slide 30 is about respiratory system

1. Pharmacology
Slide-30
Respiratory system

2. Cough remedies
• Cough : is a reflex where the stimulus may arise
from inflammation or foreign material in the
pharynx, larynx, trachea or bronchial tree.
• It is therefore advantageous to aid the removal
of foreign material from the respiratory passage
and increase the secretions of bronchial tree and
thus ‘loosening’ the sputum.

3. Expectorants
• They’re drugs that drugs that loosen the
sputum and thus aid it’s ejection from the
bronchial tree.
Examples : Ammonium chloride-ipecacuanha,
Guaifenesin, they are useful comes a syrups
preparation given orally.

4. Expectorants
• Cough suppressants (Anti-tussive drugs):
• - Sometimes it’s advantageous to suppress a
cough that is tiring the patient and serving no
useful purposes but in the other hand undue
suppression of a cough can lead to sputum
retention and thickening.
• - anti-tussives drugs should not used in
patients with chronic bronchitis, bronchiectasis
and asthma.

5. Expectorants
• Classes of cough suppressants:
• A) Demulcents:
• These drugs inhibit the cough arising from
irritation of the mucous membranes of the
mouth and throat, by soothing action which
from a protective film over the inflamed area.
• Examples: simple linctus which comes as
syrup and should not be given to diabetic
patients bcz it contains sugar.

6. Expectorants
• B) Opioids:
• 1. Codeine: which is the most popular of this group,
it was included in linctus codiene.
• side effects: Sleep disturbances, constipations.
• 2. Dextromethorphan.
• 3. Pholcodine:
• Related to codeine and it depresses cough centers.
• It is more active than codeine and it’s action lasts 4-
6 hours.

7. Expectorants
• C) Antihistamines:
• These drugs have some anti-tussives effect
through a local antihistamines action and more
through the sedatives effects on the nervous
system.

8. Inhalation and mucolytics agents
• Mucolytic drugs are those which used to liquefy
mucus.
• Examples :
• 1. Bromhexin (Bisolvon®)
• 2. Ambroxol (Mucosolvan®)
-steam a very good expectorant as it liquifies
the sputum and thus enables it to be coughed.

9. Inhalation and mucolytics agents
- Benzoin tincture when added to hot water,
the volatile oil is given off and inhaled, it exerts a
mildly soothing effect on the bronchial mucous
membrane, and it is frequently used in acute
bronchitis.
- Menthol and eucalyptus can be used in
the same way; they are used postoperatively to
avoid chest infection.

10. Pulmonary surfactants
• The function of surfactants is to allow the surface of
pulmonary alveoli to separate so that the lung can
expand and function immediately after birth.
• When those substances are lacking especially with
premature infants, it will lead to formation of
respiratory distress syndrome which need
immediate treatment with mechanical ventilators
and inhalation through the use of endotracheal
tube (ETT) of colfosceril palmitate which is the
synthetic surfactants.

11. Notes
• Avoid dehydration, giving hot drinks and
physiotherapy are more effective than medicines
in clearing the chest.
• It is important to avoid sedatives which will
further depress respiration and causes
deterioration in the patient’s conditions.

12. Asthma
• Is obstructive pulmonary disease that is
characterized of a reversible airflow
obstruction arise as inflammation and hyper-
responsive to a variety of stimuli.
• Asthmatic attacks are precipitated by trigger
factors such as infections, exercise, various
allergies and psychological factors that
release substances in the bronchial wall causes
spasm and inflammations.

13. Asthma
• Attacks are due to narrowing in the airways
and maybe due to edema in the pulmonary
system (inflammation).
Drug classes used in asthma:
1- Bronchodilators
2- Corticosteriods
3- Sodium Cromoglicate
4- Leukotriene modifiers

14. A. Bronchodilators
• 1. β2-agonists:
• Widely prescribed, given by inhalation, S.C, oral.
• When given by inhalation they treat a developing
attack or to prevent an attack, but they do not
control the inflammatory component of the
asthma.
• Examples:
• Terbutaline
• Salbutamol (Ventolin®)

15. A. Bronchodilators
• 2. Methylxanthines:
• Inhibit phosphodiesterase enzyme to relive
spasm and cause relaxations.
• Taken with a carefully measured dose bcz there
is a small difference between therapeutic and
toxic dose.
• Oral or I.V infusion.
• Aminophylline treat acute attacks by I.V
infusion.

16. A. Bronchodilators
• 3. Anticholinergic drugs:
• Ipratropium Bromide (Atrovent®):
• Given by inhaler or nebulizer.
• Given to patients not responded to beta2
agonists.
• Side effects: unpleasant taste, dry mouth due
to blocking of salivation.

17. B. Corticosteroids
• Reduce the inflammatory and allergic aspects
of asthma and decrease bronchospasm.
Examples (inhalation):
-Beclomethasone (Becotide®)
- Fluticasone (Flixotide®)

18. C. Sodium cromoglycate (Intal®)
• Relive asthmatic attacks by preventing the
secretions caused by the inflammation (work as
anti-histamines).
• By pressurized aerosols 4 times daily
• Effective mostly in young patients with allergy
history.
• Example: Nedocromil .

19. D. Leukotriene Modifiers
• Leukotrienes are substances produced by
leukocytes involved in the inflammatory actions.
• These drugs prevent spasm either by blocking
the action of leukotrienes or by preventing the
inflammation.
• Example
• Montelukast over 6 years of age only.

20. Status asthmaticus
• Management:
• 1- ensure adequate hydration of the patient.
• 2- give bronchodilators.
• 3- Give I.V hydrocortsione
• 4-never use sedatives bcz of the respiratory distress
risk
• 5- treat chest infections if present
• 6- give oxygen if required.
• If no response occur put patient on artificial
ventilation