lecture 10 respiratory drugs

7/26/2019 Lecture 10 Respiratory Drugs

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RESPIRATORY DRUGS


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RESPIRATORY SYSTEM

RESPONSIBLE FOR MEDIATING GAS EXCHANG

BETWEEN THE EXTERNAL ENVIRONMENT AND

BLOODSTREAM

THE UPPER RESPIRATORY TRACT CONDUCTS

THE LOWER RESPIRATORY PASSAGES AND

ULTIMATELY TO THE LUNGS


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RESPIRATORY SYSTEM

HUMIDIFIES AND CONDITIONS INSPIRED AIR AND

TO PROTECT THE LUNGS FROM HARMFUL SUBSTA

GAS EXCHANGE TAKES PLACE BETWEEN THE ALV

AND THE PULMONARY CIRCULATION FUNCTION: MAINTAINING PROPER AIRFLOW THRO

THE RESPIRATORY PASSAGES


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RESPIRATORY DRUGS

FIRST GROUP

INCLUDES DRUGS THAT TREAT ACUTE AND

RELATIVELY MINOR PROBLEMS

EX. NASAL CONGESTION, COUGHING, ANDSEASONAL ALLERGIES


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RESPIRATORY DRUGS

SECOND GROUP

THE SECOND CATEGORY INCLUDES DRUG

TREAT MORE CHRONIC AND SERIOUS AIRW

OBSTRUCTIONS, EX. BRONCHIAL ASTHMA

CHRONIC BRONCHITIS, AND EMPHYSEMA


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RESPIRATORY THERAPY

PHYSICAL THERAPISTS AND OCCUPATIOTHERAPISTS WILL FREQUENTLY TREAT PATWITH BOTH ACUTE AND CHRONIC RESPIRA

CONDITIONS


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DRUGS USED TO TREAT AND CONT

RESPIRATORY TRACT IRRITATION A

SECRETIONS

TREAT SYMPTOMATIC COUGHING AND IRRITA

RESULTING FROM COMMON COLD, SEASONA

ALLERGIES, AND UPPER RESPIRATORY TRACT

INFECTIONS

MANY OF THESE DRUGS ARE FOUND IN OVE

COUNTER PREPARATIONS


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DRUGS USED TO TREAT AND CONT

RESPIRATORY TRACT IRRITATION A

SECRETIONS

SEVERAL DIFFERENT AGENTS ARE COMBINED IN THE SAME

COMMERCIAL PREPARATION

EX. A DECONGESTANT, AN ANTITUSSIVE, AND AN EXPECTORBE COMBINED AND IDENTIFIED BY A SPECIFIC TRADE NAME.

AGENTS WITHIN A SPECIFIC CATEGORY MAY HAVE PROPERTOVERLAP INTO OTHER DRUG CATEGORIES

CERTAIN ANTIHISTAMINES MAY ALSO HAVE ANTITUSSIVE PR


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ANTITUSSIVES

USED TO SUPPRESS COUGHING ASSOCIATED W

COMMON COLD AND FLU SYMPTOMS

USUALLY RECOMMENDED FOR SHORT-TERM USE

RELIEVING SYMPTOMATIC COUGHING

THE EXTENSIVE USE OF ANTITUSSIVES HAS BEE

QUESTIONED IN OUR SOCIETY


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ANTITUSSIVES

COUGHING IS A DEFENSE MECHANISM THAT HE

EXPEL MUCUS AND FOREIGN MATERIAL FROM T

UPPER RESPIRATORY TRACT

ANTITUSSIVES MAY REDUCE THE ABILITY OF CO

ANTITUSSIVES MAY BE HELPFUL IN TREATING AN

ANNOYING DRY COUGH

USE OF THESE DRUGS TO TREAT AN ACTIVE AND

PRODUCTIVE COUGH MAY NOT BE USTIFIED


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ANTITUSSIVES

THERE IS ALSO CONCERN THAT MANY ANTITUSS

ARE NOT REALLY EFFECTIVE IN TREATING COUG

OVER-THE-COUNTER PRODUCTS MAY NOT CONT

ADEQUATE AMOUNT OF THE ACTIVE MEDICATIOMAY BE NO MORE EFFECTIVE THAN PLACEBO IN

TREATING COUGH

DOSES THAT ARE EFFECTIVE IN TREATING COUG

ALSO PRODUCE SERIOUS SIDE EFFECTS


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ANTITUSSIVES

MECHANISM UNDER THE COUGH REFLEX CONTI

BE STUDIED SO THAT SAFER AND MORE EFFECT

ANTITUSSIVES CAN BE DEVELOPED

CODEINE AND SIMILAR OPIATE DERIVATIVES SUPTHE COUGH REFLEX BY A CENTRAL INHIBITORY


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ANTITUSSIVES

NONOPIOID ANTITUSSIVES INHIBIT THE IRRITANT EFF

OF HISTAMINE ON THE RESPIRATORY MUCOSA OR BY

LOCAL ANESTHETIC ACTION ON THE RESPIRATORY

EPITHELIUM

THE PRIMARY ADVERSE EFFECT ASSOCIATED WITH M

ANTITUSSIVES IS SEDATION, DI!!INESS AND

GASTROINTESTINAL UPSETMAY ALSO OCCUR


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COMMON ANTITUSSIVE AGENTS

GENERIC TRADE NAME

MOA

NAME

BEN!ONATATE TESSALON LOCA

ANESTHETIC EFFECT ON RESPIRATORY

CODEINE MANY TRADE NAMES INCOUGH REFLEX BY DIRECT EFFECT ON BRAINSTEM COU

CENTER

DEXTROMETHORPHAN MANY TRADE NAMES I

COUGH REFLEX "SIMILAR TO CODEINE# BUT IS NON- NARC


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COMMON ANTITUSSIVE AGENTS

GENERIC TRADE NAME

MOA

NAME DIPHENHYDRAMINE BENADRYLANTIHISTAMINE

HYDROCODONE DONATUSSIN, HYDROPANE SIMCODEINE TUSSIGON

HYDROMORPHONE ILAUDID SIMCODEINE


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DECONGESTANTS

CONGESTION AND MUCOUS DISCHARGE FROM T

UPPER RESPIRATORY TRACT ARE FAMILIAR SYMP

ALLERGIES, COMMON COLD, AND VARIOUS

RESPIRATORY INFECTIONS OFTEN PRODUCE A RNOSE AND A STUFFY HEAD SENSATION


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DECONGESTANTS

DECONGESTANTS USED TO TREAT THESE SYMPTOMS A

USUALLY ALPHA-$%ADRENERGIC AGONISTS

THESE AGENTS BIND TO ALPHA-$ RECEPTORS LOCATE

THE BLOOD VESSELS OF THE NASAL MUCOSA AND STI

VASOCONSTRICTION

EFFECTIVELY DRY UP THE MUCOSAL VASCULATURE

DECREASING LOCAL CONGESTION IN THE NASAL PASS


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DECONGESTANTS

AGENTS TAKEN SYSTEMICALLY OR APPLIED LOCA

THE NASAL MUCOSA VIA AEROSOL SPRAYS

OCCASIONAL USE OF THESE DRUGS CAN HELP T

SYMPTOMS RELATED TO NASAL CONGESTION


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DECONGESTANTS

MIMIC THE EFFECTS OF INCREASED SYMPATHET

NERVOUS SYSTEM ACTIVITY AND CAN CAUSE SE

CARDIOVASCULAR AND CENTRAL NERVOUS SYS

"CNS# EXCITATION EXCESSIVE USE OR ABUSE SHOULD BE AVOIDED


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DECONGESTANTS

PRIMARY ADVERSE EFFECTS ASSOCIATED ARE

HEADACHE, DI!!INESS, NERVOUSNESS, NAUSEA

INCREASED BLOOD PRESSURE, PALPITATIONS

THESE EFFECTS BECOME MORE APPARENT AT HDOSES AND DURING PROLONGED OR EXCESSIV

USE


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COMMON DECONGESTANTS

GENERIC NAME TRADE NAME

DOSAGE FORMS

EPHEDRINE RYNATUSS

OXYMETAZOLINE AFRIN, DRISTANNASAL SPRAY

$&-HR NASAL SPRAY

PHENYLEPHRINE NEO-SYNEPHRINENASAL SPRAY


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COMMON DECONGESTANTS

GENERIC NAME TRADE NAME

DOSAGE FORMS

PSEUDOEPHEDRINE DIMETAPPORAL

DECONGESTANT, SUDAFED

XYLOMETAZOLINE OTRIVIN SPRAY


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ANTIHISTAMINES

USED FOR SEDATION' TREATMENT OF PARKINSO

TREATMENT OF THE RESPIRATORY ALLERGIC RE

TO SEASONAL ALLERGIES "HAY FEVER, AND SO

AND OTHER ALLERGENS ARE ENDOGENOUS CHEMICALS THAT REGULATE

GASTRIC SECRETION, CNS NEURAL MODULATIO

HYPERSENSITIVITY


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ANTIHISTAMINES

EXERT ITS EFFECTS THROUGH ( PRIMARY RECEP

SUBTYPES:

H$, H&, H), AND H(

SPECIFICALLY BLOCK THE H$SUBTYPE OF HISTARECEPTORS

THE EFFECTS OF HISTAMINE DURING ALLERGIC

REACTIONS, RESPIRATORY INFECTIONS ARE MED

THROUGH THE H$ RECEPTOR LOCATED ON VASC


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ANTIHISTAMINES

DRUGS THAT SELECTIVELY BLOCK THE H& RECE

"REFERRED TO AS H& ANTAGONISTS# MAY HELP

CONTROL GASTRIC SECRETION IN CONDITIONS

AS PEPTIC ULCER

THE H) RECEPTOR IS INVOLVED IN THE LOCAL

REGULATION OF HISTAMINE RELEASE FROM CNS

TERMINALS

H( RECEPTOR HAS BEEN IDENTIFIED ON BLOOD


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ANTIHISTAMINES

THE CLINICAL AND PHARMACOLOGIC SIGNIFICANCE

AND H( RECEPTORS REMAINS TO BE DETERMINED

IT DECREASES NASAL CONGESTION BY BLOCKING TH

EFFECTS OF HISTAMINE ON THE UPPER RESPIRATORY

TISSUES, MUCOSAL IRRITATION AND DISCHARGE "RH

SINUSITIS#, AND CONUNCTIVITIS CAUSED BY INHALE

ALLERGENS


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ANTIHISTAMINES

DECREASE THE COUGHING AND SNEE!ING

ASSOCIATED WITH THE COMMON COLD

ANTIHISTAMINES MAY BE USED AS AN ADUNCT

PATIENTS WITH ASTHMA TO HELP CONTROL RHIAND SINUSITIS BUT DO NOT REVERSE BRONCHO


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ANTIHISTAMINE SIDE EFFECTS

PRIMARY ADVERSE EFFECTS ARE SEDATION, FAT

DI!!INESS, BLURRED VISION, AND INCOORDINA

GASTROINTESTINAL DISTRESS "NAUSEA, VOMIT

CERTAIN SIDE EFFECTS ARE RELATED DIRECTLY EACH DRUG*S ABILITY TO CROSS THE BLOOD-BR

BARRIER


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FIRST-GENERATION ANTIHISTAMINES READILY

THE BLOOD-BRAIN BARRIER AND ENTER THE BR

CAUSING AS SEDATION AND PSYCHOMOTOR SLO

NEWER SECOND-GENERATION ANTIHISTAMINENOT EASILY CROSS THE BLOOD BRAIN BARRIER,

HENCE, SEDATION AND OTHER CNS SIDE EFFEC

REDUCED SUBSTANTIALLY


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NEWER AGENTS, ALSO KNOWN AS NONSEDATING

ANTIHISTAMINES, INCLUDE CETIRI!INE "!YRTEC#, LOR

"CLARITIN#, DESLORATIDINE "CLARINEX#, AND FEXOF

"ALLEGRA

NEWER ANTIHISTAMINES ARE MORE SELECTIVE FOR T

RECEPTOR SUBTYPE AND PRODUCE FEWER SIDE EFF

RELATED TO OTHER HISTAMINE RECEPTORS


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ASTEMI!OLE AND TERFENADINE MAY BE CARDIOTOXIC, A

PROBLEMS SUCH AS SEVERE VENTRICULAR ARRHYTHMIA

"TORSADES DE POINTES#

NON-SEDATING AGENTS HAVE BECOME THE AGENTS OF

FOR MANY PEOPLE BECAUSE THEY DECREASE HISTAMINERELATED SYMPTOMS WITHOUT PRODUCING EXCESSIVE S

AND OTHER NEUROPSYCHIATRIC EFFECTS


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ANTIHISTAMINES GENERIC NAME TRADE NAME SEDAPOTENTIAL

A!ATADINE OPTIMINE

BROMPHENIRAMINE BROMPHEN,DIMETAPP

CARBINOXAMINE RONDEC LOW T

MODERATE

CETIRI!INE !YRTEC V

LOW

CHLORPHENIRAMINE CHLOR-TRIMETON


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CLEMASTINE TAVIST L

CYPROHEPTADINE PERIACTIN MO

DESLORATIDINE CLARINEX, AERIUS V

LOW

DEXCHLORPHENIRAMINE POLARAMINE L

DIMENHYDRINATE DRAMAMINE


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DIPHENHYDRAMINE BENADRYL

DOXYLAMINE UNISOM HIGSLEEP-AID

FEXOFENADINE ALLEGRA VLOW HYDROXY!INE ATARAX

MODERATE LORATADINE CLAVERY LOW


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PNINDAMIN NOLAHIST L

PYRILAMINE CODIMALMODERATE

TRIPELENNAMINE PB!

MODERATE

TRIPROLIDINE ACTIFED


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MUCOLYTICS AND EXPECTORANTS

MUCOLYTIC DRUGS ATTEMPT TO DECREASE THE VISCOS

RESPIRATORY SECRETIONS

EXPECTORANT DRUGS FACILITATE THE PRODUCTION AN

EECTION OF MUCUS

THESE DRUGS ARE USED TO PREVENT THE ACCUMULAT

THICK VISCOUS SECRETIONS THAT CAN CLOG RESPIRAT

PASSAGES AND LEAD TO PULMONARY PROBLEMS


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MUCOLYTICS AND EXPECTORANTS

EXPECTORANTS AND MUCOLYTICS ARE USED IN ACUTE

DISORDERS RANGING FROM THE COMMON COLD TO

PNEUMONIA, AS WELL AS IN CHRONIC DISORDERS SUC

EMPHYSEMA AND CHRONIC BRONCHITIS

THESE DRUGS ARE OFTEN USED IN COMBINATION WITHAGENTS "ANTITUSSIVES, DECONGESTANTS, BRONCHOD

SOME STUDIES HAVE DOCUMENTED THAT THESE DRUG

IMPROVE THE ABILITY TO EXPEL MUCUS AND INCREASE

PULMONARY FUNCTION


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MUCOLYTIC

THE PRIMARY MUCOLYTIC DRUG CURRENTLY IN USE IS ACETYL

THIS DRUG IS THOUGHT TO WORK BY SPLITTING THE DISULF

BONDS OF RESPIRATORY MUCOPROTEINS FORMING A LESS VI

SECRETION

ACETYLCYSTEINE ALSO HAS ANTIOXIDANT EFFECTS, AND SOMACETYLCYSTEINE*S BENEFITS MAY BE DUE TO ITS ABILITY TO

DECREASE FREE-RADICAL DAMAGE IN THE RESPIRATORY TISS


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MUCOLYTIC

ACETYLCYSTEINE IS USUALLY ADMINISTERED DIR

TO THE RESPIRATORY MUCOSA BY INHALATION O

INTRATRACHEAL INSTILLATION "THROUGH A

TRACHEOSTOMY#

THE PRIMARY ADVERSE EFFECTS ASSOCIATED W

THIS DRUG INCLUDE NAUSEA, VOMITING,

INFLAMMATION OF THE ORAL MUCOSA "STOMAT

AND RHINORRHEA


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EXPECTORANT

BUT GUAIFENESIN IS THE ONLY DRUG CURRENTL

ACKNOWLEDGED BY THE FDA TO HAVE EVIDENC

THERAPEUTIC EFFECTS

THIS DRUG IS ADMINISTERED TO INCREASE THEPRODUCTION OF RESPIRATORY SECRETIONS

ENCOURAGING EECTION OF PHLEGM AND SPUT


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EXPECTORANT

GUAIFENESIN, WHICH IS USUALLY ADMINISTERED ORALLY IN

FORM OF SYRUP OR ELIXIR OFTEN COMBINED WITH OTHER A

OVER-THE-COUNTER PREPARATIONS

EXACT MECHANISM OF ACTION IS NOT FULLY UNDERSTOOD

PRIMARY ADVERSE EFFECT ASSOCIATED WITH GUAIFENESIN GASTROINTESTINAL UPSET, WHICH IS EXACERBATED IF EXCE

DOSES ARE TAKEN OR IF THIS DRUG IS TAKEN ON AN EMPTY


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TAPOSNAPO+++


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lecture 10 respiratory drugs

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