medical pres.pptx
TRANSCRIPT
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COUGH
Cough is a sudden and often repetitively occurring reflex which
helps to clear the large breathing passages from secretions,
irritants, foreign particles and microbes.
COLDThe common cold is a viral infectious disease of the upper
respiratory tract which affects primarily the nose. Symptomsinclude coughing, sore throat, runny nose, sneezing,and fever which usually resolve in seven to ten days, with somesymptoms lasting up to three weeks.
Usually referred to as the flu or influenza is a highly infectiousrespiratory disease. The disease is caused by certain strains ofthe influenza virus. When the virus is inhaled, it attacks cells inthe upper respiratory tract, causing typical flu symptoms suchas fatigue, fever and chills, a hacking cough, and body aches.
FLU
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BRONCHOCONSTRICTIONBronchoconstriction is defined as the narrowing of the airways
in the lungs (bronchi and bronchioles). Air flow in air passagescan get restricted due to 3 factors:
A spasmodic state of the smooth muscles in bronchi and bronchioles
An inflammation of the airways
Excessive production of mucus due to an allergic reaction or irritationcaused by mechanical friction of air (due to shear stress), overcooling ordrying of airways.
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TRIGGERING AGENTS:
INFLAMMATORY FACTORS: Allergens, respiratory
infections(flu ,cold), work IRRITANTS: cold air, sudden temperature changes, stress
exercise strong odor.
OTHERS: smoking, medications like ACE inhibitors, food
additives, gastric reflux, pollutants . Fumes. ( epoxyresins, plastic,)Organic and chemical dust.
(Woodworkers, cotton , platinum)Gases( like toluene,
nitrous oxide),Food processing, Chemical processing,
Textile, plastics and rubber manufacture
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PATHOPHYSIOLOGICAL FEATURES:
Airway hyperresponsiveness (contract too much ,
too easily spontaneously, in response to exogenous
and endogenous stimuli)
Air flow obstruction
Inflammation
Mucous hypersecretion
Airway remodeling ( in some patients
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PATHOPHYSIOLOGY OF COUGH:MEDIA
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MEDIATORS RELEASED:
MEDIATORS EFFECTS
1) Leukotrines Bronchoconstriction
Increased vascular permeability
Increased mucous secretion
1) Platelet activating factor Aggregation of platelets
Release of histamine1) Histamine
( is not consider important
mediator as anti histamine do no
provide benefit )
Bronchoconstriction
Increased mucous secretion
1) Prostaglandin D2 Bronchoconstriction
Increased vascular permeability
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TREATMENT OF COUGH COLD AND FLU:
TREATMENT STRATEGY:
Decrease mucous secretion
Bronchodilation
Decrease inflammation
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ALLOPATHIC TREATMENT:
Mucokinetics
are a class of drugs which aid in the clearance ofmucus from the airways, lungs, bronchi, and trachea.Such drugs can be further categorized by theirmechanism of action.
expectorants
mucolytic agents
An expectorant (from the Latin expectorate, to expel fromthe chest) works by signaling the body to increase theamount or hydration of secretions, resulting in more yetclearer secretions and as a byproduct lubricating theirritated respiratory tract. One expectorant guaifenesin is
commonly available in many cough syrups. ADRs:nausea, vomiting, dizziness,itching,kidney stones byguaifenesin
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A mucolytic agent : Acetylcystein,tyloxapolis an agent which dissolves thick mucus and is usuallyused to help relieve respiratory difficulties. It does so bydissolving various chemical bonds within secretions,which in turn can lower the viscosity by altering themucin-containing components. Acetylcystein reducesdisulfide linkage of mucoproteins.
Expectorant increases bronchial secretions andmucolytics help loosen thick bronchial secretions.Expectorants reduce the thickness or viscosity ofbronchial secretions thus increasing mucus flow that canbe removed more easily through coughing, Mucolyticsbreak down the chemical structure of mucus molecules.The mucus becomes thinner and can be removed moreeasily through coughing.
ALLOPATHIC TREATMENT: (CONT)
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ANTI-TUSSIVE DRUGS:
BRANDS AVAILABLE: Delsym (dextromethorphan) ,
Tessalon (benzonatate ) , Robitussin DM
( dextromethorphan/guaifenesin)
Centrally acting: Codeine phosphate, morphine,
dextromethorphane ,antihistamines like diphenhydramine. ACTIONS: Depression of modularly centres or associated
higher centres and Increased threshold of cough centre.
Peripherally acting: Tincture benzoin and menthol
ACTIONS: Interruption of tussle impulses from respiratorytract, having soothing effect.
ADRs: Headache, Dizziness, Pruritis, Nasal Congestion
,burning of eyes & tightness in chest.
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SYMPATHOMIMETIC DRUGS :
BETA 2 AGONISTS:salbutamo/albuterol,terbutaline
salmeterol, formeterol
AVAILABLE BRANDS:ventoli(salbutamol),
aerolin(salbutamol)
ACTIONS: Inhaled beta2-agonists are bronchodilator
medications by increasing level of c AMP in and around
the tightened airways so that the airways reopen.
Used in acute excerbations for relieving symptoms of
coughing and wheezing.
ADRs: in high dose also act on beta-1 & gives
palpitation, muscle tremors, tachysardia , Restlessness
Headache.
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CORTICOSTEROIDS(GLUCOCORTICOIDS):
AVAILABLE BRANDS:
Oral: prednisolone(deltacotril) , Dexamethasone(decadron)
IV:Hydrocortisone(cortef 100mg)
Inhaler:Betamethasone , Beclomethasone(bekson , betatec)
ACTIONS: anti-inflammatory action by decreasingthe
release of mediators ,mucus production,permeability of vessels so, relieve smooth musclesspasm (bronchospasm).
ADRs:oral thrush, stomach irritation ,nausea,insomnia, muscle weakness, tachycardia, high B.P.
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MAST CELL STABALIZERS:CROMOLYN,
NEDOCROMOLYN
AVAILABLE BRANDS:
cromolin(sodium cromoglycate),cromogol(sodium
cromoglycate)
ACTIONS:Inhibit degranulation of mast cells &inhibit release of mediators e.g:histamine , cytokine
etc. ,causing inflammation.Pre-treatment block
allergen or exercise induced bronchoconstriction.
ADRs.: cough , throat irritation,bitter taste
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METHYLXANTHINES:
AVAILABLE BRANDS
theophylline (quibron), aminophyline(amphyll)
ACTIONS: It block the Phosphodiesterase enzyme
that convert cAMP to 5-AMP, so increase cAMP andgives bronchodilation.
It is less recommended to use because of
NTI(naarrow therpeutic index)
ADRs:Insomnia Upset stomach,Gastroesophadealreflux symptoms
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LEUKOTRINES ANTAGONISTS:
AVAILABLE BRANDS:
montelukast (myteka), zafrilukast
ACTIONS:By selectively block csyteinyl
leukotriene receptor so, relax airway smoothmuscles.
ADRs: GI upsets, headache,
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ANTICHOLINERGICS:
AVAILABLE BRANDS
Ipratropium(atem), tiotropium(spiriva), atropine
ACTIONS:It blockM3 muscarinic receptors located onsmooth muscle cells and submucosal glands leading to areduction in smooth muscle contraction and mucus secretion,
thus producing a bronchodilatory effect. ADRs:Dry mouth and throat irritation, sedation, blurred
vision.
ANTI IGEMAB(OMALIZUMAB)
ACTIONS:A recombinant DNA derived from monoclonal Ab
bind to IgE Ab leads to decrease binding of IgE to receptors onbasophil & mast cells,
ADRs:wheezing, tightness in your chest, trouble
breathing;hives or skin rash;feeling anxious or light-headed,
fainting;
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CUFFIX AS A TREATMENT OF COUGH
COLD AND FLU:
DISCRIPTION: Cuffix cough syrup is a brownish
yellow viscous liquid with palatable taste.
COMPOSITION:
const i tuent Quant i ty in each 5mlEphedra gerardiana 66.6mg
Adhatoda vasica 83.3mgGlycyrrhiza Glabra 83.3mgHyssopus officinalis 83.3mgPapaver somniferous 83.3mgZizyphus vulgaris 83.3mgHyoscyamus niger 83.3mg
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INDICATIONS:
Cuffis syrup is indicated in the treatment of
Cough Cold
Flu
Sore throat
Chest congestion
Stuffed nose
SPECIFICATIONS:
Established safety and efficacy
Fast onset of action
Long duration of action
Non drowsy formula helps you to actively fight against thesymptoms of cold and flu.
Natural and effective broad spectrum coverage
So safe that Cuffix can b given to children with no side effects.
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CLINICAL PHARMACOLOGY:
Cuffix syrup completely relief the symptoms of cough , cold and flu bymultiple mode of actions.
ADHATODA VASICA: it contain vasicin inhibit 5HT receptors thusinhibiting histamine induced bronchoconstriction as well as act amucolytic when it act on mucous formative stage on the glands within themucus secreting cell depolymerasing and hydrolyzing fiber ofmucopolysaccharides resulting in the decreased viscosity and elasticityof tracheal mucus.
EPHEDRA GIARDIANA: it contains ephedrine which causes indirectstimulation of adrenergic receptors to increase the activity ofnorepinephrine at post syneptic beta 2 receptors and they causebronchodilaion and relaxation of smooth muscles of airways.
GLYCYRRHIZA GLABRA: it contains glycyrrhizin which inhibitphospholipase A2 inhibiting the inflammatory process and also act asantileukotrienic agent.
PAPAVER SOMNIFERRUM: it contain codein and morphine which areopiod receptor agonists suppress cough reflex by direct action on coughcenter.
HYOCYAMUS NIGER: it contains hyocyamine and scopolamine whichare potent ACH inhibitor and inhibit the ACH induced bronchoconstrictionand mast cells degradation which release histamine.
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PHARMACOKINETICS:
Cuffix cough syrup is 75% absorbed orally and
plasma half life is 3-11 hours.