This document provides information about drugs used to treat respiratory conditions like asthma and COPD. It begins by outlining the contents to be covered, which include anti-asthmatic drugs, drugs for COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then discusses the pathogenesis and treatment of asthma in detail. It describes the classes of drugs used for asthma including bronchodilators, corticosteroids, leukotriene antagonists, and monoclonal antibody treatment. The principles and specific drugs for managing COPD are also outlined.
Nasal decongestants and Respiratory Stimulants.pdfShaikh Abusufyan
At the end of this e-learning session you are able to…
A. Discuss definition and therapeutic uses, limitation, classification and pharmacology of nasal decongestant.
B. Explain definition and uses, limitation, classification and pharmacology of respiratory stimulants.
I am happy to share lecture series on different topics of Pharmacology experiments, Pharmacy practice, Clinical pharmacy and Pharmacology. Wish you all happy learning.
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Histamine, meaning ‘tissue amine’ (histos—tissue) is almost ubiquitously present in animal tissues and in certain plants, e.g. stinging nettle. Its pharmacology was studied in detail by Dale in the beginning of the 20th century when close parallelism was noted between its actions and the manifestations of certain allergic reactions. It was implicated as a mediator of hypersensitivity phenomena and tissue injury reactions. It is now known to play important physiological roles.
Nasal decongestants and Respiratory Stimulants.pdfShaikh Abusufyan
At the end of this e-learning session you are able to…
A. Discuss definition and therapeutic uses, limitation, classification and pharmacology of nasal decongestant.
B. Explain definition and uses, limitation, classification and pharmacology of respiratory stimulants.
I am happy to share lecture series on different topics of Pharmacology experiments, Pharmacy practice, Clinical pharmacy and Pharmacology. Wish you all happy learning.
For 30+ video lecture series on Pharmacology Experiment as per PCI B Pharm Syllabus refer link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1Ba6WSJjeBaK0HMF79hdad3g
For 2+ video lecture series on Pharmacoeconomics refer link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1BY8U1TnlcHttsRB8hwpoJRL
For 5+ video lecture series on Pharmacoepidemiology refer link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1BbqIaLoMmuF0Bf66SMFZtnb
For 5+ video lecture series on Drug discovery refer link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1Bbn9IE6c4MagVHZMNNinJov
For 5+ video lecture series on Drugs used in Special population use link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1BZAed7zkXxyrgomJx2sSwHR
For 5+ video lecture series on Adverse Drug Reaction use link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1BbWpd06N6RcV2q0K3JT29Wv
For 2+ video lecture series on Therapeutic drug monitoring refer link given below: https://www.youtube.com/playlist?list=PLBVbJ9HCa1BZQtOerZuDjx4yo0eOeTHIy
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To support this channel you can through UPI ID: abushaikh07-yahoo.com@okhdfcbank
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Histamine, meaning ‘tissue amine’ (histos—tissue) is almost ubiquitously present in animal tissues and in certain plants, e.g. stinging nettle. Its pharmacology was studied in detail by Dale in the beginning of the 20th century when close parallelism was noted between its actions and the manifestations of certain allergic reactions. It was implicated as a mediator of hypersensitivity phenomena and tissue injury reactions. It is now known to play important physiological roles.
Expt. 1 Introduction to in vitro pharmacology and physiological salt solutionsVISHALJADHAV100
Definitions of pharmacology & drug
Aims of experimental pharmacology
Pre-clinical pharmacology
Clinical pharmacology
Types of experiments in pharmacology
Assembly for isolated organ/ tissue related experiments
Recording (writing) levers
Physiological salt solution (PSS)
Introduction
Examples
Composition
Role of ingredients
Precautions in preparation of PSS
Selection of PSS
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Neurohumoral transmission in CNS-
The term neurohumoral transmission designates the transfer of a nerve impulse from a presynaptic to a postsynaptic neuron by means of a humoral agent e.g. a biogenic amine, an amino acid or a peptide.
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassayVISHALJADHAV100
Objective
Principle
Requirements
Experimental specifications (conditions)
Preparation of ACh stock and standard solutions
Preparation of frog ringer solution (PSS)
Procedure
Kymograph recording of contractions
Observation table
Calculation
Result and interpretation
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.
Expt. 1 Introduction to in vitro pharmacology and physiological salt solutionsVISHALJADHAV100
Definitions of pharmacology & drug
Aims of experimental pharmacology
Pre-clinical pharmacology
Clinical pharmacology
Types of experiments in pharmacology
Assembly for isolated organ/ tissue related experiments
Recording (writing) levers
Physiological salt solution (PSS)
Introduction
Examples
Composition
Role of ingredients
Precautions in preparation of PSS
Selection of PSS
5-Hydroxytryptamine & it’s Antagonist is a Topic in Pharmacology which will defiantly Help You in pharmacy field All information is related to pharmacology drug acting and it's effect on body. it is collage project given by our department i would like to share with you.
this presentation gives the knowledge about the decongestants are a type of medication that can provide short relief for a blocked nose ................
My all and slides mostly try to simplify pharmacy knowledge. Any time you are free to connect me. It's my pleasure to help you to get simplified pharmacy concepts. You may suggest topics needs to simplify the terminolog
Neurohumoral transmission in CNS-
The term neurohumoral transmission designates the transfer of a nerve impulse from a presynaptic to a postsynaptic neuron by means of a humoral agent e.g. a biogenic amine, an amino acid or a peptide.
Expt. 7 Bioassay of acetylcholine using rat ileum by four point bioassayVISHALJADHAV100
Objective
Principle
Requirements
Experimental specifications (conditions)
Preparation of ACh stock and standard solutions
Preparation of frog ringer solution (PSS)
Procedure
Kymograph recording of contractions
Observation table
Calculation
Result and interpretation
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.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
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Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
1. Unit I
Pharmacology of Respiratory
System
Presented by:
Prof. Mirza Anwar Baig
Dept of Pharmacology
AIKTC, School of Pharmacy, New Panvel
2. Contents:
a. Anti -asthmatic drugs
b. Drugs used in the management of COPD
c. Expectorants and antitussives
d. Nasal decongestants
e. Respiratory stimulants
3. Course Outcome:
At the end of the topic students should be able to
1. understand the mechanism of drug action and its relevance in
the treatment of different infectious diseases
2. comprehend the principles of toxicology and treatment of
various poisonings and
3. appreciate correlation of pharmacology with related medical
sciences
4. What is Asthma?
Asthma is the commonest chronic disease in children and adults.
Inflammatory condition
Recurrent (repeatable) reversible airways obstruction in response
to irritant stimuli.
Causes wheeze, although the natural history of asthma includes
spontaneous remissions (disappearance)
5. CHARACTERISTICS OF ASTHMA
Acute attacks are reversible, can progress in older patients to a chronic state
superficially resembling COPD.
COPD, where the obstruction is either not reversible or at best incompletely
reversible by bronchodilators.
Acute severe asthma (status asthmaticus) is not easily reversed and causes
hypoxaemia.
Hospitalization is necessary
Asthma is characterized by:
a. inflammation of the airways
b. bronchial hyper-reactivity
c. reversible airways obstruction.
6. PATHOGENESIS OF ASTHMA
• Asthmatics have activated T-helper (Th)2 followed by cytokine production
(might be activated by allergen).
The Th2 cytokines that are released do the following:
1. Attract eosinophils, to the mucosal surface.
2. Interleukin (IL)-5 and granulocyte–macrophage colony-stimulating factor
prime eosinophils to produce cysteinyl leukotrienes, and to release
granule proteins that damage the epithelium.
3. This damage is one cause of bronchial hyper-responsiveness.
7. 5. Promote IgE synthesis and responsiveness in some asthmatics
6. IL-4 and IL-13 ‘switch’ B cells to IgE synthesis and cause expression of
IgE receptors on mast cells and eosinophils; they also enhance adhesion
of eosinophils to endothelium.
7. Triggering degranulation with release of histamine and leukotriene B4
(powerful bronchoconstrictors )
8. The omalizumab (an anti-IgE antibody) serves to antiasthmatics.
8. Noxious gases (e.g. sulfur dioxide, ozone) and airway dehydration can
also cause mast cell degranulation.
8. The immediate phase of the asthmatic attack
(i.e. the initial response to allergen)
• Occurs abruptly and is mainly caused by spasm of the bronchial smooth
muscle.
• Causes release of histamine, leukotriene B4 and prostaglandin (PG) D2, IL-
4, IL-5, IL-13, macrophage inflammatory protein-1α and TNF-α.
• Attract leukocytes—particularly eosinophils and mononuclear cells—into
the area, setting the stage for the delayed phase.
10. The late phase
1. May be nocturnal
2. A progressing inflammatory reaction
3. The inflammatory cells include activated eosinophils.
4. These release cysteinyl leukotrienes, interleukins IL-3, IL-5 and IL-8, and
the toxic proteins, eosinophil cationic protein, major basic protein and
eosinophil-derived neurotoxin.
5. Toxic proteins causing damage and loss of epithelium
11. Fig. Immediate and late phases of asthma, with the actions of the
main drugs
12. DRUGS USED TO TREAT AND PREVENT ASTHMA
• There are two categories of antiasthma drugs: bronchodilators
and anti-inflammatory agents.
• Bronchodilators reverse the bronchospasm of the immediate phase;
antiinflammatory agents inhibit or prevent the inflammatory components of
both phases.
• Corticosteroids are the mainstay of therapy because they are the only
asthma drugs that potently inhibit T-cell activation,and thus the
inflammatory response, in the asthmatic airways.
• Cromoglicate has only a weak effect and is now seldom used.
13. 5 therapeutic steps to treat chronic asthma
Step 1: Very mild disease: short-acting bronchodilator alone.
Step 2: If patients need this more than once a day, a regular inhaled corticosteroid should be
added.
Step 3: If the asthma remains uncontrolled, add a long-acting bronchodilator
(salmeterol or formoterol); this minimises the need for increased doses of inhaled
corticosteroid .
Step 4: For symptomatic patient where the dose of inhaled corticosteroid to be increased
Corticosteroid-sparing agent to be added (Theophylline and leukotriene antagonists,
such as montelukast)
Step 5: If the patient’s condition is still poorly controlled, it may be necessary to add a
regular oral corticosteroid (e.g. Prednisolone).
14. CLASSIFICATION:
I. Bronchodilators
A. β2 Sympathomimetics: Salbutamol, Terbutaline, Bambuterol, Salmeterol,
Formoterol,Ephedrine.
B. Methylxanthines: Theophylline (anhydrous),Aminophylline, Choline theophyllinate,
Hydroxyethyl theophylline, Theophylline ethanolate of piperazine, Doxophylline.
C. Anticholinergics: Ipratropium bromide,Tiotropium bromide.
II. Leukotriene antagonists
Montelukast, Zafirlukast.
III. Mast cell stabilizers
Sodium cromoglycate, Ketotifen.
IV. Corticosteroids
A. Systemic: Hydrocortisone, Prednisolone and others.
B. Inhalational: Beclomethasone dipropionate,Budesonide, Fluticasone propionate,
Flunisolide, Ciclesonide.
V. Anti-IgE antibody
Omalizumab
15. A. SYMPATHOMIMETICS (β-Adrenoceptor agonists)
Cause bronchodilatation through β2 receptor stimulation → increased
cAMP formation in bronchial muscle cell → relaxation.
Increased cAMP in mast cells and other inflammatory cells decreases
mediator release.
Since β2 receptors on inflammatory cells desensitize quickly, the
beneficial effect of β2 agonists is uncertain, and at best minimal.
They are the most effective and fastest acting bronchodilators when
inhaled.
• Though adrenaline (β1+β2+α receptor agonist) and isoprenaline (β1+β2
agonist) are effective bronchodilators, it is the selective β2 agonists that
are now used in asthma to minimize cardiac side effects.
16. • Relax bronchial muscle
• Inhibit mediator release from mast cells and TNF-α release from
monocytes,
• Increase mucus clearance by an action on cilia.
Two categories of β2-adrenoceptor agonists are used in asthma.
1. Short-acting agents: (salbutamol and terbutaline). (duration 3-5 hrs)
Inhalation
Used on an ‘as needed’ basis to control symptoms.
2. Longer-acting agents: e.g. salmeterol and formoterol. (duration 8–12 h)
Inhalation.
Given regularly, twice daily
Adjunctive therapy in patients whose asthma is inadequately controlled by
glucocorticoids.
17. METHYL XANTHINES
Extensively used in asthma, but are not considered first line drugs.
Often used in COPD.
Methylated xanthine alkaloids are caffeine, theophylline and theobromine.
Sources:
19. Pharmacological actions
1. CNS:
• CNS stimulants, primarily affect the higher centres.
• Caffeine 150–250 mg produces a sense of wellbeing, alertness etc
• Caffeine is more active than theophylline in producing these effects.
• Higher doses cause nervousness, restlessness, panic, insomnia and
excitement. Still higher doses produce tremors, delirium and convulsions.
• Stimulate medullary vagal, respiratory and vasomotor centres. Vomiting at
high doses is due to both gastric irritation and CTZ stimulation.
20. 2. CVS :
Methylxanthines directly stimulate the heart and increase force of myocardial
Contractions and decrease it by causing vagal stimulation—net effect is
variable.
Tachycardia is more common with theophylline, but caffeine generally lowers
heart rate.
At high doses cardiac arrhythmias may be produced.
Dilate systemic blood vessels-- peripheral resistance is reduced.
Cranial vessels are constricted, especially by caffeine; (use in migraine).
Effect on BP is variable and unpredictable—
• Vasomotor centre and direct cardiac stimulation—tends to raise BP.
• Vagal stimulation and direct vasodilatation—tends to lower BP.
Usually a rise in systolic and fall in diastolic BP is observed.
21. 3. Smooth muscles:
All smooth muscles are relaxed, most prominent effect is exerted on
bronchi, especially in asthmatics.
Theophylline is more potent than caffeine.
Vital capacity is increased.
Biliary spasm is relieved, but effect on intestines and urinary tract is
negligible.
22. 4. Kidney:
Mild diuretics
Act by inhibiting tubular reabsorption of Na+ and water as well as
increased renal blood flow and g.f.r.
Theophylline is more potent, but action is brief.
5. Skeletal muscles:
Contraction.
Increases release of Ca2+ from sarcoplasmic reticulum by direct action.
Increasing Ach release.
Relieves fatigue and increases muscular work.
Enhanced diaphragmatic contractility noted contributes to its beneficial
effects in dyspnoea and COPD.
23. 6. Stomach:
Methylxanthines enhance secretion of acid and pepsin in stomach, even on
parenteral injection.
They are also gastric irritants—theophylline more than caffeine.
7. Mast cells and inflammatory cells:
Theophylline decreases release of histamine and other mediators from mast
cells and activated inflammatory cells.
This may contribute to its therapeutic effect in bronchial asthma.
24. Mechanism of action
Three distinct cellular actions of methylxanthines have been defined—
(a) Release of Ca2+ from sarcoplasmic reticulum,especially in skeletal
and cardiac muscle.
(b) Inhibition of phosphodiesterase (PDE) which degrades cyclic
nucleotides intracellularly.
The concentration of cyclic nucleotides is increased.
Bronchodilatation, cardiac stimulation and vasodilatation occur when cAMP
level rises in the concerned cells.
(c) Blockade of adenosine receptors:
Adenosine acts as a local mediator in CNS, CVS and other organs—contracts
smooth muscles, especially bronchial; dilates cerebral blood vessels, depresses
cardiac pacemaker and inhibits gastric secretion.
Methylxanthines produce opposite effects.
25. Muscarinic receptor antagonists
Longer acting drug
Block of M2 autoreceptors on the cholinergic nerves increases acetylcholine
release.
Inhibits the mucus secretion that occurs in asthma and
May increase the mucociliary clearance of bronchial secretions.
Used in maintenance treatment of COPD.
Examples: ipratropium. Tiotropium
Cysteinyl leukotriene receptor antagonists
The ‘lukast’ drugs (montelukast and zafirlukast) antagonise only CysLT1.
Inhibit exercise-induced asthma
Relax the airways in mild asthma
Reduce sputum eosinophilia,.
26. Histamine H1-receptor antagonists
Effective in the immediate phase of allergic asthma (Fig. 27.3) and in some
Types of exercise-induced asthma
Modestly effective in mild atopic asthma (precipitated by acute histamine
Release)
Anti-IgE treatment
Humanised monoclonal anti-IgE antibody.
Effective in allergic asthma and in allergic rhinitis.
Expensive
28. Introduction:
• A major global health problem.
• Cigarette smoking and air pollution is the main cause.
• Received much less attention than asthma.
Clinical features.
Attacks of morning cough during the winter
Progresses to chronic cough with intermittent exacerbations (upper
respiratory infection).
Progressive breathlessness.
Pulmonary hypertension is a late complication
Condition of patient may be complicated by respiratory failure
Tracheostomy and artificial ventilation may prolong survival.
https://www.youtube.com/watch?v=T1G9Rl65M-Q
29. Pathogenesis:
There is small airways fibrosis, resulting in obstruction, and/or destruction of
alveoli (emphysema ) and of elastin fibres in the lung parenchyma.
Caused by proteases, including elastase, released during the inflammatory
response.
Chronic inflammation, (small airways and lung parenchyma), characterized by
increased numbers of macrophages, neutrophils and T lymphocytes.
Lipid mediators, inflammatory peptides, reactive oxygen and nitrogen
species, chemokines, cytokines and growth factors are all involved.
30. Principles of treatment:
Stopping smoking slows the progress of COPD.
Patients should be immunised against influenza and Pneumococcus, because
superimposed infections with these organisms are potentially lethal.
Glucocorticoids are generally ineffective, in contrast to asthma, but a trial of
glucocorticoid treatment is worthwhile because asthma may coexist with
COPD and have been overlooked.
During asthma and COPD, multiple inflammatory genes are activated.
HDAC activity is inhibited by smoking-related oxidative stress.
Inflammatory gene causes acetylation of nuclear histones (DNA) is initiated
lead to synthesis of inflammatory proteins.
31. Histone deacetylases (HDACs) are enzymes that catalyze the
removal of acetyl functional groups (deacetylation) from the
lysine residues of both histone and nonhistone proteins.
Corticosteroids recruit HDAC to activated genes, reversing acetylation and
switching off inflammatory gene transcription.
There is a link between the severity of COPD (but not of asthma) and
reduced HDAC activity in lung tissue.
HDAC is a key molecule in suppressing production of proinflammatory
cytokines.
32. Long-acting bronchodilators
Give modest benefit, but do not deal with the underlying inflammation.
No currently licensed treatments reduce the progression of COPD or
suppress the inflammation in small airways and lung parenchyma.
Some, such as chemokine antagonists, are directed against the influx of
inflammatory cells into the airways and lung parenchyma
Phophodiesterase IV inhibitors (e.g. roflumilast) show some promise.
Other drugs that inhibit cell signalling include inhibitors of p38 mitogen-
activated protein kinase, nuclear factor κβ and phosphoinositide-3
kinase-γ.
33. More specific approaches are to give antioxidants, inhibitors of inducible
NO synthase and leukotriene B4 antagonists (Leukotriene B4 induces
recruitment and activation of neutrophils, monocytes and eosinophils.)
Other treatments have the potential to combat mucus hypersecretion, and
there is a search for serine protease and matrix metalloprotease inhibitors
to prevent lung destruction and the development of emphysema.
34. Specific aspects of treatment.
Short- and long-acting inhaled bronchodilators
Shortacting drugs are ipratropium and salbutamol
Long-acting drugs include tiotropium and salmeterol or formoterol
Theophylline can be given, its respiratory stimulant effect may be useful
for patients who tend to retain CO2.
Other respiratory stimulants (e.g. doxapram) are sometimes used briefly in
acute respiratory failure (e.g.postoperatively) but have largely been
replaced by ventilatory support.
Long-term oxygen therapy administered at home prolongs life in patients
with severe disease and hypoxaemia
35. Acute exacerbations.
Acute cases are treated with inhaled O2 in a concentration (initially, at least) of
only 24% O2, i.e. only just above atmospheric O2 concentration
(approximately 20%).
The need for caution is because of the risk of precipitating CO2 retention as
a consequence of terminating the hypoxic drive to respiration.
Blood gases and tissue oxygen saturation are monitored, and inspired O2
subsequently adjusted accordingly.
Broad-spectrum antibiotics (e.g. cefuroxime), including activity against
Haemophilus influenzae, are used if there is evidence of infection.
Inhaled bronchodilators may provide some symptomatic improvement
36. A systemically active glucocorticoid (intravenous hydrocortisone
or oral prednisolone) is also administered routinely, although efficacy is
modest.
Inhaled steroids do not influence the progressive decline in lung function in
patients with COPD, but do improve the quality of life, probably as a result
of a modest reduction in hospital admissions.
38. COUGH:
A protective reflex that removes foreign material and secretions from the
bronchi and bronchioles.
Occurs due to stimulation of mechano- or chemoreceptors in throat
respiratory passages or stretch receptors in the lungs
Triggered by inflammation in the respiratory tract.
Present in undiagnosed asthma or chronic reflux with aspiration, bronchial
carcinoma etc).
Cough is common adverse effect of angiotensin-converting enzyme
inhibitors.
Antitussive drugs are sometimes useful but can cause undesirable thickening
and retention of sputum and risk of respiratory depression.
• https://www.youtube.com/watch?v=dVac4G3e84Y
39. Treatment:
Apart from specific remedies (antibiotics, etc.), cough may be treated as a
Symptom (nonspecific therapy) with:
1. Pharyngeal demulcents:
Lozenges, cough drops, linctuses containing syrup, glycerine,liquorice.
2. Expectorants (Mucokinetics)
(a) Bronchial secretion enhancers:
Sodium or Potassium citrate, Potassium iodide, Guaiphenesin (Glyceryl
guaiacolate), balsum of Tolu, Vasaka, Ammonium chloride.
(b) Mucolytics:
Bromhexine, Ambroxol, Acetylcysteine, Carbocisteine
3. Antitussives (Cough centre suppressants)
(a) Opioids: Codeine, Ethylmorphine,Pholcodeine.
(b) Nonopioids: Noscapine, Dextromethorphan,Chlophedianol.
(c) Antihistamines: Chlorpheniramine, Diphenhydramine,Promethazine.
(d) Peripherally acting: Prenoxdiazine.
4. Adjuvant antitussives
Bronchodilators: Salbutamol, Terbutalin.
41. Treatment:
• Pharyngeal demulcents - reduce afferent impulses from the
inflamed/irritated pharyngeal mucosa, thus provide symptomatic relief in
dry cough arising from throat.
• Expectorants (Mucokinetics) - increase bronchial secretion or reduce its
viscosity, facilitating its removal by coughing.
• Sodium and potassium citrate are considered to increase bronchial secretion
by salt action.
• Potassium iodide is secreted by bronchial glands and can irritate the airway
mucosa. Prolonged use can affect thyroid function and produce iodism. It is
not used now.
• Guaiphenesin, vasaka, tolu balsum are plant products which are supposed
to enhance bronchial secretion and mucociliary function while being
secreted by tracheobronchial glands.
42. • Ammonium salts are nauseating— reflexly increase respiratory secretions.
• The US-FDA has stopped marketing of all expectorants, except
guaiphenesin.
• Steam inhalation and proper hydration may be more helpful in clearing
airway mucus.
43. Antitussives:
Suppress coughing (cough suppressants).
All opioid analgesics are in clinical use which act by an ill-defined effect in
the brain stem, depressing an even more poorly defined ‘cough centre’.
They suppress cough in doses below those required for pain relief.
Those used as cough suppressants have minimal analgesic actions and
addictive properties.
New opioid analogues that suppress cough by inhibiting release of excitatory
neuropeptides through an action on μ receptors on sensory nerves in the
bronchi are being assessed.
44. Codeine (methylmorphine):
A weak opioid with considerably less addiction liability than the main opioids,
and is a mild cough suppressant.
Decreases secretions in the bronchioles, which thickens sputum, and
inhibits ciliary activity.
Constipation is common.
Dextromethorphan and pholcodine have similar but possibly less intense
adverse effects.
Respiratory depression is a risk with all drugs of this type.
Morphine is used for palliative care in cases of lung cancer associated with
distressing cough.
46. What is nasal congestion?
It is swelling of the nasal tissues.
Blood vessels in nasal tissues become dilated, to get the immune
response cells to the nose to fight the virus that has entered the body.
Causes include:
• A Virus. The viruses entered through nose and begins to multiply.
The body’s response leads to inflammation that brings nasal
congestion.
• Allergies. Allergen, causes swelling of nasal tissues which leads to
nasal congestion.
47. What is nasal decongestants?
• α agonists, produce local vasoconstriction.
• The imidazoline compounds— naphazoline, xylometazoline and
oxymetazoline are relatively selective α2 agonist (like clonidine).
• They have a longer duration of action (12 hours) than ephedrine.
Side effects:
After-congestion (less than that with ephedrine or phenylephrine).
Stinging sensation (specially naphazoline).
Impaired mucosal ciliary function (on long term use)
Atrophic rhinitis and anosmia (due to persistent vasoconstriction).
CNS depression and rise in BP (systemic effects).
https://www.mountsinai.org/health-library/symptoms/stuffy-or-runny-nose-
adult
49. Phenylephrine:
• Selective α1 agonist, has negligible β action.
• It raises BP by causing vasoconstriction.
Therapeutic use:
• Nasal decongestant
• For producing mydriasis when cycloplegia is not required.
• To reduce intraocular tension by constricting ciliary body blood vessels.
• Constituent of orally administered nasal decongestant preparations
50. Pseudophedrine:
• A stereoisomer of ephedrine
• causes vasoconstriction, especially in mucosae and skin.
Therapeutic use:
• Oral decongestant of upper respiratory tract, nose and eustachian
tubes.
• Combined with antihistaminics, mucolytics,antitussives and
analgesics
• For symptomatic relief in common cold, allergic rhinitis, blocked
eustachian tubes and upper respiratory tract infections.
Side effects:
• rise in BP can occur, especially in hypertensives.
51. Phenylpropanolamine (PPA)
• Chemically and pharmacologically similar to ephedrine,
• Causes vasoconstriction and has some amphetamine like CNS effects,
including suppression of hunger.
Therapeutic Uses:
• Included in a large number of oral cold/decongestant combination remedies,
and in USA it was used as an appetite suppressant as well.
Side Effects/Adverse Effects:
Can precipitate hemorrhagic stroke and behavioural/psychiatric disturbances
Prohibited the sale of PPA containing medicines decades back in USA and
may countries.
Lower amounts of PPA (25–50 mg) continued to be available over-the-
counter in India till recently.
52. II. ANALEPTICS (Respiratory stimulants)
Have resuscitative value in coma or fainting.
Stimulate respiration in subconvulsive doses.
Margin of safety is narrow; the patient may get convulsions while still in
coma.
Therapeutics use is very limited and dubious
Mechanical support to respiration to improve circulation are more effective
and safe.
53. Situations in which they may be employed are:
(a) As a measure in hypnotic drug poisoning untill mechanical ventilation is
instituted.
(b) Suffocation on drowning, acute respiratory insufficiency.
(c) Apnoea in premature infant.
(d) Failure to ventilate spontaneously after general anaesthesia.
54. Doxapram
• It acts by promoting excitation of central neurones.
• At low doses it is more selective for the respiratory centre than other
analeptics.
• Respiration is stimulated through carotid and aortic body chemoreceptors
as well.
• Falling BP rises.
• Continuous i.v. infusion of doxapram may abolish episodes of apnoea in
premature infant not responding to theophylline.
.