antitussives, expectorants, and antiasmatic drugs ximei wu dept. of pharmacology, zjums
TRANSCRIPT
![Page 1: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/1.jpg)
Antitussives, expectorants, Antitussives, expectorants, and and
antiasmatic drugsantiasmatic drugs
Ximei WuXimei WuDept. of pharmacology,Dept. of pharmacology,
ZJUMSZJUMS
![Page 2: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/2.jpg)
![Page 3: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/3.jpg)
Drugs acting on respiratory systemDrugs acting on respiratory system
• Cough Cough antitussive drugsantitussive drugs• centrally actingcentrally acting• peripherally actingperipherally acting
• SputumSputum expectorant drugs expectorant drugs• sputum-diluting drugssputum-diluting drugs• mucolytic drugsmucolytic drugs
• AsthmaAsthma antiasthmatic drugs antiasthmatic drugs• bronchial dilatorsbronchial dilators• receptor agonistsreceptor agonists• theophyllinestheophyllines• muscarinic antagonistsmuscarinic antagonists• anti-inflammatory drugsanti-inflammatory drugs• glucocorticosteroidsglucocorticosteroids• mediator release inhibitorsmediator release inhibitors
![Page 4: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/4.jpg)
1.1. AntitussivesAntitussives
![Page 5: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/5.jpg)
• Centrally actingCentrally acting• Addictive drugs: Addictive drugs: • codeine codeine 可待因可待因• Non-addictive drugs: Non-addictive drugs: • dextromethorphan dextromethorphan 右美沙芬右美沙芬• pentoxyverine pentoxyverine 喷托维林喷托维林 (( 咳必清咳必清 ))
• Peripherally actingPeripherally acting• benzonatate benzonatate 苯佐那酯苯佐那酯
![Page 6: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/6.jpg)
![Page 7: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/7.jpg)
Codeine Codeine 可待因可待因
O
N CH3
HO
H3CO
![Page 8: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/8.jpg)
• 1. 1. Pharmacological effectsPharmacological effects• suppression of coughsuppression of cough
• analgesiaanalgesia
• 2. 2. Clinical usesClinical uses• Cough without sputumCough without sputum
• 3. 3. Adverse effectsAdverse effects• Respiratory depression (at larger doses)Respiratory depression (at larger doses)
• AddictionAddiction• Contraindicated in patients with thick sputumContraindicated in patients with thick sputum
![Page 9: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/9.jpg)
DextromethorphanDextromethorphan 右美沙芬右美沙芬
![Page 10: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/10.jpg)
• 1. 1. Pharmacological effectsPharmacological effects• suppression of coughsuppression of cough• muscarinic and NMDA receptor antagonismmuscarinic and NMDA receptor antagonism
• 2. 2. Clinical usesClinical uses• Upper respiratory infection, cough without Upper respiratory infection, cough without
sputumsputum
• 3. 3. Adverse effectsAdverse effects• Atropine-like side effectsAtropine-like side effects• Contraindicated in patients with glaucoma, Contraindicated in patients with glaucoma,
pregnancy (< 3 m), psychotic disorders, pregnancy (< 3 m), psychotic disorders, etc.etc.
![Page 11: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/11.jpg)
PentoxyverinePentoxyverine
喷托维林喷托维林 ((咳必清咳必清 ))
![Page 12: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/12.jpg)
Pharmacological effectsPharmacological effects
• Suppression of coughSuppression of cough• Muscarinic antagonism and local Muscarinic antagonism and local
anesthetic effectsanesthetic effects• Uses and adverse effects are similar to Uses and adverse effects are similar to
dextromethorphandextromethorphan
![Page 13: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/13.jpg)
BenzonatateBenzonatate
苯佐那酯苯佐那酯
![Page 14: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/14.jpg)
Pharmacological effectsPharmacological effects
• Peripherally actingPeripherally acting• Blocking cough reflex Blocking cough reflex • Local anesthetic effectsLocal anesthetic effects• CNS depressionCNS depression
![Page 15: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/15.jpg)
2.2. ExpectorantsExpectorants
![Page 16: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/16.jpg)
Sputum-diluting drugsSputum-diluting drugs Stimulating bronchial secretionStimulating bronchial secretion Amonium chloride Amonium chloride 氯化铵氯化铵 Potassium iodide Potassium iodide 碘化钾碘化钾
Mucolytic drugsMucolytic drugs Bromhexine Bromhexine 溴己新溴己新 Ambroxol Ambroxol 氨溴索 氨溴索 Acetylcysteine Acetylcysteine 乙酰半胱氨酸乙酰半胱氨酸 Methylcysteine Methylcysteine 美司坦美司坦 Carbocisteine Carbocisteine 羧甲司坦羧甲司坦 Mesna Mesna 美司钠美司钠
![Page 17: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/17.jpg)
3.3. Antiasthmatic Antiasthmatic
drugsdrugs
![Page 18: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/18.jpg)
Asthma
• Asthma is physiologically characterized by increased responsiveness of the trachea and bronchi to various stimuli and by widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy.
• Its pathologic features are contraction of airway smooth muscle, mucosal thickening from edema and cellular infiltration, and inspiration in the airway lumen of abnormally thick, viscid plugs of mucus.
![Page 19: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/19.jpg)
![Page 20: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/20.jpg)
• Symptom: dyspnea, wheezing, stridor, coughing, an inability for physical exertion. The cough may sometimes produce clear sputum.
• Between episodes, most patients feel well but can have mild symptoms and they may remain short of breath after exercise for longer periods of time than the unaffected individual.
Asthma
![Page 21: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/21.jpg)
![Page 22: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/22.jpg)
inflammationinflammation bronchoconstrictionbronchoconstriction
Airway hyperresponsivenessAirway hyperresponsiveness
Immunological andImmunological and
non-immunological stimulinon-immunological stimuli
Wheezing (asthmatic Wheezing (asthmatic symptoms)symptoms)
glucocorticosteroidsglucocorticosteroids
disodium cromoglycate disodium cromoglycate
2 2 receptor agonistsreceptor agonists
TheophyllineTheophylline
muscerinic antagonistsmuscerinic antagonists
![Page 23: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/23.jpg)
Receptor agonistsReceptor agonists Non-selectiveNon-selective :: adrenaline, isoprotereroladrenaline, isoprotererol 22-selective: -selective: moderate-acting:moderate-acting: salbutamol, terbutalinesalbutamol, terbutaline long-acting:long-acting: salmeterol, formoterolsalmeterol, formoterol
Theophyllines:Theophyllines: aminophyllineaminophylline
Muscarinic antagonists:Muscarinic antagonists: ipratropine ipratropine
1. Bronchial dilators1. Bronchial dilators
![Page 24: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/24.jpg)
Glucocorticosteroids:Glucocorticosteroids: Systemic: Systemic: hydrocortisone, dexamethasonehydrocortisone, dexamethasone Inhalation: Inhalation: beclomethasone, budesonidebeclomethasone, budesonide
Inhibitors of mediator release: Inhibitors of mediator release: cromolyn sodium, nedocromilcromolyn sodium, nedocromil
2. Anti-inflammatory drugs2. Anti-inflammatory drugs
![Page 25: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/25.jpg)
Bronchial dilatorsBronchial dilators 22 receptor selective agonists receptor selective agonists
SalbuterolSalbuterol
沙丁胺醇沙丁胺醇
TerbutalineTerbutaline
特布他林特布他林
![Page 26: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/26.jpg)
1. 1. Pharmacological effectsPharmacological effects Relaxing bronchial smooth musclesRelaxing bronchial smooth muscles
2. 2. Clinical usesClinical uses Controlling asthmatic symptomsControlling asthmatic symptoms Given by Given by inhalationinhalation, oral or injection, oral or injection
3. 3. Adverse effectsAdverse effects Skeletal muscle tremorSkeletal muscle tremor Cardiac stimulation (larger doses)Cardiac stimulation (larger doses) Dysfunction of metabolism (hypokalemia, etc.)Dysfunction of metabolism (hypokalemia, etc.)
Salbuterol Salbuterol 沙丁胺醇沙丁胺醇
![Page 27: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/27.jpg)
Selectivity of Selectivity of 22 agonistsagonists
![Page 28: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/28.jpg)
Aerosol Aerosol inhalationinhalation
less systemic toxicity
![Page 29: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/29.jpg)
Spacer used for aerosol inhalationSpacer used for aerosol inhalation
定量手控定量手控
气雾器气雾器
![Page 30: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/30.jpg)
Spacer will aid patients Spacer will aid patients inhale the aerosolized inhale the aerosolized drugs easierdrugs easier
![Page 31: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/31.jpg)
22 receptor selective agonists receptor selective agonists
long-actinglong-acting
SalmeterolSalmeterol
FormoterolFormoterol
![Page 32: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/32.jpg)
TheophyllinesTheophyllines
AminophyllineAminophylline
N
N N
NH3C H
CH2NH2
2H2OCH2NH2
O
O
CH3--
--
--
--
2
. .
Bronchial dilatorsBronchial dilators
![Page 33: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/33.jpg)
1. 1. Pharmacological effectsPharmacological effectsBronchus dilationBronchus dilation
Inhibiting phosphodiesterase; Inhibiting phosphodiesterase;
Blocking adenosine receptors;Blocking adenosine receptors;
Increasing catecholamine release;Increasing catecholamine release;
Immunomodulation;Immunomodulation;
Increasing respiratory muscle contractility;Increasing respiratory muscle contractility;
CNS stimulation, diuretic, gastric acid CNS stimulation, diuretic, gastric acid secretion, etc.secretion, etc.
TheophyllinesTheophyllines
![Page 34: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/34.jpg)
2. 2. Clinical usesClinical uses Bronchial asthma (Bronchial asthma (p.o.p.o., , i.v.i.v.)) Others: Others: acute pulmonary edema, acute pulmonary edema, etc.etc.
3. 3. Adverse effectsAdverse effects GI reactionsGI reactions CNS stimulationCNS stimulation Acute toxication ( Acute toxication ( i.vi.v. injection too rapidly ). injection too rapidly )
tachycarida, arrhythmia, seizure, coma, deathtachycarida, arrhythmia, seizure, coma, death
TheophyllinesTheophyllines
![Page 35: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/35.jpg)
Muscarinic antagonistsMuscarinic antagonists
IpratropineIpratropine
O
C
CH2
CH2 CH2
C6H5CHOCH
CH3
CH3
CH
NCH3
CH
OH
(CH3)2CH
Bronchial dilatorsBronchial dilators
![Page 36: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/36.jpg)
• Relaxing bronchial smooth musclesRelaxing bronchial smooth muscles
• No effect on sputum secretionNo effect on sputum secretion
• Replaced with or combined with Replaced with or combined with 2 2 receptor selective agonistsreceptor selective agonists
![Page 37: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/37.jpg)
Systemic (adverse effect):Systemic (adverse effect): hydrocortisonehydrocortisone prednisoneprednisone dexamethasonedexamethasone Inhalation:Inhalation: beclomethasone dipropionatebeclomethasone dipropionate budesonidebudesonide triamcinolone acetonide triamcinolone acetonide fluticasone propionate fluticasone propionate flunisolideflunisolide
Glucocorticosteroids Glucocorticosteroids
![Page 38: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/38.jpg)
Beclomethasone dipropionateBeclomethasone dipropionate
O
HO
Cl
CH3
OCOC2H5
C O
CH2OCOC2H5
![Page 39: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/39.jpg)
1. 1. Pharmacological effects Pharmacological effects ((Antiinflammation)Antiinflammation) Inhibiting inflammatory cell activities, Inhibiting inflammatory cell activities, Antibody production, mediator release, Antibody production, mediator release, Inhibit increased responsiveness of the trachea and Inhibit increased responsiveness of the trachea and
bronchibronchi
2. 2. Clinical usesClinical uses As first-line drugs, currentlyAs first-line drugs, currently Controlling chronic symptomsControlling chronic symptoms Ineffective for acute symptomsIneffective for acute symptoms
Beclomethasone dipropionateBeclomethasone dipropionate
![Page 40: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/40.jpg)
Adverse effectsAdverse effects• Local:Local: oropharyngeal candidiasisoropharyngeal candidiasis -- using spacerusing spacer
• Systemic effects Systemic effects • a) Hypercorticism-like syndrome: central obesity a) Hypercorticism-like syndrome: central obesity (moon face, buffalo hump, etc.); hypertension; (moon face, buffalo hump, etc.); hypertension; glycosuria, hypokalemia; glycosuria, hypokalemia; etcetc..• b) Increasing susceptibility to infectionsb) Increasing susceptibility to infections• c) Ingestive system: peptic ulcers, c) Ingestive system: peptic ulcers, etcetc..• d) Cardiovascular system: hypertension, d) Cardiovascular system: hypertension, arteriosclerosisarteriosclerosis• e) Myopathy and osteoporosis: vertebral e) Myopathy and osteoporosis: vertebral compression fractures, spontaneous fractures, compression fractures, spontaneous fractures, especially in postmenopausal womenespecially in postmenopausal women• f) Adrenal suppressionf) Adrenal suppression
![Page 41: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/41.jpg)
Inhibitors of mediator releaseInhibitors of mediator release
O ONaOOC COONa
OCH2CHCH2O
OH
O O
Disodium cromoglycateDisodium cromoglycate ( cromolyn )( cromolyn )
![Page 42: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/42.jpg)
1. 1. Pharmacological effectsPharmacological effects Inhibiting mediator release from mast or other cellsInhibiting mediator release from mast or other cells Inhibiting sensory neuropeptide release and non-Inhibiting sensory neuropeptide release and non-
specific stimulus induced bronchus contractionspecific stimulus induced bronchus contraction
2. 2. Clinical uses (only inhalation)Clinical uses (only inhalation) Prevention of allergic asthmaPrevention of allergic asthma Acting slowly (2-4 weeks)Acting slowly (2-4 weeks)
3. 3. Adverse effectsAdverse effects Oropharyngeal irritationOropharyngeal irritation
Disodium cromoglycateDisodium cromoglycate
![Page 43: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/43.jpg)
![Page 44: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/44.jpg)
Other inhibitors of mediator releaseOther inhibitors of mediator release
• Nedocromil sodium: GI effectNedocromil sodium: GI effect
• TranilastTranilast
• KetotifenKetotifen (H(H11 receptor antagonist) receptor antagonist)
![Page 45: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/45.jpg)
Leukotriene pathway inhibitors
• Airways
LTC4, LTD4, LTE4----bronchoconstrictors, increase microvascular permeability, mucus secretion
LTB4----chemoattractant for neutrophils
• Leukotriene pathway inhibitors
CysLT1 receptor antagonist (zafirlukast):
for mild or moderate asthma, but not use alone
for acute asthma
5-LOX inhibitor (zileuton)
![Page 46: Antitussives, expectorants, and antiasmatic drugs Ximei Wu Dept. of pharmacology, ZJUMS](https://reader036.vdocuments.site/reader036/viewer/2022062301/56649e905503460f94b951ba/html5/thumbnails/46.jpg)