antihistamines mani
TRANSCRIPT
ANTI HISTAMINICS
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Histamine (H) - ‘Tissue amine’.
Pharmacological profile- Dale.
Its present in mast cells, Skin, GIT mucosa, lungs, liver &
Placenta.
Non-mast cells histamines present in brain, epidermis,
gastric mucosa & growing regions.
Its also present in blood, secretions, venoms & pathological
fluids.
Turn over of mast & non-mast cells.
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Synthesis, Storage & Metabolism-
Synthesized from Histidine-Oxidation & Methylation.
Histamine
Histamine actions resembles the manifestation of certain
allergic reactions.
So its a mediator of hypersensitivity & tissue injury
reactions.
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T-Pr-K
PIP2
IP3
Ca2+
Mechanism of histamine release
from Mast cell due to Ag- Ab
reaction.
Ag
Ab
Exocytosis
Mast cell
Storage vesicles
Granules contains histamine
Fc εRI
Ca2+/Na+
Histamine
CAMP- Ca2+ Histamine release
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+
L-Histidine
Histamine
Histaminase / oxidation
Imidazole acetic acid
Imidazole acetic acid
ribose
Ribose
Storage vesicle
Release Na+ ECF
Heparin
Protein
C=O
O Na
+ Histamine
Methylation/ Transferase
N-methyl histamine
N-methyl imidazole
Acetic acid
Histidine decarboxylase
MAO-BHeparin--
Protein
Histamine+
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L-amino acid
decarboxylase
Immune reaction,
Mechanical,
chemical physical
+
Histaminergic receptors
H1 & H2 receptors- Asch & Schild.
H1 blockers- Antihistamines
H2 blockers- Burimamide -Sir James Black.
H3 receptors- Auto receptors -controls H-release.
H4- Eosinophils, Neutrophils, CD4T cells, Chemotaxis of
WBC- blockers are used in Chr. allergy inflammatory
conditions
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H1 H2
Agonists 2-methyl histamine,
2-pyridylethylamine
4-methyl histamine
Dimaprit
Impromidine
Antagonist Mepyramine
Chlorpheniramine
Cimetidine
Ranitidine
Receptor type Gq -coupled receptor G s-coupled receptor
Effector pathway PIP2 hydrolysis—IP3/DAG
Intracellular Ca 2+ release
Ptn. Kinase C- activation.
Adenylyl cyclase
activation-
CAMP- phosphorylation of
specific proteins.
Distribution -Smooth muscles
-Blood vessels
-Afferent nerve endings-stimulation
-Ganglionic cell +.
Adrenal medulla- release of C.A’s
Brain- neurotransmitter.
-Gastric glands
-Blood vessels
-Heart
-Uterus (rats)
-Brain- neurotransmitter.
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Pharmacological actions
1) CVS & Blood vessels- vasodilation, B.P, tachycardia &
headache, flushing, heat.
Triple response- Flush, Wheal & Flare.
2) Smooth muscle-
Contraction- Br.spasm, GIT motility.
No action human uterus.
3) Glands- secretions of exocrine glands.
Bronchi, pancreas, salivary, gastric & lacrimal glands.
4) CNS- B.P, Behavioural change, N,V, hypothermia & ADH release.
5) Nerve endings- Pain & itching.
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Pathophysiological role-
1) Gastric acid secretions-
2) Allergic phenomena- Early type-1 hypersensitivity.
3) As transmitter-
4) Inflammation-
5) Tissue growth & repair -
6) Headache-
Contra indications- Asthma & P.U.
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3)As a transmitter- pathophysiology
Histamine-H1R
Peripheral
+ Sensory nerve
endings
Pain & Itching
Brain
Hypothalamus
Mid brain
Wakefulness
-Appetite centre
Wt.gain Regulates
Temp, CVS
&
Thirst
Release
Anterior
Pituitary hormones
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Histamine Uses
- Histamine is of no therapeutic value.
1) Testing gastric acid secretion-
- To test acid secreting ability of stomach.
2) Diagnosis of pheochromocytoma –
-Histamine releases CA & BP raises.
3) Pulmonary function-
- To test for bronchial hyper activity.
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Histamine substitutes-
Betahistine - H1 agonist – Meniere’s disease.
Betazole - H2 agonist- used in gastric acid function test.
Drugs that liberate H Drugs that inhibit H
Morphine, d-Tc, Trimethapan,
Polymyxin -B,
Sch, PVP, Dextran, bile salts.
Radio contrast media
Heat, cold, sunlight & x-rays.
Proteolytic enzymes- venoms,
trypsin & chymotrypsin.
Ag-Ab reactions
Adrenaline, Ephedrine,
Isoproterenol
Mast cell membrane
stabilizers- Cromogylate,
Pizotifen & Ketotifen.
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Pharmacological action of antihistamines
1) Antagonism of histamine-
Blocks histamine induced-
-Broncho constriction & smooth muscle constriction.
- Triple response
- Fall in B.P
- Animal death (pre-treatment with H1 blockers).
- Adrenaline release
- vasoconstriction of large B.V.
- No action on gastric acid secretion.
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2) Anti allergic action-
Type -1 manifestations - suppressed.
Fall in B.P- partially prevented.
Asthma is unaffected
3) CNS-
Cross BBB-sedation due high affinity to central H1R.
Stimulant effects- some individuals.
Excitement & convulsions – toxic dose.
Anti motion sickness
Morning sickness.
Anti cholinergic S/E- tremors, rigidity & sialorrhoea.
Antitussive action.
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Parkinsonism
4) Anticholinergic action-
5) Local anaesthetic action- membrane stabilizing activity.
6) Fall in B.P- on I.V inj.
High Low Minimal/ Absent
Promethazine Chlorpheniramine Fexofenadine
Diphenhydramine Hydroxyzine Astemizole
Dimenhydrinate Tripolidine Loratadine
Pheniramine Cyclizine Cetirizine
Cyproheptadine Mizolastin
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1st generation 2nd generation
Short- intermediate acting Long acting
Cross BBB- More sedative. X BBB- No CNS effects & No sedative
Anti-muscarinic S/E . No anti-muscarinic S/E.
Antihistamine action Anti allergic action- acting on LT’s / PAF.
X both central & peripheral H.R X only peripheral H.R
Impairs psychomotor performances. No
Antipruritic, Antiemetic & Antitussive
Anticholinergic & Antiparkinonian
Only antihistaminic & anti-allergic.
Urticaria, Dermographisim, atopic eczema,
Food & dug allergy.
Synergistic actions i.e., D.I No
Allergic rhinitis, conjunctivitis, hay fever,
pollinosis, sneezing, watery eyes.
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1st Generation Antihistamines
DRUGS Adult dose
(oral)
Duration of
action (Hr )
Uses
Highly sedative
Dimenhydrinate
Diphenhydramine
Doxylamine
Hydroxyzine
Promethazine
-25-50mg
-20-50mg
-1.5-25mg
-25-50g
-10-25mg
4-6 hrs
-Anti-motion sickness
- do-
- used as sleep aid
- anti emetic
- anti emetic
Moderately sedative
Pheniramine
Cyproheptadine
Meclizine
Buclizine
Cinnarizine
-20-50mg
-4mg
-25-50mg
-25-50mg
-20-50m
4-6hrs-Anti serotonin effects
-Anti motion sickness
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DRUGS Adult dose
(oral)
Duration of
action (Hr )
Uses
Mild sedative
-Cyclizine
-Chlorpheniramine
-Dimethindine
-Tripolidine
-50 mg
-2-4 mg
-1 mg
-2.5-5 mg
- 4-6hrs
2nd Generation antihistamines
-Fexofenadine
-Loratadine
-Des loratadine
-Astemizole
-Cetirizine
-Levo cetirizine
-Azelastine
-Ebastine
-120-180 mg
-10 mg
-5 mg
-10 mg
-10 mg
-5mg
-4mg
-10mg
12-24hrs- Anti inflammatory
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S/E & Toxicity
1st Generation- S/E are frequent & mild.
Tolerance is developed on repeated use.
Sedation, alertness & concentration, headache, motor-
incoordination, fatigue & sleep.
Impaired psychomotor performances.
Should not drive & operate machines.
Anticholinergic effects
Teratogenicity- in animals.
Over dose- excitation, muscular incordination, respiratory &
cardiovascular failure.
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P.K-
Metabolised by liver microsomal enzymes
Terfenadine & Astemizole (CYP3A4) X Ketoconazole.
Hydroxyzine Cetirizine L isomer.
Terfenadine Fexofenadine
Loratadine Desloratedine
Long term use- effectiveness is reduced.
Excretion is slow in hepatic impairment.
Children eliminates faster than adults.
Less toxic
More potent
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Fexofenadine- Terfenadine
- Torsades de pointes- X delayed rectifier K+ channels.
- Less propensity to block K+ - No prolonged QTc interval.
- No D.I with CYP3A4 inhibitors.
Loratadine-
- Fast & long acting-
- Desloratadine is a active metabolite.
-Used in urticaria & atopic dermatitis.
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Cetirizine Hydroxyzine.
- Cross BBB- subjective somnolence at high dose.
- X release of H & cytotoxic mediators-2nd phase of allergy.
- Attains high & long lasting con. in skin.
- O.D dosing.
- Superior in urticaria, atopic dermatitis, respiratory allergies
- Adjuvant to seasonal asthma.
- Levo cetirizine- ½ dose is effective with less S/E.
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Azelastine -Topically effective,
- X H & inflammatory mediators release (LT & PAF).
- Bronchodilator property.
- Down regulates ICAM-1 expression in nasal mucosa.
- Nasal spray in seasonal & perennial allergic rhinitis.
Ebastine- carbastine.
- Used nasal & skin allergies.
- May prolong QT interval.
Rupatadine - Antihistaminic & PAF antagonist.
- used in allergic rhinitis.
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Therapeutic uses
1) Allergic disorders- itching, urticaria, hay fever,
conjunctivitis, angioedema of lips & eyelids.
- Adr - life saving in laryngeal angioedema & A. shock.
- Seasonal asthma-cetirizine.
-Drug induced hypersensitivity.
- Skin rashes.
-Ineffective in asthma, humoral & cell mediated allergies.
-Suppress urticaria and swelling in serum sickness but mot
other components.
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2) Antipruitic action- older antihistamines.
3) Common cold- symptomatic relief (older).
4) Motion sickness-prophylactic value & 1hr before journey.
Promethazine, Dimenhydrinate, Cyclizine.
Promethazine-Morning sickness, DIV, POV, RIV.
5) Vertigo- H1,M1 & 5HT blocker, sedative, vasodilator &
Ca2+ influx- Cinnarizine.
6) Preanaesthetic medication- Promethazine.
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7) Cough- symptomatic relief.
8) Parkinsonism-Promethazine.
9) Acute muscle dystonia - anti-dopaminergic & anti-psychotics.
10) As sedative, hypnotic & anxiolytic - Promethazine & Hydroxyzine.
-should not used below 2yrs child.
11) Appetite stimulant- Cyproheptadine.
12) Dermographisim, sting & ivy poisoning.
13) Prophylactic value in blood & saline infusion induced
rigour.
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Histamine release inhibitors
Disodium Cromogylate
Nedocromil
Iodoxasmide
Permirolast
Ketotifen
They act by preventing mast cell degranulation due to
immunological reaction.
Prevent the release of H & other inflammatory mediators.
Used in Br.asthma & allergic rhinitis.
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Thank u
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