PHARMACOTHERAPEUTICS

1. P H A R M . D T H I R D Y E A R ( 2 0 1 6 - 2 0 2 2 )
P H A R M A C O T H E R A P E U T I C S - 2
UPPER RESPIRATORY TRACT
INFECTIONS (URTI):

2. UPPER RESPIRATORY TRACT:
The upper respiratory tract includes the sinuses, nasal passages,
pharynx, and larynx. These structures direct the air we breathe
from the outside to the trachea and eventually to the lungs for
respiration to take place.
An upper respiratory tract infection, or upper respiratory
infection, is an infectious process of any of the components of
the upper airway.

3. TYPES OF INFECTIONS:
Infection of the specific areas of the upper respiratory
tract can be named specifically. Examples of these may
include rhinitis (inflammation of the nasal cavity), sinus
infection (sinusitis or rhino sinusitis) - inflammation of
the sinuses located around the nose, common cold
(nasopharyngitis) - inflammation of the nares, pharynx,
hypo pharynx, uvula, and tonsils, pharyngitis
(inflammation of the pharynx, uvula, and tonsils),
epiglottitis (inflammation of the upper portion of the
larynx or the epiglottis), laryngitis (inflammation of the
larynx), laryngotracheitis (inflammation of the larynx
and the trachea), and tracheitis (inflammation of the
trachea).

4. SYPMPTOMS FOR URTI:
 Cough
 Sneezing
 Nasal discharge
 Nasal congestion
 Runny nose
 Fever
 Sore throat
The symptoms of upper respiratory infection usually last
between 3-14 days; if symptoms last longer than 14 days,
an alternative diagnosis can be considered such as,
sinusitis, allergy, pneumonia, or bronchitis

5. ETIOLOGY:
 An upper respiratory tract infection is generally caused
by the direct invasion of the inner lining (mucosa or
mucus membrane) of the upper airway by the culprit
virus or bacteria. In order for the pathogens (viruses and
bacteria) to invade the mucus membrane of the upper
airways, they have to fight through several physical and
immunologic barriers.
 Despite these defense processes, invading viruses and
bacteria adapt various mechanisms to resist destruction.
They can sometimes produce toxins to impair the body's
defense system or change their shape or outer structural
proteins to disguise from being recognized by the
immune systems (change of antigenicity).

6. COMMON PATHOGENS:
Some of the common pathogens for upper respiratory
infection and their respective incubation times are
the following:
 Rhinoviruses, 1-5 days;
 Group A streptococci, 1-5 days;
 Influenza and para influenza viruses, 1-4 days;
 Respiratory syncytial virus (RSV), 7 days;
 Whooping cough (pertussis), 7-21 days;
 Diphtheria, 1-10 days; and
 Epstein-Barr virus (EBV), 4-6 weeks.

7. RHINITIS (HAY FEVER) :
 There are two types of rhinitis: allergic and non-allergic
Allergic Rhinitis
 If you have allergic rhinitis, your immune system
mistakenly identifies a typically harmless substance as an
intruder. This substance is called an allergen. The immune
system responds to the allergen by releasing histamine and
chemical mediators that typically cause symptoms in the
nose, throat, eyes, ears, skin and roof of the mouth.
 Seasonal allergic rhinitis (hay fever) is most often caused by
pollen carried in the air during different times of the year in
different parts of the country.
 Allergic rhinitis can also be triggered by common indoor

8. RHINITIS (continued)
 allergens such as the dried skin flakes, urine and saliva found on pet
dander, mold, droppings from dust mites and cockroach particles. This
is called perennial allergic rhinitis, as symptoms typically occur year-
round.
 In addition to allergen triggers, symptoms may also occur from irritants
such as smoke and strong odors, or to changes in the temperature and
humidity of the air. This happens because allergic rhinitis causes
inflammation in the nasal lining, which increases sensitivity to
inhalants.
 Many people with allergic rhinitis are prone to allergic conjunctivitis
(eye allergy). In addition, allergic rhinitis can make symptoms of
asthma worse for people who suffer from both conditions.
Nonallergic Rhinitis
At least one out of three people with rhinitis symptoms do not have
allergies. Nonallergic rhinitis usually afflicts adults and causes year-
round symptoms, especially runny nose and nasal congestion. This
condition differs from allergic rhinitis because the immune system is
not involved.

9. COMMON COLD ( naso pharyngitis):
 The common cold is a viral infection of your nose
and throat (upper respiratory tract). It's usually
harmless, although it might not feel that way. Many
types of viruses can cause a common cold.
 Children younger than six are at greatest risk of
colds, but healthy adults can also expect to have two
or three colds annually.
 Most people recover from a common cold in a week
or 10 days. Symptoms might last longer in people
who smoke.

10. SINUSITIS:
Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Healthy
sinuses are filled with air. But when they become blocked and filled with fluid, germs
can grow and cause an infection. Humans have four pairs of sinuses, hollow spaces
behind the bones of the face. These cavities produce the mucus that is necessary for
the nasal passages to work effectively. Sinusitis can be acute or chronic, and it can
be caused by viruses, bacteria, fungi, allergies, or even an autoimmune reaction.
Acute sinusitis lasts up to 4 weeks. Chronic sinusitis persist, or continually return,
after 12 weeks. It may need functional endoscopic sinus surgery (FESS)

11. PHARYNGITIS:
Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It’s
most often referred to simply as “sore throat.” Pharyngitis can also cause
scratchiness in the throat and difficulty swallowing. There are numerous viral and
bacterial agents that can cause pharyngitis. They include:
measles
adenovirus, which is one of the causes of the common cold
chickenpox
croup, which is a childhood illness distinguished by a barking cough
whooping cough
group A streptococcus.
According to the Centers for Disease Control and Prevention (CDC),
amoxicillin and penicillin are the most commonly prescribed treatments for strep
throat. It’s important that you take the entire course of antibiotics to prevent the
infection from returning or worsening. An entire course of these antibiotics usually
lasts 7 to 10 days.

12. TONSILITIS:
 Tonsils are the two lymph nodes located on each side of the back of your
throat. They function as a defense mechanism. They help prevent your
body from infection. When the tonsils become infected, the condition is
called tonsillitis.
 Tonsillitis can occur at any age and is a common childhood infection. It is
most often diagnosed in children from preschool age through their mid
teens. Symptoms include a sore throat, swollen tonsils, and fever.
 This condition is contagious and can be caused by a variety of common
viruses and bacteria, such as Streptococcal bacteria, which causes strep
throat. Tonsillitis caused by strep throat can lead to serious complications
if left untreated.
 Tonsillitis can be caused by a virus, such as the common cold, or by a
bacterial infection, such as strep throat. According to the American
Academy of Family Physicians (AAFP), an estimated 15 to 30 percent of
tonsillitis cases are due to bacteria. Most often it's strep bacteria.
 Viruses are the most common cause of tonsillitis. The Epstein-Barr virus
can cause tonsillitis, which can also cause mononucleosis.

13. LARYNGITIS:
 Laryngitis occurs when your voice box or vocal cords become inflamed
from overuse, irritation, or infection. Laryngitis can be acute (short-term),
lasting less than three weeks. Or it can be chronic (long-term), lasting more
than three weeks.
 Many conditions can cause the inflammation that results in laryngitis. Viral
infections, environmental factors, and bacterial infections can all cause
laryngitis.
Acute laryngitis
 Acute laryngitis is a temporary condition caused by overusing the vocal
cords. It can also be caused by an infection. Treating the underlying
condition causes the laryngitis to go away. Acute laryngitis can be caused
by:
 viral infections
 straining your vocal cords by talking or yelling
 bacterial infections
 drinking too much alcohol

14. CHRONIC LARYNGITIS
Chronic laryngitis
Chronic laryngitis results from long-term exposure to irritants. It’s usually
more severe and has longer-lasting effects than acute laryngitis.
Chronic laryngitis can be caused by:
 frequent exposure to harmful chemicals or allergens
 acid reflux
 frequent sinus infections
 smoking or being around smokers
 overusing your voice
 low-grade yeast infections caused by frequent use of an asthma inhaler
 Cancer, paralysis of the vocal cords, or changes in vocal cord shape as you
age can also cause persistent hoarseness and sore throats.

15. EPIGLOTTITIS:
 Epiglottitis is inflammation of the epiglottis—the flap at the base of the
tongue that keeps food from going into the trachea (windpipe). Symptoms are
usually rapid in onset and include trouble swallowing which can result in
drooling, changes to the voice, fever, and an increased breathing rate. As the
epiglottis is in the upper airway, swelling can interfere with breathing. People
may lean forward in an effort to open the airway. As the condition worsens
stridor and bluish skin may occur.
 Epiglottitis was historically mostly caused by infection by H. influenzae type b.
With vaccination it is now more often caused by other bacteria. Other possible
causes include burns and trauma to the area. The most accurate way to make
the diagnosis is to look directly at the epiglottis. X-rays of the neck from the
side may show a "thumbprint sign" but the lack of this sign does not mean the
condition is absent.
 An effective vaccine, the Hib vaccine, has been available since the 1980s.The
antibiotic rifampicin may also be used to prevent the disease among those who
have been exposed to the disease and are at high risk. The most important part
of treatment involves securing the airway, which is often done by endotracheal
intubation. Intravenous antibiotics such as ceftriaxone and possibly
vancomycin or clindamycin is then given. Corticosteroids are also typically
used. With appropriate treatment, the risk of death among children with the
condition is about one percent and among adults is seven percent.

16. COMMON TREATMENT FOR URTI:

17. TREATMENT continued.

18. TREATMENT continued.