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Respiratory System Disorders (Asthma & COPD ..)

This document discusses respiratory system disorders including asthma, COPD, allergic rhinitis, and cough. [1] Drugs used for treating asthma include beta-2 agonists, corticosteroids, leukotriene antagonists, mast cell stabilizers, and omalizumab. [2] COPD treatment involves bronchodilators, inhaled corticosteroids, and antibiotics. [3] Allergic rhinitis is treated with antihistamines, decongestants, corticosteroids, and cromolyn.

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35 views5 pages

Respiratory System Disorders (Asthma & COPD ..)

This document discusses respiratory system disorders including asthma, COPD, allergic rhinitis, and cough. [1] Drugs used for treating asthma include beta-2 agonists, corticosteroids, leukotriene antagonists, mast cell stabilizers, and omalizumab. [2] COPD treatment involves bronchodilators, inhaled corticosteroids, and antibiotics. [3] Allergic rhinitis is treated with antihistamines, decongestants, corticosteroids, and cromolyn.

Uploaded by

KC Palattao
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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:Lecture 13

Respiratory System Disorders


(Asthma & COPD…..)

1
:Respiratory System Disorders*
:Drugs for Asthma Drugs for allergic :COPD :Cough
:Rhinitis
- adrenergic agonists .1 .adrenergic agonists .1  adrenergic agonists .1 Antitussives .1
.Corticosteroids .2 .Corticosteroids .2 Corticosteroids .2 Expectorants .2
Mast cell stabilizers .3 Cromolyn .3 Ipratropium .3 Mucolytics .3
Ipratropium .4 Antihistamines .4 .Tiotropium .4
Leukotriene antagonists .5
Omalizumab .6
Theophylline .7

I. Drugs for Asthma: persistent cough

:Classification of Asthmatic attacks*


:Classification Symptoms of broncho- :Spirometry Long term ttt :Quick relief
:constrictive episodes )FEV1(
Mild- .1 per week 2 ≤ Near normal No daily medication
:intermittent 80% >
Mild .2 per week 2 > Near normal Low doses of
Short acting
persistent % 80 ≥ corticosteroids
agonists
Moderate .3 Daily % 60-80 Low doses of
:persistent corticosteroids + long
agonists
Severe .4 Continuous 60% < High doses of
persistent corticosteroids + long
agonists

:- adrenergic agonists .1

Short acting- adrenergic agonists Long acting - adrenergic agonists


.Albuterol- Terbutaline- Pirbuterol (APT) Salmetrol- Formetrol (SF) → chemical analogs for
.Albuterol with lipophilic side chain
Quick relief: 5- 30 min→ 4-6 hrs Long term control: 12 hrs & used as adjunctive
.therapy with long acting corticosteroids
. S.E: Tachycardia, Hyperglycemia, Hypokalemia & Hypomagnesaemia
:Q) A common S.E of  agonist is
.Hypokalemia
N.B: Long acting agonist shouldn't be used alone while short acting could be used in mild
.intermittent alone

2
.Corticosteroids: Beclomethasone, Fluticasone, Triamcinolone )2
.D.O.C in persistent asthma (mild, moderate & severe)*

:Route of Administration*
:Inhalation )1
. Metered-dose→ slowly & deeply*
Dry powder→ rapidly & deeply→ deposition in the oral & laryngeal mucosa *
.can cause oropharyngeal candidiasis & hoarseness
. Patient counseling→ rinsing (swish & spit)
:Oral/ systemic )2
Patients with severe exacerbation of Asthma I.V methyl prednisolone *
.Oral prednisone
Withdrawal within 1-2 weeks (depression of hypothalamus- pituitary & adrenal *
.axis will not occur)
:Spacers )3
deposition of drug in the mouth caused by improper inhalation ↓*
.Important for Children < 5 years & elderly*

.Leukotriene Antagonists: Montelukast, Zafirlukast & Zileuton )3


& M.O.A: Arachidonic à Lipoxygenase Leukotriene LTB4 *
. Cysteinyl leukotriene LTC4 LTD4 & LTE4

.Zileuton → 5- Lipoxygenase inhibitor→ (-) LTB4 & Cysteinyl leukotrienes*


.Montelukast & Zafirlukast→ Cysteinyl leukotriene receptor antagonist*
.Montelukast→ available dosage for children (chewable & granules)*
.Prophylaxis not in acute attacks**
.dose of - agonist & Inhaled corticosteroids (ICs) ↓**
:Adverse effects*
Hepatic enzyme in serum ↑ )1
Eosinophilic Vasculitis = Chrug- Strauss syndrome (inflammation of blood )2
.vessels)

Mast cell stabilizers→ Cromolyn & Nedocromyl )4


.Prophylactic anti-inflammatory agents*
.Cromolyn→ inhaled powder or aerosol → (S.E: mild bitter taste) *
.Useful in Allergic Rhinitis*

"Cholinergic Antagonists: "Ipratropium Bromide )5


.Quaternary derivative of Atropine*
.vagal contraction of bronchial smooth muscle & ↓ mucous secretion ↓*
.Not used unless COPD is present→ bec. it decreases mucous secretion *
."Theophylline: "bronchodilator for chronic Asthma )6
.It provides relief for airway obstruction & ↓ symptoms*

3
Have narrow therapeutic Index→ High doses Seizures*
.Fatal arrhythmias
. N.B: Pamabrom (Theophylline derivative): used in ttt of PMS
:Omalizumab )7
Recombinant-DNA monoclonal antibody binds to human Ig E & Prevents *
binding to its receptors on mast cells & basophiles
.↓Release of mediators
II. COPD: Chronic irreversible obstruction of airflow
.ttt: Combination of Albuterol & Ipratropium*
.Combination of Salmetrol & Ipratropium→ less frequent dosing *
.Inhaled corticosteroids is restricted to FEV< 50%*

:Stage :Characteristics :Long term control


:Mild COPD )1 FEV> 80% Bronchodilator (short acting) when
.needed
:Moderate COPD )2 FEV 50-80% Bronchodilator + Inhaled corticosteroids
:Severe COPD )3 FEV < 30% Bronchodilator + Inhaled corticosteroids
.+ Antibiotics + long term O2 therapy
:III. Allergic Rhinitis
.ttt Combination of oral antihistamines + decongestants

:A) Antihistamines Diphenhydramine, Chlorpheniramine, Loratidine & Fexofenadine


.In combination with decongestants in case of Rhinitis *
.available as Ocular & Nasal drops (OTC)*
.S.E. of 1st generation→ sedation, dry mouth, ↓ urination & constipation*
B) - Adrenergic . Phenylephrine, Oxymetazoline
:agonists .They constrict arterioles in the nasal mucosa*
Only for few days→ otherwise it will lead to Rebound Congestion *
.(Rhinitis Medicamentosa)
. Not used for long term ttt (not more than 3 days)
:C) Corticosteroids . Beclomethasone, Budesonide, Fluticasone, Triamcinolone & Flunisolide
.More effective than oral anti-histamines*
.ttt of Chronic Rhinitis may not result in improvement until 1-2 weeks *
.Tell patient not to deeply inhale as they target tissues (Nose)*
:D) Cromolyn .Synthetic Analogue of Khellin (spasmolytic) *
.weeks prior to exposure to Allergens 2*

:IV. Cough

A. Antitussives: for symptomatic relief of non-productive cough.


Opioid Cough .1 Codeine, Pholcodine, Dihydrocodeine and Dextromethorphan
:suppressants :Codeine .1
.Dose:10-20 mg q 6 hrs
.It suppresses cough centers in CNS & ↓ mucous secretion *

4
.S.E: Constipation dysphoria & addiction*
2. Dextromethorphan" Synthetic derivative of morphine":
Dose: 10- 20 mg q 4 hrs. Maximum 120 mg.
*Suppresses cough centers in CNS.
*Better S.E profile (no analgesia) but causes dysphoria.
N.B. Dextromethorphan and pholcodine may be preferred as they have
fewer adverse effects.
:Diphenhydramine .2 .Dose: 25mg q 6 hrs
:Camphor & Menthol .3 Rubbed on chest **Steam vaporizer*
.Camphor: as lozenges*

.B. Expectorants: ↓ viscosity & Facilitate removal of mucus


Water .1 .glasses of H2O / day 8-10
:Guaifenesin .2 .The only FDA approved expectorant *
Dose 200- 400 mg q 4 hrs*
.M.O.A: irritation of receptors in gastric mucosa
:Q) Put (T) or (F)
Pethidine is antitussive (F)*
.Pethidine = Mepridine is analgesic

:C. Mucolytics
Acetyl cysteine .1 .It liquefies mucus & DNA*
.M.O.A: *Opening disulfide bonds of mucoproteins & so lower viscosity *
Best activity at pH7-9*
.Taken by inhalation or by direct application*
:Bromohexine .2 M.O.A: Depolymerization of mucopolysaccarides→ ↓ viscosity of *
.bronchial secretions
Carboxymethyl -5 .Mucolytic & ↓ mucous gland hyperplasia
:cysteine

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