viscosity, facilitating removal by coughing. Only guaiphenesin is approved as an expectorant in the U.S. Expectorants are classified as bronchial secretion enhancers or mucolytics. Antitussives act in the CNS to suppress cough or act peripherally in the respiratory tract. Antitussives are classified as opioids, nonopioids, antihistamines, or peripherally acting drugs. The document provides examples and doses of expectorants and antitussives and discusses some combination antitussive-expectorant formulations.
This document discusses drugs used to treat cough. It begins by defining cough and classifying it based on duration and characteristics. Nonspecific therapies for cough include demulcents to soothe the throat, expectorants to enhance mucus secretion or reduce viscosity, and antitussives to suppress the cough center. Demulcents include lozenges and cough drops. Expectorants include bronchial secretagogues like guaifenesin and mucolytics like bromhexine that break down mucus. Antitussives include opioids like codeine, nonopioids like dextromethorphan, and antihistamines. Specific treatments depend on the underlying cause of cough such as antibiotics for infection
Introduction to autacoids and classificationDikshakaushal8
Local hormones, also known as autacoids, are physiologically active substances produced locally in the body that have short-lived, localized effects. Some key classes of local hormones include amine derivatives like histamine and serotonin, peptide derivatives like bradykinin and angiotensins, and lipid derivatives like prostaglandins, leukotrienes, and platelet activating factor. These endogenous compounds play important roles in physiological and pathological processes through their actions on local tissues.
Proton pump inhibitors (PPIs) block the gastric H,K-ATPase, inhibiting gastric acid secretion. This effect enables healing of peptic ulcers, gastroesophageal reflux disease (GERD), Barrett's esophagus, and Zollinger-Ellison syndrome, as well as the eradication of Helicobacter pylori as part of combination regimens.Proton-pump inhibitors (PPIs) are a class of medications that cause a profound and prolonged reduction of stomach acid production. They do so by irreversibly inhibiting the stomach's H+/K+ ATPase proton pump.[1]
They are the most potent inhibitors of acid secretion available.[2] Proton-pump inhibitors have largely superseded the H2-receptor antagonists, a group of medications with similar effects but a different mode of action, and antacids.[3]
PPIs are among the most widely sold medications in the world. The class of proton-pump inhibitor medications is on the World Health Organization's List of Essential Medicines.[4][5] Omeprazole is the specific listed example.[4][5]
Mechanism of action
The activation of PPIs
Proton pump inhibitors act by irreversibly blocking the hydrogen/potassium adenosine triphosphatase enzyme system (the H+/K+ ATPase, or, more commonly, the gastric proton pump) of the gastric parietal cells.[71] The proton pump is the terminal stage in gastric acid secretion, being directly responsible for secreting H+ ions into the gastric lumen, making it an ideal target for inhibiting acid secretion.[citation needed]Because the H,K-ATPase is the final step of acid secretion, an inhibitor of this enzyme is more effective than receptor antagonists in suppressing gastric acid secretion.[72] All of these drugs inhibit the gastric H,K-ATPase by covalent binding, so the duration of their effect is longer than expected from their levels in the blood.[73]
Targeting the terminal step in acid production, as well as the irreversible nature of the inhibition, results in a class of medications that are significantly more effective than H2 antagonists and reduce gastric acid secretion by up to 99%.[2
Asthma is characterized by airway hyperresponsiveness and inflammation. Common symptoms include wheezing, coughing, and shortness of breath. Treatment approaches include preventing antigen exposure, reducing inflammation, blocking mediators, and dilating airways. Main drug classes used are bronchodilators like beta-2 agonists, methylxanthines, anticholinergics; leukotriene antagonists; mast cell stabilizers; inhaled and systemic corticosteroids; and anti-IgE antibodies for severe cases. Medications work by various mechanisms like increasing cAMP, blocking receptors, or inhibiting inflammatory pathways. Choice of treatment depends on severity and goals of management.
Bronchial asthma is a chronic disease characterized by recurrent episodes of coughing, wheezing and shortness of breath. It has various etiologies and types based on clinical features. The document discusses the pathophysiology and classification of drugs used to treat asthma including bronchodilators, corticosteroids, leukotriene antagonists, mast cell stabilizers and anti-IgE antibody. Treatment approaches for acute severe asthma involving nebulized bronchodilators, systemic corticosteroids and monitoring are also outlined.
This document discusses drugs for cough. It begins by describing the mechanism and causes of cough. Cough can be voluntary or reflexive, and has afferent and efferent pathways involving various nerves. Causes include upper respiratory infections, pneumonia, and other conditions. The document then classifies drugs for cough into four main categories: pharyngeal demulcents to soothe the throat; expectorants to increase or thin mucus; antitussives to suppress coughing; and bronchodilators to relieve cough caused by bronchospasm. Specific drugs and combinations are provided as examples for each category. The document concludes by describing specific treatments for cough based on its underlying cause.
The document discusses expectorants and antitussives. It defines expectorants as drugs that increase bronchial secretion or reduce viscosity, facilitating removal by coughing. Only guaiphenesin is approved as an expectorant in the U.S. Expectorants are classified as bronchial secretion enhancers or mucolytics. Antitussives act in the CNS to suppress cough or act peripherally in the respiratory tract. Antitussives are classified as opioids, nonopioids, antihistamines, or peripherally acting drugs. The document provides examples and doses of expectorants and antitussives and discusses some combination antitussive-expectorant formulations.
This document discusses drugs used to treat cough. It begins by defining cough and classifying it based on duration and characteristics. Nonspecific therapies for cough include demulcents to soothe the throat, expectorants to enhance mucus secretion or reduce viscosity, and antitussives to suppress the cough center. Demulcents include lozenges and cough drops. Expectorants include bronchial secretagogues like guaifenesin and mucolytics like bromhexine that break down mucus. Antitussives include opioids like codeine, nonopioids like dextromethorphan, and antihistamines. Specific treatments depend on the underlying cause of cough such as antibiotics for infection
Introduction to autacoids and classificationDikshakaushal8
Local hormones, also known as autacoids, are physiologically active substances produced locally in the body that have short-lived, localized effects. Some key classes of local hormones include amine derivatives like histamine and serotonin, peptide derivatives like bradykinin and angiotensins, and lipid derivatives like prostaglandins, leukotrienes, and platelet activating factor. These endogenous compounds play important roles in physiological and pathological processes through their actions on local tissues.
Histamine is a biogenic amine found in many tissues that is involved in allergic and inflammatory processes as well as gastric acid secretion and neurotransmission. It is synthesized and stored in mast cells and basophils and released during allergic reactions. Histamine exerts its effects through four receptor subtypes (H1-H4), with H1 and H2 receptors having drugs that target them clinically. H1 receptor antagonists are used to treat allergic rhinitis, chronic urticaria, and motion sickness, while H2 receptor antagonists suppress gastric acid secretion. New drugs targeting H3 and H4 receptors may provide treatments for neurological and inflammatory conditions, respectively.
This document discusses anti-asthmatic drugs, including their classification, mechanisms of action, routes of administration, and examples. It begins by defining anti-asthmatic drugs as medicines that treat or prevent asthma attacks by opening up airways. It then classifies these drugs based on their mechanism of action (bronchodilation or anti-inflammatory) and route of administration (oral, inhaled, etc.). The document provides examples of different drug classes, their advantages and disadvantages, and precautions for specific drugs. It concludes with monitoring advice for certain anti-asthmatic medications.
Respiratory stimulants are drugs that stimulate respiration and can restore consciousness in coma or fainting. They work by directly activating the respiratory center or through reflex action. At low doses, they stimulate respiration, but the margin of safety is narrow, and high doses can cause convulsions. Their role in therapeutics is limited, as they may be used in conditions like overdose with sedatives until mechanical ventilation, suffocation from drowning, or respiratory depression after anesthesia or in premature infants. Respiratory stimulants are classified as those acting directly on the respiratory center, those acting through reflex action, or those with mixed mechanisms of action. Doxapram, for example, promotes excitation of central neurons controlling
Anti-adrenergic drugs work by antagonizing the effects of adrenaline at alpha and beta adrenergic receptors. They are classified as alpha-adrenergic blocking drugs or beta-adrenergic blocking drugs. Alpha blockers are further classified as nonselective, alpha1 selective, or alpha2 selective. They are used to treat conditions like hypertension, benign prostatic hyperplasia, and congestive heart failure. Beta blockers are classified as nonselective or cardioselective. They decrease heart rate and cardiac output, lower blood pressure, and are used to treat hypertension, angina, arrhythmias, and migraines. Common side effects of beta blockers include fatigue, bradycardia
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Histamine is a chemical messenger that mediates allergic and inflammatory reactions. It is synthesized and stored in mast cells and basophils before being released in response to stimuli. Histamine binds to H1, H2, H3, and H4 receptors, with the H1 and H2 receptors being clinically relevant drug targets. Antihistamines are used to treat allergic conditions by blocking H1 receptors, and H2 receptor blockers inhibit gastric acid secretion. First-generation antihistamines have greater sedative and anticholinergic side effects than second-generation drugs due to interactions with other receptors.
Codeine is a commonly used antitussive (cough suppressant) that works by raising the stimulus threshold of the cough center in the brain. It is effective at reducing coughs by 40-60% compared to placebos. Codeine is also a mild opioid analgesic. Other antitussives include dextromethorphan (non-opioid), expectorants like guaifenesin to loosen mucus, and mucolytics like acetylcysteine that work to liquefy mucus in the respiratory tract.
This document discusses cough suppressants and expectorants. It describes how cough is either productive in expelling secretions or nonproductive and should be suppressed. It then covers the mechanisms of cough and different types of drugs used to treat cough, including demulcents, expectorants, mucolytics, antitussives, bronchodilators, and antihistamines. The main classes of drugs are described along with their mechanisms of action and side effects.
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Seretonin (5HT) and Its Antagonists PharmacologyPranatiChavan
Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness.
The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.
Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to wellbeing and happiness, among other things. As the precursor for melatonin, it helps regulate the body’s sleep-wake cycles and the internal clock.
It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in co-ordinating the nervous system.
This document discusses drugs used as digestants and carminatives. Digestants are substances that promote digestion by containing enzymes like pepsin, papain, pancreatin, and diastase. They are occasionally beneficial for people with deficient enzyme production, but their routine use is irrational. Carminatives are agents that promote the expulsion of gases from the gastrointestinal tract and provide a feeling of warmth. Common carminatives include sodium bicarbonate, peppermint oil, cardamom oil, dill oil, and ginger tincture. These drugs are used to treat dyspepsia, discomfort in the upper abdomen, gas formation, and feelings of fullness or burning.
This document discusses antihyperlipidemic agents used to treat hyperlipidemia, a condition of high lipid levels in the blood. It begins by defining hyperlipidemia and describing its causes such as diet, genetics, and medical conditions. It then covers the main classes of antihyperlipidemic drugs like HMG CoA inhibitors, fibrates, bile acid sequesterants, and their mechanisms and examples like lovastatin, atorvastatin, clofibrate, and cholestyramine. The document concludes by explaining how these drugs work to lower lipid levels through inhibiting cholesterol synthesis and absorption or increasing lipid catabolism.
Histamine is a biogenic amine present in many animal and plant tissues. It is implicated as a mediator in hypersensitivity and tissue injury reactions. Histamine is present and stored in mast cells, especially in the skin, lungs, and gastrointestinal mucosa. It is synthesized from the amino acid histidine and acts on H1, H2, and H3 receptors to cause various pharmacological effects like vasodilation, increased capillary permeability, smooth muscle contraction, and increased gastric acid secretion. Serotonin is another amine present in enterochromaffin cells of the gastrointestinal tract. It is synthesized from tryptophan and acts on multiple 5-HT receptor subtypes to cause vasoconstriction, intestinal per
This document discusses various haematinics including iron, vitamin B12, and folic acid. It provides information on their dietary sources, daily requirements, absorption, transport, storage, and roles in treating anaemia. Iron is mainly stored in hemoglobin and myoglobin. Vitamin B12 and folic acid are important for cellular growth and the conversion of homocysteine to methionine. Deficiencies can result from inadequate intake, malabsorption, increased demands, or impaired release/circulation. Oral supplements are usually sufficient but injections may be needed for malabsorption.
This document provides an overview of asthma, including its definition, characteristics, classification, pathophysiology, symptoms, diagnosis, treatment approaches, and medications. Asthma is defined as a chronic inflammatory airway disorder characterized by bronchial hyperresponsiveness and reversible airway obstruction. It is classified as extrinsic, intrinsic, or mixed. Diagnosis involves assessing history, symptoms, and lung function tests. Treatment follows a stepwise approach starting with short-acting bronchodilators and inhaled corticosteroids, adding additional controllers as needed. Status asthmaticus refers to an acute, severe exacerbation unresponsive to usual treatment.
The document discusses drugs used to treat asthma. It describes asthma as a chronic inflammatory airway disorder characterized by wheezing, breathlessness, and reversible airflow obstruction. It outlines the classification of asthma drugs into short-term relievers for acute symptoms and long-term controllers to reduce symptoms and prevent attacks. Short-term relievers include beta-2 adrenergic agonists, methylxanthines, and antimuscarinic agents. Long-term controllers include inhaled corticosteroids, leukotriene pathway antagonists, and mast cell stabilizers.
Coagulants and anticoagulants work in opposing ways to regulate blood coagulation. Coagulants such as vitamin K and plasma fractions help promote coagulation by activating clotting factors. Anticoagulants like heparin and warfarin inhibit coagulation factors or their production. Thrombolytics such as streptokinase and tissue plasminogen activator dissolve clots by activating plasmin. Platelet aggregation inhibitors including aspirin and clopidogrel prevent platelet activation and aggregation, which are key steps in clot formation. These drugs are used to treat and prevent thrombotic conditions.
This document summarizes drugs acting on the respiratory system, including expectorants, antitussives, nasal decongestants, respiratory stimulants, antiasthmatic drugs, and drugs for chronic obstructive pulmonary disease (COPD). It describes the mechanisms and classifications of expectorants, antitussives, nasal decongestants, respiratory stimulants, bronchodilators, methylxanthines, anticholinergics, leukotriene antagonists, mast cell stabilizers, and glucocorticoids. It also discusses the mechanisms of action, uses, and adverse effects of these drug classes in treating respiratory conditions.
This document discusses various types of drugs used to treat cough, including expectorants, mucolytics, and antitussives. It describes the mechanisms and classifications of cough and the roles of expectorants, mucolytics and various classes of antitussives like opioids, non-opioids, and peripherally-acting drugs. Specific drugs are discussed in each category, along with their mechanisms of action, dosages, and side effects. The document provides detailed information on commonly used cough medications.
Histamine is a biogenic amine found in many tissues that is involved in allergic and inflammatory processes as well as gastric acid secretion and neurotransmission. It is synthesized and stored in mast cells and basophils and released during allergic reactions. Histamine exerts its effects through four receptor subtypes (H1-H4), with H1 and H2 receptors having drugs that target them clinically. H1 receptor antagonists are used to treat allergic rhinitis, chronic urticaria, and motion sickness, while H2 receptor antagonists suppress gastric acid secretion. New drugs targeting H3 and H4 receptors may provide treatments for neurological and inflammatory conditions, respectively.
This document discusses anti-asthmatic drugs, including their classification, mechanisms of action, routes of administration, and examples. It begins by defining anti-asthmatic drugs as medicines that treat or prevent asthma attacks by opening up airways. It then classifies these drugs based on their mechanism of action (bronchodilation or anti-inflammatory) and route of administration (oral, inhaled, etc.). The document provides examples of different drug classes, their advantages and disadvantages, and precautions for specific drugs. It concludes with monitoring advice for certain anti-asthmatic medications.
Respiratory stimulants are drugs that stimulate respiration and can restore consciousness in coma or fainting. They work by directly activating the respiratory center or through reflex action. At low doses, they stimulate respiration, but the margin of safety is narrow, and high doses can cause convulsions. Their role in therapeutics is limited, as they may be used in conditions like overdose with sedatives until mechanical ventilation, suffocation from drowning, or respiratory depression after anesthesia or in premature infants. Respiratory stimulants are classified as those acting directly on the respiratory center, those acting through reflex action, or those with mixed mechanisms of action. Doxapram, for example, promotes excitation of central neurons controlling
Anti-adrenergic drugs work by antagonizing the effects of adrenaline at alpha and beta adrenergic receptors. They are classified as alpha-adrenergic blocking drugs or beta-adrenergic blocking drugs. Alpha blockers are further classified as nonselective, alpha1 selective, or alpha2 selective. They are used to treat conditions like hypertension, benign prostatic hyperplasia, and congestive heart failure. Beta blockers are classified as nonselective or cardioselective. They decrease heart rate and cardiac output, lower blood pressure, and are used to treat hypertension, angina, arrhythmias, and migraines. Common side effects of beta blockers include fatigue, bradycardia
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Histamine is a chemical messenger that mediates allergic and inflammatory reactions. It is synthesized and stored in mast cells and basophils before being released in response to stimuli. Histamine binds to H1, H2, H3, and H4 receptors, with the H1 and H2 receptors being clinically relevant drug targets. Antihistamines are used to treat allergic conditions by blocking H1 receptors, and H2 receptor blockers inhibit gastric acid secretion. First-generation antihistamines have greater sedative and anticholinergic side effects than second-generation drugs due to interactions with other receptors.
Codeine is a commonly used antitussive (cough suppressant) that works by raising the stimulus threshold of the cough center in the brain. It is effective at reducing coughs by 40-60% compared to placebos. Codeine is also a mild opioid analgesic. Other antitussives include dextromethorphan (non-opioid), expectorants like guaifenesin to loosen mucus, and mucolytics like acetylcysteine that work to liquefy mucus in the respiratory tract.
This document discusses cough suppressants and expectorants. It describes how cough is either productive in expelling secretions or nonproductive and should be suppressed. It then covers the mechanisms of cough and different types of drugs used to treat cough, including demulcents, expectorants, mucolytics, antitussives, bronchodilators, and antihistamines. The main classes of drugs are described along with their mechanisms of action and side effects.
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Seretonin (5HT) and Its Antagonists PharmacologyPranatiChavan
Serotonin is a chemical that has a wide variety of functions in the human body. It is sometimes called the happy chemical, because it contributes to wellbeing and happiness.
The scientific name for serotonin is 5-hydroxytryptamine, or 5-HT. It is mainly found in the brain, bowels, and blood platelets.
Serotonin is used to transmit messages between nerve cells, it is thought to be active in constricting smooth muscles, and it contributes to wellbeing and happiness, among other things. As the precursor for melatonin, it helps regulate the body’s sleep-wake cycles and the internal clock.
It is thought to play a role in appetite, the emotions, and motor, cognitive, and autonomic functions. However, it is not known exactly if serotonin affects these directly, or if it has an overall role in co-ordinating the nervous system.
This document discusses drugs used as digestants and carminatives. Digestants are substances that promote digestion by containing enzymes like pepsin, papain, pancreatin, and diastase. They are occasionally beneficial for people with deficient enzyme production, but their routine use is irrational. Carminatives are agents that promote the expulsion of gases from the gastrointestinal tract and provide a feeling of warmth. Common carminatives include sodium bicarbonate, peppermint oil, cardamom oil, dill oil, and ginger tincture. These drugs are used to treat dyspepsia, discomfort in the upper abdomen, gas formation, and feelings of fullness or burning.
This document discusses antihyperlipidemic agents used to treat hyperlipidemia, a condition of high lipid levels in the blood. It begins by defining hyperlipidemia and describing its causes such as diet, genetics, and medical conditions. It then covers the main classes of antihyperlipidemic drugs like HMG CoA inhibitors, fibrates, bile acid sequesterants, and their mechanisms and examples like lovastatin, atorvastatin, clofibrate, and cholestyramine. The document concludes by explaining how these drugs work to lower lipid levels through inhibiting cholesterol synthesis and absorption or increasing lipid catabolism.
Histamine is a biogenic amine present in many animal and plant tissues. It is implicated as a mediator in hypersensitivity and tissue injury reactions. Histamine is present and stored in mast cells, especially in the skin, lungs, and gastrointestinal mucosa. It is synthesized from the amino acid histidine and acts on H1, H2, and H3 receptors to cause various pharmacological effects like vasodilation, increased capillary permeability, smooth muscle contraction, and increased gastric acid secretion. Serotonin is another amine present in enterochromaffin cells of the gastrointestinal tract. It is synthesized from tryptophan and acts on multiple 5-HT receptor subtypes to cause vasoconstriction, intestinal per
This document discusses various haematinics including iron, vitamin B12, and folic acid. It provides information on their dietary sources, daily requirements, absorption, transport, storage, and roles in treating anaemia. Iron is mainly stored in hemoglobin and myoglobin. Vitamin B12 and folic acid are important for cellular growth and the conversion of homocysteine to methionine. Deficiencies can result from inadequate intake, malabsorption, increased demands, or impaired release/circulation. Oral supplements are usually sufficient but injections may be needed for malabsorption.
This document provides an overview of asthma, including its definition, characteristics, classification, pathophysiology, symptoms, diagnosis, treatment approaches, and medications. Asthma is defined as a chronic inflammatory airway disorder characterized by bronchial hyperresponsiveness and reversible airway obstruction. It is classified as extrinsic, intrinsic, or mixed. Diagnosis involves assessing history, symptoms, and lung function tests. Treatment follows a stepwise approach starting with short-acting bronchodilators and inhaled corticosteroids, adding additional controllers as needed. Status asthmaticus refers to an acute, severe exacerbation unresponsive to usual treatment.
The document discusses drugs used to treat asthma. It describes asthma as a chronic inflammatory airway disorder characterized by wheezing, breathlessness, and reversible airflow obstruction. It outlines the classification of asthma drugs into short-term relievers for acute symptoms and long-term controllers to reduce symptoms and prevent attacks. Short-term relievers include beta-2 adrenergic agonists, methylxanthines, and antimuscarinic agents. Long-term controllers include inhaled corticosteroids, leukotriene pathway antagonists, and mast cell stabilizers.
Coagulants and anticoagulants work in opposing ways to regulate blood coagulation. Coagulants such as vitamin K and plasma fractions help promote coagulation by activating clotting factors. Anticoagulants like heparin and warfarin inhibit coagulation factors or their production. Thrombolytics such as streptokinase and tissue plasminogen activator dissolve clots by activating plasmin. Platelet aggregation inhibitors including aspirin and clopidogrel prevent platelet activation and aggregation, which are key steps in clot formation. These drugs are used to treat and prevent thrombotic conditions.
This document summarizes drugs acting on the respiratory system, including expectorants, antitussives, nasal decongestants, respiratory stimulants, antiasthmatic drugs, and drugs for chronic obstructive pulmonary disease (COPD). It describes the mechanisms and classifications of expectorants, antitussives, nasal decongestants, respiratory stimulants, bronchodilators, methylxanthines, anticholinergics, leukotriene antagonists, mast cell stabilizers, and glucocorticoids. It also discusses the mechanisms of action, uses, and adverse effects of these drug classes in treating respiratory conditions.
This document discusses various types of drugs used to treat cough, including expectorants, mucolytics, and antitussives. It describes the mechanisms and classifications of cough and the roles of expectorants, mucolytics and various classes of antitussives like opioids, non-opioids, and peripherally-acting drugs. Specific drugs are discussed in each category, along with their mechanisms of action, dosages, and side effects. The document provides detailed information on commonly used cough medications.
DRUGS USED IN THE RESPIRATORY SYSTEM - Copy - Copy - Copy.pptAnthonyMatu1
This document discusses drugs used to treat respiratory conditions. It begins by categorizing respiratory tract infections and outlining the symptomatic and causal approaches to treatment. It then focuses on drugs that treat cough, including demulcents, expectorants, and antitussives that act centrally or peripherally. Asthma drugs are also discussed, including beta-agonists, methylxanthines, corticosteroids, and others. Respiratory stimulants that can be used to treat conditions like apnea are also mentioned.
This document discusses cough remedies and treatments for respiratory conditions. It describes expectorants that loosen mucus in the lungs, including ammonium chloride-ipecacuanha and guaifenesin. It also discusses cough suppressants that can reduce tiring coughs. Classes of cough suppressants include demulcents, opioids like codeine, and antihistamines. The document also outlines treatments for asthma, including bronchodilators, corticosteroids, sodium cromoglycate, and leukotriene modifiers. Status asthmaticus is treated with hydration, bronchodilators, hydrocortisone, oxygen, and ventilation if needed.
This document discusses the pharmacotherapy of cough. It begins by describing the types of cough as being either non-productive (dry) or productive (tenacious) and the appropriate treatments for each. It then covers the classification of cough medications, including peripherally-acting expectorants, centrally-acting antitussives, and combinations. Specific drug classes and examples like expectorants, antitussives, antihistamines, and bronchodilators are explained. The document concludes by discussing the treatment approach based on the underlying cause of cough.
1. The document discusses various types of cough, anti-cough agents including antitussives, expectorants, mucolytics, and their mechanisms of action.
2. It also covers bronchial asthma drugs including bronchodilators, glucocorticoids, leukotriene receptor antagonists, mast cell stabilizers and their classifications and mechanisms of action.
3. Treatment approaches for acute severe asthma involving nebulized bronchodilators, systemic steroids, oxygen and fluids are summarized.
This document discusses various agents used to treat cough. It begins by describing the pathophysiology of cough and differentiating between acute, chronic, and subacute cough. It then categorizes cough medications as peripherally or centrally acting. Peripherally acting medications include demulcents, mucosal anesthetics, bronchodilators, expectorants, and miscellaneous agents. Centrally acting medications include opioid/narcotics and non-opioid/non-narcotics. Specific medications are discussed under each category along with their mechanisms of action, pharmacokinetics, indications, and side effects. The document provides detailed information on commonly used antitussive medications to treat cough.
This document discusses cough physiology and antitussives. It begins by explaining the physiology of cough including the receptors, afferent and efferent pathways involved. It then classifies antitussives as expectorants, which promote secretion clearance, anti-tussives which suppress cough, and other drugs. Specific expectorants discussed include mucolytics like acetylcysteine and carbocisteine. Anti-tussives are classified as opioids like codeine, non-opioids like dextromethorphan, and antihistamines. The document cautions against fixed dose combinations of antitussives that are not rational.
This document discusses respiratory physiology and the management of respiratory conditions. It covers topics such as ventilation, gas exchange in the lungs, the cough reflex, treatments for cough including suppressants and expectorants, bronchodilators for conditions like asthma, and the adverse effects of medications like inhaled corticosteroids.
This document discusses respiratory physiology and the management of respiratory conditions. It covers topics such as ventilation, gas exchange in the lungs, the cough reflex, treatments for cough including suppressants and expectorants, bronchodilators for conditions like asthma, and the adverse effects of medications like inhaled corticosteroids.
The document discusses drugs that act on the respiratory system. It describes the main functions of the respiratory system as delivering oxygen to cells, eliminating carbon dioxide from the body, and regulating blood pH. It then discusses various components of lung function including ventilation, distribution, diffusion, and perfusion. It provides details on common respiratory drugs like bronchodilators, corticosteroids, leukotriene receptor antagonists, expectorants, mucolytics, antitussives, and methylxanthines. It also covers adverse effects and guidelines for treating conditions like asthma and acute bronchitis.
Cough occurs due to stimulation of receptors in the respiratory tract clearing mucus and foreign substances. It is classified as dry or productive depending on the presence of mucus. Drugs used to treat cough include expectorants to increase mucus secretion, mucolytics to reduce mucus viscosity, and centrally-acting antitussives to raise the cough threshold. Peripherally-acting drugs include guaifenesin and ammonium chloride while centrally-acting drugs include codeine, dextromethorphan, and noscapine. Treatment is tailored based on the underlying cause of cough such as antibiotics for infection or cessation of smoking for chronic bronchitis.
The document discusses drugs used to treat cough and bronchial asthma. It describes drugs that are used as expectorants to enhance bronchial secretions and make mucus easier to cough up, including sodium/potassium citrate, potassium iodide, balsam of Tolu, and guaiphenesin. It also discusses antitussives that suppress coughing, including opioids like codeine, nonopioids, and antihistamines. While expectorants are commonly used, evidence for their efficacy is inconclusive. Proper hydration and steam inhalation may be more effective in clearing airways.
Cough can be productive or non-productive. Common causes include environmental irritants, smoking, allergens, and the common cold. Antitussives suppress cough through central or peripheral mechanisms. Common antitussives include codeine, dextromethorphan, and pholcodine. Expectorants increase respiratory tract fluid production to thin mucus and make coughing more effective. Direct expectorants include volatile oils and guaifenesin. Reflex expectorants like potassium iodide and ammonium carbonate act through gastric irritation. Vasicine from Adhatoda vasaca has weak bronchodilator, expectorant and mucolytic properties.
This document discusses drugs used to treat bronchial asthma. It classifies the main types of drugs as bronchodilators including beta-sympathomimetics, methyl xanthines, anticholinergics; leukotriene antagonists; mast cell stabilizers; and corticosteroids. It provides examples of commonly used drugs within each class and describes their mechanisms of action and uses. Guidelines for treating acute severe asthma involving nebulized bronchodilators, corticosteroids, oxygen supplementation and monitoring are also summarized.
Expectorants and antitussives-Dr.Jibachha Sah,M.V.Sc,LecturerDr. Jibachha Sah
Dr. Jibachha Sah,M.V.Sc( Veterinary pharmacology, TU,Nepal),posted lecturer notes on AUTONOMIC AND SYSTEMIC PHARMACOLOGY for B.V.Sc & A.H. 6 th semester veterinary students of College of veterinary science,Nepal Polytechnique Institute, Bharatpur, Bhojard, Chitwan, Nepal.I hope this lecture notes may be beneficial for other Nepalese veterinary students. Please send your comment and suggestion .Email:jibachhashah@gmail.com,moble,00977-9845024121
Respiratory drugs and its side effects And useswajidullah9551
This document discusses drugs used to treat respiratory conditions like asthma and COPD. It begins by defining key terms like antihistamines, decongestants, antitussives, and expectorants. It then covers specific drug classes for respiratory diseases like bronchodilators, corticosteroids, leukotriene inhibitors, and monoclonal antibodies. For each drug class, it discusses mechanisms of action, indications, side effects, and nursing implications. The document provides an in-depth review of pharmacology for treating common respiratory conditions.
This document discusses bronchial asthma, including its definition, clinical features, pathological findings, precipitating factors, goals of treatment, and various treatment options. Bronchial asthma is an inflammatory disorder characterized by bronchoconstriction and wheezing. The underlying cause is inflammation of the airways. Symptoms are triggered by factors like allergens, infections, and irritants. Treatment focuses on bronchodilation to relieve symptoms and suppressing inflammation. Common medications include bronchodilators, corticosteroids, leukotriene antagonists, and mast cell stabilizers.
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This document summarizes common fungal infections and the antifungal drugs used to treat them. It discusses both superficial and systemic mycoses caused by fungi like Candida, Dermatophytes, Aspergillus, and Cryptococcus. The main classes of antifungal drugs covered are polyenes like amphotericin B and nystatin, azoles including imidazoles and triazoles, antimetabolites like flucytosine, and allylamines such as terbinafine. Specific drugs discussed in detail include amphotericin B, griseofulvin, ketoconazole, fluconazole, itraconazole, voriconaz
This document summarizes antiprotozoal drugs used to treat amoebiasis and giardiasis. It describes the life cycles and treatment of Entamoeba histolytica and Giardia lamblia. Nitroimidazoles like metronidazole are first-line to treat intestinal infections while tissue amoebicides like emetine are used for extra-intestinal amoebiasis. Metronidazole is also used to treat giardiasis. Other drugs discussed include luminal amoebicides, nitazoxanide, paromomycin, and 8-hydroxyquinolines. Adverse effects and mechanisms of action are provided for major antiproto
Anthelminthic drugs are used to treat helminthic parasite infections. The main types of helminths that infect humans are nematodes (roundworms and hookworms), trematodes (flukes), and cestodes (tapeworms). Common anthelminthic drugs include mebendazole, albendazole, pyrantel pamoate, praziquantel, ivermectin, diethylcarbamazine, niclosamide, and piperazine. These drugs work by paralyzing or killing the parasites and helping expel them from the intestinal tract or tissues. The ideal anthelminthic is broad spectrum, achieves high cure rates with
This document summarizes various classes of antimicrobials including lincosamide antibiotics, glycopeptide antibiotics, oxazolidinones, polypeptide antibiotics, and urinary antiseptics. It describes the mechanism of action, antimicrobial spectrum, pharmacokinetics, uses, and adverse effects of lincomycin, clindamycin, vancomycin, teicoplanin, linezolid, polymyxin B, colistin, bacitracin, nitrofurantoin, and methenamine. It also discusses the treatment of lower urinary tract infections with these urinary antiseptics and other antimicrobials like cotrimoxazole, quinolones
Aminoglycosides are a class of bactericidal antibiotics that inhibit protein synthesis in gram-negative aerobic bacteria. They are highly polar compounds that are poorly absorbed from the GI tract and must be administered parenterally. They are effective against aerobic gram-negative bacilli but not anaerobes. Common side effects include ototoxicity and nephrotoxicity. Resistance can develop through bacterial enzyme inactivation of the drug, decreased drug entry into cells, or decreased drug affinity for ribosomes.
Macrolides are a class of antibiotics that contain a large lactone ring to which deoxy-sugar derivatives are attached. They work by binding to the 50S ribosomal subunit of bacteria and inhibiting protein synthesis. The main macrolides are erythromycin, clarithromycin, azithromycin, and roxithromycin. They are used to treat respiratory infections, sexually transmitted diseases, skin and soft tissue infections, and others. Common side effects include nausea and diarrhea. Some macrolides can interact with other drugs by inhibiting the CYP3A4 enzyme or increasing their effects. Newer macrolides like azithromycin have fewer drug interactions than older ones like erythromycin
This document discusses different classes of diuretic drugs, including their mechanisms of action, sites of action in the kidney, therapeutic uses, and side effects. It covers loop diuretics, thiazide diuretics, potassium-sparing diuretics, and osmotic diuretics. Loop diuretics act in the thick ascending limb of the loop of Henle and have the highest efficacy for increasing sodium excretion. Thiazide diuretics act in the early distal convoluted tubule and have medium efficacy. Potassium-sparing diuretics and osmotic diuretics have various mechanisms of action and are used to treat conditions like hypertension, heart failure, and edema. All diure
Haematinics such as iron, vitamin B12, and folic acid are used to treat various types of anemia by increasing the formation of red blood cells. Coagulants and anti-coagulants like heparin affect blood clotting, while fibrinolytics dissolve clots that have already formed. Antiplatelet drugs inhibit platelet aggregation to prevent excessive clotting. These drugs work by targeting different parts of the blood formation and clotting process.
Pharmacodynamics is the study of how drugs act on the body. Drugs can act through various mechanisms including stimulation, depression, irritation, replacement, and cytotoxic effects. The main mechanisms of drug action are receptor-mediated and non-receptor mediated effects. Receptor-mediated effects occur through ligand-gated ion channels, G-protein coupled receptors, enzyme-linked receptors, and nuclear receptors. Non-receptor effects include physical, chemical, and enzymatic actions. The dose-response relationship determines a drug's potency and efficacy. Drug interactions can result in additive, synergistic, or antagonistic effects.
Pharmacokinetics deals with the absorption, distribution, metabolism, and excretion of drugs in the body. Drug absorption involves movement of a drug from its site of administration into systemic circulation by crossing biological membranes. Distribution refers to the reversible transfer of a drug between blood and tissues. Key factors affecting distribution include a drug's physicochemical properties, binding to plasma proteins, and barriers to tissue permeability. Highly protein-bound drugs are restricted to the vascular compartment and have a prolonged duration of action.
This document discusses various antiviral agents used to treat different viral infections. It describes drugs used against herpes viruses like acyclovir, valacyclovir and famciclovir. It also discusses antiretroviral agents used to treat HIV infection, including nucleoside reverse transcriptase inhibitors like zidovudine, non-nucleoside reverse transcriptase inhibitors like nevirapine, and protease inhibitors like saquinavir. It also mentions anti-influenza agents amantadine and oseltamivir, as well as other antiviral drugs like interferons and ribavirin.
This document summarizes anti-tubercular drugs used to treat tuberculosis and other mycobacterial diseases. It discusses first-line drugs like isoniazid, rifampicin, pyrazinamide, ethambutol, and streptomycin which are effective, less toxic options routinely used to treat tuberculosis. Second-line drugs discussed include fluoroquinolones, macrolides, rifapentine, and rifabutin which are used for multidrug-resistant tuberculosis or atypical mycobacterial infections. World Health Organization recommended treatment regimens including the directly observed treatment short course protocol are mentioned. Mechanisms of action, pharmacokinetics, uses, and side effects of various anti
β-Lactam antibiotics such as penicillin, cephalosporins, monobactams, and carbapenems contain a β-lactam ring. Penicillin was the first antibiotic discovered and is effective against streptococcal infections, syphilis, and diphtheria. It works by inhibiting bacterial cell wall synthesis. Resistance can arise via β-lactamase production or altered penicillin binding proteins. Semisynthetic penicillins like ampicillin and amoxicillin are acid stable and have a broader spectrum of activity against gram-negative bacteria. They are used to treat a variety of infections affecting the respiratory tract, skin, and urinary tract.
This document discusses sulfonamides, including their history, mechanism of action, uses, and adverse effects. It notes that sulfonamides were the first synthetic antibacterial agents and are bacteriostatic, inhibiting bacterial synthesis of folic acid. Co-trimoxazole is a fixed dose combination of sulfamethoxazole and trimethoprim that has a synergistic effect. The combination is widely used to treat urinary tract infections, pneumonia, and travelers' diarrhea. Common adverse effects include rashes, nausea, and hematologic issues.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
2. • Cough –a physiologically useful protective reflex that clears
the respiratory tract of the accumulated mucus & foreign
substances.
• Etiology:- Irritant triggers cough from different source
Exogeneous source
Smoke
Dust
Infection
Tumor
Foreign body
Endogenous source
Airways secretion
Gastric content
Drug induced cough
ACE-I
Amiodarone
Iodine
Inhaled medication include
e.g.-ether, cromolyn sodium, glucocorticoids
3. Types of cough
Productive Cough/
tenacious/Purulent
Non-Productive Cough/Dry cough
Should be suppressed
Use Anti-tussive drugs-
Drug that suppress cough
center
Should be drain the airways
Should never be suppressed
Use Expectorants/ Mucokinetics
Rx- Rx-
Consequences:-
↑ discomfort to the pt.
Pt. unable to sleep
Serious in pt. of cardiac disease,
after ocular surgery or hernia
Production of mucous secretion
that helps in expulsion of harmful
materials
4. Cause Treatment
Bacterial infection Anti-bacterial drugs
Pulmonary TB Anti-bacterial drugs
URTI-upper respiratory tract
infection
Anti-bacterial if bacterial infection
Viral infection Symptomatic
Bronchitis Stream inhalation, drainage
bronchiectasis
Pulmonary eosinophilia Diethylcarbamazine
Asthma Inhaled bronchodilators,
corticosteroids
Smoking Avoid smoking
Drug induced Change the drug
e.g. ACE-I induced case change to
ARBS
Common cause of cough & Treatment Protocol
5. Cough reflex:- is complex & comprises of three main
stages.
1.An inspiration
2.Building up of pressure in the lungs by contraction of
expiratory muscle against a closed glottis
3.Forceful expiration through narrowed airway with high
linear velocity of airflow which sweeps irritant material up
towards the pharynx.
7. • Pharyngeal demulcents:-
Coat the pharynx & provide Soothing effect
↓afferent impulses from the inflamed/irritated pharyngeal mucosa.
↓frequency & severity of cough
Provide symptomatic relief in dry cough arising from throat.(above
the larynx)
Dosage form-syrup, lozenges, linctus,
Syrup:-conc. Solution of sugar containing the drug to mask the bitter
taste of the drug
Lozenges-solid dosage form placed in the mouth and sucked it
dissolves slowly to liberate the active ingredient.It soothes the irritated
mucosa of the throat,e.g.-dyclonine (local anaesthetic) lozenge for
sore throat
8. Expectorants/Mucokinetics:-
• Use in productive cough
Bronchial secretion enhancer:-
• Sodium/potassium citrate-by salt action
• Potassium iodide-irritation of mucosa
• Ammonium chloride-It is a gastric irritant which reflexly
↑bronchial secretions
• Guaiphenesin
• Balsum of tolu
• vasaka
Expectorants acts via two ways
↑↑Bronchial secretions/Bronchial
secretion enhancer
Reduces its viscosity/Mucolytics
These are plant products, they increases
bronchial secretion & mucocilliary
function
9. • Mucolytics:-
• These agents break the thick tenacious sputum
• lower the viscosity of sputum →sputum comes out easily
with less effort
Drugs include- Bromhexine, Acetylcysteine, Carbocisteine,
Ambroxol
Bromhexine:-
It is a semisynthetic agent used orally
Derivatives of alkaloid vasicine(vasaka)
Process mucolytic and mucokinetic effects
MOA:- Bromhexine
↓↓
Liberate Lysosomal enzyme
10. ↓↓
Digests the mucopolysaccharides
↓↓
↓viscosity of sputum
↓↓
Cough becomes less tiring and productive
SE:- rhinorrhoea and lacrimation
Acetylcysteine and carbocisteine:- metabolites of
bromhexine
MOA:- Acetylcysteine and carbocisteine
↓↓
open disulphide bonds in mucoproteins of sputum
↓↓
11. sputum becomes thin and less viscid
↓↓
cough becomes less tiring and productive
Carbocysteine- can be given orally
Ambroxol-is a metabolite of Bromhexine
A metabolite of bromhexine & has similar action, uses &
side effects.
It is more useful if mucus plugs are present
12. Anti-tussives
• Use in symptomatic treatment of non-productive cough
• MOA:-
• ↑cough threshold by directly acting on cough center
(medulla oblongata)
• Act peripherally in the respiratory tract to reduce tussel
impulses or both these actions.
• Should be avoided in children below the age of 1 year
Narcotics/opioids Antitussives:-
Codeine-Like morphine but less potent than morphine as
they are semi-synthetic derivatives
• Dose administered lower than analgesic dose(10 mg B.D.)-
lesser addiction liability or lesser constipation.
13. • Over dosage-respiratory depression, convulsions, postural
hypotension & tachycardia.
• contraindicated in asthmatics & in patients with diminished
respiratory reserve
Pholcodein:-
• Structurally related to codeine but slightly
• More potent & longer acting & better tolerated (No
addiction liability) than codeine.
• Non-Narcotics/Non-opioids:-
• Noscapine:-
• It suppress cough but has no narcotic, Analgesic or
dependance tendency
• Equipotent anti-tussive as codeine especially in spasmodic
cough
14. • Dextromethorphan:-
• D-isomer of codeine
• Efficacy → equal to codeine
• Advantage over codeine-
• Non-opioids action-so no constipation, no addiction
• Doesn’t ↓mucociliary clearence
• Side effect:- dizziness, nausea, drowsiness, ataxia etc.
• Peripherally acting antitussives:-
• Prenoxdiazine-
• It acts in contrast to other antitussives, it acts peripherally,
desensitizes the pulmonary stretch recep & reduces tussel
impulses originating in the lungs.
• Useful in cough of bronchial origin.
15. Antihistaminics:-
• Drugs:- Diphenhydramine, dimenhydrinate, promethazine
• H1 antihistamines- First generation H1 blockers acts via
sedative & Anti-cholinergic action
• Anti-cholinergic action-↓secretion
• Effective in allergic cough (Productive cough)
• Second generation anti-histaminics- ineffective
• Role of other agents in cough:-
1. Role of hydration in cough:-
by adequate intake of water/fluid ↓viscosity of bronchial
secretion/mucus secretion/sputum
2.Role of steam inhalation in cough:-
• steam inhalation-treating the cough particularly with
tenacious below the larynx.
17. Definition-A state of bronchial hyper reactivity resulting
from a persistent inflammatory process on response to a
number of stimuli in a genetically susceptible individual
Pathophysiology:-
Persistence inflammatory process in response to a number
of stimuli (allergens,virus,environmental pollutants, irritant
chemicals, cold air, kitchen fumes, dust)
Bronchoconstriction→ due to inflammatory process
Bronchi become hyperactive→↑level of Ig E
Exposure to allergens→ activation of mast cells
Airway obstruction -due to the release of mediators from
sensitized mast cells in the lungs
Mediators includes-histamine, serotonin (5-HT), PGs,
leukotrienes (LTC4 and LTD4), proteases, PAF, etc
18. • Types:-
1.Acute Asthma:-
It is characterized by episode of dyspnoea associated with
expiratory wheezing
Mediators release-histamine & Leukotrienes release from
mast cells
2.Chronic Asthma:-
There is continuous wheeze and breathlessness on exertion.
cough and mucoid sputum with recurrent respiratory
infection are common
Mediators release-histamine & Leukotrienes release from
mast cells & from basophils (IL-4 & IL-13)
19.
20. Status asthmaticus (acute severe asthma):-
Prolonged attack of asthma with severe intractable
wheezing
Life threatening form of asthma (Emergency condition)-
leading to pulmonary insufficiency
Airway obstruction is unresponsiveness to usual therapy
21. Classification of antiasthmatic drugs
1.Bronchodilators:-
A. Sympathomimetics:-
(i)Selective β2-adrenergic agonists:-
Salbutamol, terbutaline (short acting)
Salmeterol, formoterol (long acting)
(ii) Nonselective:- Adrenaline
B. Methylxanthines:-
Theophylline, aminophylline, etophylline
C. Anticholinergics:-
Ipratropium bromide, tiotropium bromide.
2. Leukotriene receptor antagonists
Zafirlukast, montelukast.
22. 3. Mast cell stabilizers:- Sodium cromoglycate, ketotifen.
4. Glucocorticoids:-
A. Inhaled glucocorticoids:-
Beclomethasone, budesonide, fluticasone.
B. Systemic glucocorticoids:-
Hydrocortisone, prednisolone, methylprednisolone.
5. Anti-IgE monoclonal antibody:- Omalizumab
Bronchodilators
Drugs for acute use quick relievers, use on demand as
needed to suppress symptoms
23. MOA:- Sympathomimetics
↓↓
Acts by stimulating β2-receptors
in the bronchial smooth muscle
and mast cells
↓↓
↑↑cAMP
Leading to
– Bronchodilatation
– Inhibit the release of histamine,LTC4 and LTD4 from mast
cells
– Promote mucociliary clearance
• Also they ↑K+ conductance in bronchial smooth muscle-
Hyperpolarization & relaxation of Bronchial smooth
muscle
24. • Adrenaline (nonselective sympathomimetic):-
• It produces prompt and powerful bronchodilatation by
acting through β2-adrenergic receptors.
USES:-acute attack of asthma – 0.2–0.5 mL of 1:1000
solution is given S.C.
Use has declined - dangerous cardiac side effects
Selective β2-adrenergic agonists:-
They are the first-line drugs for bronchial asthma.
They are well tolerated when inhaled.
At high doses, they may cause tremors, tachycardia,
palpitation, hypokalemia and rarely cardiac arrhythmias
Short acting Agents- Provides rapid relief due to fast onset
of action- effective for acute attack of asthma
Most effective when use via inhalational route(MDI)
Not suitable for prophylaxis
25. • Salbutamol:-
• Highest selectivity (about 10 time more) for β2 receptor
• ↑ selectivity→ use via inhalational route
• BA-50% due to High first pass metabolism in gut
• Onset of action-within 5min (inhalational route) & persist
for 3-6hrs.
• Not suitable for prophylaxis-due to short action
• SE:-Tremor, tachycardia, palpitation, hypokalaemia,
restlessness
• Prolong use-development of tolerance due to
downregulation of β2 receptor
• Terbutaline- similar action like salbutamol
• Prodrug- is bambuterol (long acting bronchodilator)
• Long acting bronchodilators:-
• They can improve lung function
26. • Drug must never be used for emergency rescue
from an acute attack-slow onset of action
• Salmeterol-
• Partial agonist + partial antagonist in β2 receptor
• Commonly use long acting drug
• Highly lipophilic
• USES:-
Prophylaxis of asthma
Nocturnal asthmatic attack
Exercise induced asthma
Formoterol-similar to salmeterol
Full agonist at β-receptor
27. Adverse effect of inhalational β2 agonist:-
Higher dose systemic absorption & side effect occurs due
to activation of β-adrenergic receptor
1. Muscle tremor & palpitation (most common)
2. Hypokalemia-shifts potassium into cells
3. Hyperglycemia-due to β2 mediated gluconeogenesis &
glycogenolysis
4. Tolerance:- due to down regulation of β2 receptor cause
by continuous exposure of tissue to β-agonist. this may
cause tachyphylaxis (rapidly development of tolerance)-
so,β2 agonist should not be used on regular basis
5. Throat irritation
6. Ankle edema
28. Anti-cholinergic Drug
• Drugs-Ipratropium bromide and tiotropium bromide are
atropine substitutes
• They selectively block the effects of acetylcholine in the
bronchial smooth muscles and cause bronchodilatation
• Relax the airways & prevent them from getting narrower
→this makes it easier to breath
• They may protect the airways from spasms that can
suddenly cause the airways to become
narrower(bronchospasm)
• They also ↓amount of mucus produced by airways
• Ipratropium bromide-short-acting anti-cholinergic
• Tiotropium-long-acting Anticholinergic
• Work after 1-2hr. Usually last upto-6hr
29. • Preferred in COPD and can also be used in bronchial
asthma
• Administered by inhalational route.
• In acute severe asthma- ipratropium +β2-adrenergic
agonists→produce greater and more prolonged
bronchodilatation
• Anticholinergics acts on→ larger central airways where as
sympathomimetics primarily acts on peripheral bronchioles
• Vagal tone in major reversible factor in COPD-Ipratropium
bromide and tiotropium bromide-DOC
• Use in pt. of bronchial asthma exacerbation due to β-
blocker→β2 agonist in effective due to blocked of β2
receptor
• Less effective in acute bronchial asthma
• SE:- Dryness of mouth, scatching in trachea,cough,bad taste
30. 3rd or 4th line drugs in the treatment of asthma
Limited use due to-
Narrow margin of safety
Availability of better antiasthmatic drugs (selective β2-
agonists, inhaled steroids and LT-blockers)
Theophylline:-methylated xanthine alkaloids
• MOA:- Theophylline & Aminophylline
↓↓
Inhibition of Phosphodiesterase
↓↓
↓degradation of cAMP or cGMP
↓↓
↑Intracellular cAMP→Bronchodilatation
Methylxanthines
31. • Also cause blocked of adenosine receptor
• Release of Ca++ from sarcoplasmic reticulum especially in
skeletal & cardiac muscle
• Low dose exert-Anti-inflammatory action(PG & TNF-α
inhibition )
• Pharmacological Action:-
CNS stimulation-may cause convulsion which is treated by BZDs i.e.
diazepam
Heart-stimulation(positive chronotropic & ionotropic )
cause tachycardia –Rx by β-blockers
Blood vessel & bronchi-dilatation
Kidney-diuresis
Skeletal muscle-↑contractility
Gastric mucosa-irritation (↑secretion of acid & pepsin)
32. • ↑BMR-↑plasma free fatty acid
• ↓release of histamine & other mediators from mast cells &
activated inflammatory cells
• Interaction of theophylline:-
Drug inhibiting Theophylline
metabolism & ↑Its plasma level
Drug increasing Theophylline
metabolism by CYP1A2 & ↓Its plasma
level
Erythromycin
Ciprofloxacin
Cimetidine
OC pills
Allopurinol
Phenytoin
Phenobarbitone
Rifampicin
Smoking
Theophylline enhances the effects of Theophylline decreases the effects of
Furosemide , Digitalis, Hypoglycemia
,Oral Anti-coagulants
,Sympathomimetics
Phenytoin , lithium
33. Pharmacokinetics of Methylxanthines:-
Absorption-well absorbed after oral and parenteral
administration
food delays the rate of absorption
Distribution-well distributed all over the body
cross placental and blood–brain barriers
Metabolism- in liver
Excretion- by kidney
USES:-
1. Bronchial asthma and chronic obstructive pulmonary
disease (COPD).
2. Apnoea in premature infants: Theophylline is used orally
or I.V. to reduce the duration of episodes of apnoea
34. Leukotriene Antagonist
• Leukotrienes→ pro-inflammatory mediators that play an
important role in pathophysiology of asthma
• LTs-derived from cell membrane
• Release following activation of mast cells & infiltrating
cells (eosinophils & neutrophils)
• LTs- potent bronchoconstrictor –cause airway edema,mucus
secretion & recruitment of eosinophils into airways
• LTs- Block by LT-receptor Antagonist, lipo-oxygenase
inhibitors, corticosteroids
• These drugs competitively block the effects of cysteinyl
leukotrienes (LTC4, LTD4 and LTE4) on bronchial smooth
muscle
35. • Montelukast & Zafirlukast:-
Block cysteinyl leukotriene receptor(CysLT1)→Anti-
asthmatic action
Cysteinyl leukotrienes(C4,D4,E4)-product of arachidonic
acid metabolism & release from mast cells & eosinophils
CysLT-1 receptor-found in human airway smooth muscle &
airway macrophages & on other pro-inflammatory cells
Montelukast:- block both CysLT-1 & CysLT-2 receptors
thereby interfering with inflammatory pathways that are
involve in pathogenesis of asthma & allergic rhinitis
Montelukast has been shown to reduce symptoms of asthma
& allergic rhinitis & prevent acute attacks
Uses:- prophylaxis & chronic treatment of asthma
Allergic rhinitis & prevention of exercise induced asthma
36. SE:-Dyspepsia, abdominal discomfort, headache, skin
rashes and rarely eosinophilia
Pharmacokinetics:-
Absorption-well absorbed after oral administration
Distribution-body
Metabolism-liver
Excretion-urine
Zafirlukast:-same to montelukast but longer acting
Lipoxygenase inhibitor:-
Zileuton:-inhibitor of the enzyme 5-lipoxygenase
Arachidonic acid
LT-A4
5-lipoxygenase Zileuton
Short duration of action
SE:-Hepatotoxicity
37. Corticosteroids
1. Systemic:- Hydrocortisone, prednisolone, methylprednisolone
2. Inhalational:- Beclomethasone, budesonide, fluticasone, etc.
They are not bronchodilators
MOA:-
↑synthesis of lipocortin→which inhibits phospholipase A2
and thereby prevent the formation of various mediators
such as PGs, TXA2, SRS-A, etc.
Advantages:-
Complete & sustained symptomatic relief than bronchodilators
Improve airflow
Suppress inflammatory response to AG–AB reaction
Reduce asthma exacerbation
Decrease mucosal oedema.
Retard disease progression
38. • Inhalational corticosteroids:-
• 1st line therapy for all pt. with persistent asthma
• These are glucocorticoids with high topical & low systemic
activity
• Not considered necessary for pt. With mild episodic asthma
• They have no role during acute attack or In status
asthmaticus
• Inhaled Long acting β2 agonist + Inhaled corticosteroids –
(synergistic action) improve pt. Compliance
• Safe during pregnancy
• Systemic steroids-
• use in sever chronic asthma & status asthmaticus
• Prednisolone-most commonly use steroids
39. Mast cell stabilizer
Sodium cromoglycate and ketotifen are mast cell
stabilizers
They are not bronchodilators.
They inhibit the release of various mediators—histamine,
LTs, PGs, PAF, etc. by stabilizing the mast cell membrane
They ↓bronchial hyperreactivity to some extent but
antigen–antibody reaction (AG–AB reaction) is not
affected.
Uses:-
long term prophylaxis in mild→moderate asthma
Acute attack-not effective (degranulation of mast cells
with release of mediators has already occured )
40. • MOA:-
Uses:-
1. Allergic asthma:- Sodium cromoglycate -prophylactic
agent to prevent bronchospasm induced by allergens and
irritants.
• Sodium cromoglycate-not absorbed orally(inhalational
route)
2. also used in allergic conjunctivitis, allergic rhinitis, allergic
dermatitis, etc. by topical route as a prophylactic agent.
41. • Ketotifen:-
• Additional H1-blocking effect-so indicated in pt. with
multiple disorders
• Mechanism of action is similar to sodium cromoglycate,
• Orally effective but has a slow onset of action.
• Omalizumab→ recombinant DNA derived humanized monoclonal
antibody
• MOA:-
• Omalizumab prevents the binding of immunoglobulin E (IgE) to mast
cell and thus prevents mast cell degranulation.
• Uses:-
• moderate-to-severe asthma and allergic disorders such as nasal
allergy, food allergy, etc
Anti-Ig-E Monoclonal Antibody: Omalizumab
42. • It has no effect on IgE already bound to mast cells
• It is administered parenterally
• It is approved for use in patients above 12 years of age.
• SE:-
• redness, stinging, itching and induration.
• Exercise induced asthma:-
• Defined as “transient narrowing of the lower airways
following exercise in the presence or absence of clinically
recognized asthma”
• Rx-
Inhalational Short acting β2 agonist –most effective
Inhalational corticosteroid therapy-↓frequency & severity
43. Status asthmaticus(acute severe asthma)
• Life-threatening form of asthma -leading to pulmonary
insufficiency
• Emergency condition-required quick management & pt.
should be hospitalized
• Prolonged attack of asthma with severe intractable
wheezing may lead to hypoxemia & acidosis
• Usually precipitated by→ sever upper respiratory tract
infection
• Airway obstruction is unresponsiveness to usual therapy-
due to obstruction by mucous plag.(drug may not reach at
the site of action)
44. Rx-
General supportive measures:-
1. Humidified oxygen(60%) inhalation
2. Acidosis-corrected by I.V. sodium bicarbonate
3. Dehydration- corrected by I.V. fluid (NS)
4. K+ supplements:- To correct hypokalemia produced by
repeated doses of salbutamol/terbutaline
Specific treatment:-
1. Nebulized salbutamol 5 mg or terbutaline 10 mg +
ipratropium bromide 0.5 mg
2. I.V. hydrocortisone 200 mg or prednisolone 30-60mg
orally depending on the patient’s condition
3. Suitable antibiotics-if there is evidence of infection such
as chlamydia pneumoniae,mycoplasma pneumoniae,H
influenzae
45. Stepwise treatment of bronchial asthma
Oral
corticosteroids
Long acting β2
agonist
Long acting β2
agonist
Long acting β2
agonist
Inhale
corticosteroids-
High dose
Inhale
corticosteroids-
High dose
Inhale
corticosteroids-
low dose
Inhale
corticosteroids-
low dose
Short acting β2 agonist for symptomatic relief
Mild intermittent Mild persistent Moderate
persistent
Severe
persistent
Very sever
persistent
47. Question Paper
1.Discuss briefly the therapeutic uses & common Adverse effects of:
Salbutamol
2.Discuss the drug treatment of the following conditions:- (3M)
Acute attack of bronchial asthma
3.Discuss the pharmacological basis of :- Steroids in bronchial
asthma(4M)
4.Write drug treatment of : Status asthmaticus
5.Disuss the drug treatment of the Following:- status asthmaticus (5M)
6.Discuss the pharmacological basis of the use of the following:-(5M)
Salbutamol in bronchial asthma
Steroid in bronchial asthma
7.Discuss the rational of using:- Beta-2 Agonist with Methylxanthines