DRUGS AFFECTING DRUGS AFFECTING THE RESPIRATORY THE RESPIRATORY ORGANS FUNCTIONORGANS FUNCTION

Lector prof. Posokhova K.A.Lector prof. Posokhova K.A.

Drugs affecting the respiratory organsDrugs affecting the respiratory organs function function

anticough drugsanticough drugs;;

expectorantsexpectorants;;

breathing stimulantsbreathing stimulants;;

drugs used for bronchial asthmadrugs used for bronchial asthma;;

drugs used for lungs edemadrugs used for lungs edema

COUGHCOUGH

with presence of secretion inwith presence of secretion in bronchibronchi

drydry

PRODUCTIVEPRODUCTIVESputum with significant viscous-elastic properties: - muco- and proteolytic drugsmuco- and proteolytic drugsSputum with significant adhesive properties: - drugs which stimulate production of surfactantdrugs which stimulate production of surfactantDecreasing of speed of mucociliar transport with unchanged properties of sputum: - drugs which stimulate ciliar functiondrugs which stimulate ciliar functionSignificant disorders of bronchial permeability, morphological changes of bronchi (atrophy of mucous membrane, bronchial stenosis), excessive production of mucus: - alkali inhalationsalkali inhalationsSigns of allergic reaction with increased histamine activity:- antihistamine drugsantihistamine drugs

NONPRODUCTIVENONPRODUCTIVECataral inflammation (usually viral), reflector and central cough: - anticough drugsanticough drugsSigns of allergic reaction: - antihistamine drugsantihistamine drugsBronchospasm: - broncholyticsbroncholytics

REHYDRANTS IN ALL CASESREHYDRANTS IN ALL CASES

Anticough drugsAnticough drugs

Drugs of central actionDrugs of central action ( (depress central depress central links of cough reflexlinks of cough reflex):):

а)а) narcoticnarcotic:: codeincodein, , dextromethorphandextromethorphan

б) б) nonnarcoticnonnarcotic:: glaucin hydrochlorideglaucin hydrochloride ((glauventglauvent), ), oxeladin citrate (tussuprex)oxeladin citrate (tussuprex)

Drugs of peripheral actionDrugs of peripheral action ( (block block sensitivesensitive receptors of cough receptors of cough reflexogenic zonesreflexogenic zones): ): libexinlibexin

Oxeladin citrateOxeladin citrate, Tussuprex, Tussuprex

Glaucin hydrochlorideGlaucin hydrochloride ( (glauventglauvent) + ) + ephedrineephedrine + + Sage oilSage oil

LibexinLibexin

ExpectorantsExpectorants

Secrete-motor drugsSecrete-motor drugs ( (stimulate expectorationstimulate expectoration):):а) а) drugs of reflex actiondrugs of reflex action: : drugs of medical plantsdrugs of medical plants, , sodium benzoatesodium benzoate, , bronchicum elixirbronchicum elixir, , mucaltinmucaltinб) б) drugs of resorbtive and local actiondrugs of resorbtive and local action: : bromide -bromide -sodium and potassiumsodium and potassium, , ammonium chlorideammonium chloride, , sodium sodium hydrocarbonatehydrocarbonate, , ether oilsether oilsBronchosecretolytic drugs Bronchosecretolytic drugs ((mucolyticsmucolytics))::а) а) proteolytic enzymesproteolytic enzymes: : tripsintripsin, , chimopsinchimopsin, , chimotripsinchimotripsin, , desoxyribonuclease desoxyribonuclease б) б) mucolyticsmucolytics: : acetylcysteinacetylcystein, , carbocysteincarbocysteinв) в) drugs which influence surfactant production or drugs which influence surfactant production or surfactantssurfactants: : bromhexin, ambroxol, “Alveofakt”, bromhexin, ambroxol, “Alveofakt”, “Ekzosurf”“Ekzosurf”

Drugs of medical plantsDrugs of medical plants

Althea officinalisAlthea officinalis ThermopsisThermopsis Viola Viola

Combined remedyCombined remedy “ “BronchicumBronchicum””

MucaltinMucaltin (Mucaltinum) (Mucaltinum)

Drugs of medical plantsDrugs of medical plants

Ledum palustraeLedum palustrae Origanum vulgarisOriganum vulgaris

Crystal tripsinCrystal tripsin (Trуpsinum crystallisatum) (Trуpsinum crystallisatum) Ampoules -Ampoules - 0,005 0,005 gg andand 0,01 0,01 gg

AcetylcysteinAcetylcystein (Acetylcysteinum) (Acetylcysteinum) Forms of production:Forms of production: tablets - tablets - 0,1, 0,2 0,1, 0,2 andand 0,6, 20 % 0,6, 20 % solution for inhalation in ampoules –solution for inhalation in ampoules –

5 5 andand 10 10 mlml; 10 % ; 10 % solution for injection in ampoules -solution for injection in ampoules - 2 2 ml andml and 5 % 5 % solution in ampoules –solution in ampoules – 10 10mlml. .

BromhexinBromhexin (Bromhexinum) (Bromhexinum)

АmbroxolАmbroxol (Lasolvan) (Lasolvan)Forms of productionForms of production: : tablets -tablets - 0,03 0,03 and syrupand syrup..

COUGHCOUGHDry Dry

With presence of sputum in bronchiWith presence of sputum in bronchi

PRODUCTIVEPRODUCTIVESputum with significant viscous-elastic properties - muco- and proteolytic muco- and proteolytic

drugsdrugsSputum with significant adhesive properties - drugs which stimulate drugs which stimulate

production of surfactantproduction of surfactantDecreasing of speed of mucociliar transport with unchangedproperties of sputum - drugs which stimulate cilia functiondrugs which stimulate cilia functionSignificant disorders of bronchial permeability, morphological changes of

bronchi (atrophy of mucous membrane, bronchial stenosis), excessive production of mucus - alkali inhalations

Signs of allergic reaction with increased histamine activity - antihistamine antihistamine drugsdrugs

NONPRODUCTIVENONPRODUCTIVECataral inflammation (usually viral), reflector and central cough - anticough anticough

drugsdrugsSigns of allergic reaction - antihistamine drugsantihistamine drugsBronchospasm - broncholyticsbroncholytics

REHYDRANTS IN ALL CASES

Stimulants of breathingStimulants of breathing ((analepticsanaleptics))

Analeptics of direct actionAnaleptics of direct action: : bemegrid, bemegrid, ethymisol, caffeineethymisol, caffeine

Analeptics of mixed actionAnaleptics of mixed action: : cordiamin, cordiamin, camphorcamphor, , carbon acidcarbon acid ( (carbogen – carbogen – mixture of Omixture of O22 and CO and CO22))

Analeptics of reflex actionAnaleptics of reflex action: :

lobelin, cytitonlobelin, cytiton

AethimizolAethimizol (Aethimizolum) (Aethimizolum)Sodium caffeine-benzoateSodium caffeine-benzoate (Coffeinum-natrii (Coffeinum-natrii

benzoas)benzoas)BemegridBemegrid (Bemegridum) (Bemegridum)

CordiaminCordiamin (Cordiaminum) (Cordiaminum)Camphor Camphor (Camphora)(Camphora)

DRUGS FOR BRONCHIAL DRUGS FOR BRONCHIAL ASTHMAASTHMA

To remove attack of bronchial To remove attack of bronchial asthma asthma

Broncholytic drugsBroncholytic drugs::AdrenomimeticsAdrenomimetics ( (αα,, ββ--adremonimeticsadremonimetics, , ββ--adrenomimeticsadrenomimetics, , ββ22--adrenomimeticsadrenomimetics))MethylxantinesMethylxantinesCholinoblockersCholinoblockers ( (MM--cholinoblockerscholinoblockers, , ganglionblockersganglionblockers))

Antiallergics and drugs that reduce Antiallergics and drugs that reduce airway hyperresponsivenessairway hyperresponsivenessExpectorants Expectorants

Beta-adrenomimeticsBeta-adrenomimetics

SalbutamolSalbutamol, , Ventolin,Ventolin, Berotek,Berotek, AsthmopentAsthmopent

MethylxanthinesMethylxanthinesTheophyllinTheophyllin (of prolonged action)(of prolonged action)

M-cholinoblockersM-cholinoblockersAtropine sulfateAtropine sulfate, , Solutan, Ipratropii bromidum Solutan, Ipratropii bromidum

(Atrovent)(Atrovent)

Inhibitors of mast cells degranulationInhibitors of mast cells degranulation

Cromolyn, KetotifenCromolyn, Ketotifen and and NNedocromiledocromil antagonize antigen-induced (IgE-mediated) antagonize antigen-induced (IgE-mediated) mast cell degranulation mast cell degranulation

they prevent the release of histamine and slow-they prevent the release of histamine and slow-reacting substance of anaphylaxis (SRS-A) - reacting substance of anaphylaxis (SRS-A) - mediators of type I allergic reactionsmediators of type I allergic reactions

their beneficial effects in the treatment of their beneficial effects in the treatment of asthma are largely asthma are largely prophylacticprophylactic

KetotifenKetotifen

TiladeTilade ( (sodium nedocromilsodium nedocromil))

Corticosteroid hormones in the Corticosteroid hormones in the management of asthmamanagement of asthma

In 1991- guidelines for the diagnosis and In 1991- guidelines for the diagnosis and management of asthma were published by management of asthma were published by the National Asthma Education Program the National Asthma Education Program (USA). This report described the patho-(USA). This report described the patho-physiology of asthma including airway physiology of asthma including airway obstruction, airway inflammation, and obstruction, airway inflammation, and airway hyperresponsiveness. airway hyperresponsiveness. Since then, Since then, corticosteroids have moved to corticosteroids have moved to the forefront in the treatment of asthmathe forefront in the treatment of asthma..

Inhaled corticosteroidsInhaled corticosteroids

BeclomethasoneBeclomethasone BudesonideBudesonide

Dexamethasone Dexamethasone Flunisolide Flunisolide Fluticasone Fluticasone

TriamcinoloneTriamcinolone

Administration corticosteroids by inhalation Administration corticosteroids by inhalation limits the systemic adverse reactions limits the systemic adverse reactions

associated with oral or parenteral therapy associated with oral or parenteral therapy

Administration of inhaled corticosteroidsAdministration of inhaled corticosteroids

by the use of chambers or spacers by the use of chambers or spacers these devices help decrease systemic these devices help decrease systemic absorption and subsequent adverse absorption and subsequent adverse reactions of the corticosteroids reactions of the corticosteroids most inhaled therapy is delivered via most inhaled therapy is delivered via metered dose inhalersmetered dose inhalersother method - the breath-actuated dry other method - the breath-actuated dry powder inhaler devices (Rotahaler, powder inhaler devices (Rotahaler, Diskhaler, Turbuhaler) Diskhaler, Turbuhaler)

PrednisolonPrednisolon, , HydrocortizoneHydrocortizone, , DexamethazoneDexamethazone..

Potential role in the treatment of Potential role in the treatment of asthmaasthma

ZileutonZileuton - a 5-lipoxygenase inhibitor - a 5-lipoxygenase inhibitor

ZafirlukastZafirlukast - a leukotriene-receptor antagonista leukotriene-receptor antagonist

Leukotrienes attract cellular infiltrates producing Leukotrienes attract cellular infiltrates producing epithelial injury, abnormalities in neural epithelial injury, abnormalities in neural mechanisms, increases in airway smooth muscle mechanisms, increases in airway smooth muscle responsiveness, and airway obstructionresponsiveness, and airway obstruction

DRUGS FOR LUNGS EDEMADRUGS FOR LUNGS EDEMA

Classification of lungs edema::

Cardiogenic Cardiogenic

Toxic Toxic

NeurogenicNeurogenic

Caused by prolonged inspire Caused by prolonged inspire resistanceresistance

Treatment measures for lungs edemaTreatment measures for lungs edema

а) а) decreasing of hydrostatic pressure in pulmonary decreasing of hydrostatic pressure in pulmonary vessels vessels and decreasing of cardiac inputand decreasing of cardiac input bb) ) decreasing the volume of blood circulation decreasing the volume of blood circulation c) lungs dehydrationc) lungs dehydration dd) ) decreasing of permeability of alveolar-capillary decreasing of permeability of alveolar-capillary membranesmembranes ee) ) improvement of tissue oxygenationimprovement of tissue oxygenation, , renewing of renewing of respiratory ways penetrability,respiratory ways penetrability, removing the foam in removing the foam in alveolialveoli f) correction of acid-base and electrolyte balancef) correction of acid-base and electrolyte balancegg) ) removal of pain syndrome and acute disorders of removal of pain syndrome and acute disorders of heart rhythmheart rhythmg)g) strengthening of contractive ability of myocardium strengthening of contractive ability of myocardium and fighting with bronchospasmand fighting with bronchospasm

Morphine hydrochlorideMorphine hydrochloride(Morphini hydrochloridum)(Morphini hydrochloridum)

GANGLIONBLOCKERSGANGLIONBLOCKERSHygroniumHygronium, , PentaminPentamin

VasodilatorsVasodilatorsNitroglycerinNitroglycerin (Nitroglycerinum) (Nitroglycerinum)

NitromintNitromint

DiureticsDiuretics

Furosemid Furosemid ((LazixLazix), ), MannitMannit

Modified Bobrov’s apparatusModified Bobrov’s apparatus(Alcohol 55-90 % for inhalation with oxygen – to reduce (Alcohol 55-90 % for inhalation with oxygen – to reduce

the foam in alveoli)the foam in alveoli)

DimedrolDimedrol, , SuprastinSuprastin, , PrednisolonePrednisolone