DRUGS AFFECTING THE RESPIRATORY ORGANS FUNCTION Lector prof. Posokhova K.A.

Drugs affecting the respiratory organs function anticough drugs; anticough drugs; expectorants; expectorants; breathing stimulants; breathing stimulants; drugs used for bronchial asthma; drugs used for bronchial asthma; drugs used for lungs edema drugs used for lungs edema

COUGH with presence of secretion in bronchi bronchi PRODUCTIVE Sputum with significant viscous-elastic properties: muco- and proteolytic drugs - muco- and proteolytic drugs Sputum with significant adhesive properties: drugs which stimulate production of surfactant - drugs which stimulate production of surfactant Decreasing of speed of mucociliar transport with unchanged properties of sputum: drugs which stimulate ciliar function - drugs which stimulate ciliar function Significant disorders of bronchial permeability, morphological changes of bronchi (atrophy of mucous membrane, bronchial stenosis), excessive production of mucus: alkali inhalations - alkali inhalations Signs of allergic reaction with increased histamine activity: antihistamine drugs - antihistamine drugsNONPRODUCTIVE Cataral inflammation (usually viral), reflector and central cough: anticough drugs - anticough drugs Signs of allergic reaction: antihistamine drugs - antihistamine drugs Bronchospasm: broncholytics - broncholytics dry REHYDRANTS IN ALL CASES

Anticough drugs Drugs of central action (depress central links of cough reflex): а) narcotic: codein, dextromethorphan б) nonnarcotic: glaucin hydrochloride (glauvent), oxeladin citrate (tussuprex) Drugs of peripheral action (block sensitive receptors of cough reflexogenic zones): libexin

Oxeladin citrate, Tussuprex

Glaucin hydrochloride (glauvent) + ephedrine + Sage oil

Libexin

Expectorants Secrete-motor drugs (stimulate expectoration): а) drugs of reflex action: drugs of medical plants, sodium benzoate, bronchicum elixir, mucaltin б) drugs of resorbtive and local action: bromide - sodium and potassium, ammonium chloride, sodium hydrocarbonate, ether oils Bronchosecretolytic drugs (mucolytics): а) proteolytic enzymes: tripsin, chimopsin, chimotripsin, desoxyribonuclease б) mucolytics: acetylcystein, carbocystein в) drugs which influence surfactant production or surfactants: bromhexin, ambroxol, “Alveofakt”, “Ekzosurf”

Drugs of medical plants Althea officinalis ThermopsisViola

Combined remedy “Bronchicum”

Mucaltin (Mucaltinum)

Drugs of medical plants Ledum palustrae Origanum vulgaris

Crystal tripsin (Trуpsinum crystallisatum) Ampoules - 0,005 g and 0,01 g Ampoules - 0,005 g and 0,01 g

Acetylcystein (Acetylcysteinum) Forms of production: tablets - 0,1, 0,2 and 0,6, 20 % solution for inhalation in ampoules – Forms of production: tablets - 0,1, 0,2 and 0,6, 20 % solution for inhalation in ampoules – 5 and 10 ml; 10 % solution for injection in ampoules - 2 ml and 5 % solution in ampoules – 10ml.

Bromhexin (Bromhexinum)

Аmbroxol (Lasolvan) Forms of production: tablets - 0,03 and syrup.

COUGH Dry With presence of sputum in bronchi PRODUCTIVE muco- and proteolytic drugs Sputum with significant viscous-elastic properties - muco- and proteolytic drugs drugs which stimulate production of surfactant Sputum with significant adhesive properties - drugs which stimulate production of surfactant Decreasing of speed of mucociliar transport with unchanged drugs which stimulate cilia function properties of sputum - drugs which stimulate cilia function Significant disorders of bronchial permeability, morphological changes of bronchi (atrophy of mucous membrane, bronchial stenosis), excessive production of mucus - alkali inhalations antihistamine drugs Signs of allergic reaction with increased histamine activity - antihistamine drugsNONPRODUCTIVE anticough drugs Cataral inflammation (usually viral), reflector and central cough - anticough drugs antihistamine drugs Signs of allergic reaction - antihistamine drugs broncholytics Bronchospasm - broncholytics REHYDRANTS IN ALL CASES

Stimulants of breathing (analeptics) Analeptics of direct action: bemegrid, ethymisol, caffeine Analeptics of mixed action: cordiamin, camphor, carbon acid (carbogen – mixture of O 2 and CO 2 ) Analeptics of reflex action: lobelin, cytiton lobelin, cytiton

Aethimizol (Aethimizolum) Sodium caffeine-benzoate (Coffeinum-natrii benzoas) Bemegrid (Bemegridum)

Cordiamin (Cordiaminum) Camphor (Camphora)

DRUGS FOR BRONCHIAL ASTHMA

To remove attack of bronchial asthma Broncholytic drugs: Adrenomimetics (α, β-adremonimetics, β-adrenomimetics, β 2 - adrenomimetics) Methylxantines Cholinoblockers (M-cholinoblockers, ganglionblockers) Antiallergics and drugs that reduce airway hyperresponsiveness Expectorants

Beta-adrenomimetics Salbutamol, Ventolin, Berotek, Asthmopent

Methylxanthines Theophyllin (of prolonged action)

M-cholinoblockers Atropine sulfate, Solutan, Ipratropii bromidum (Atrovent)

Inhibitors of mast cells degranulation Cromolyn, Ketotifen and Nedocromil antagonize antigen-induced (IgE- mediated) mast cell degranulation they prevent the release of histamine and slow-reacting substance of anaphylaxis (SRS-A) - mediators of type I allergic reactions their beneficial effects in the treatment of asthma are largely prophylactic

Ketotifen Tilade (sodium nedocromil)

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

Inhaled corticosteroids BeclomethasoneBudesonideDexamethasoneFlunisolideFluticasoneTriamcinolone Administration corticosteroids by inhalation limits the systemic adverse reactions associated with oral or parenteral therapy

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

Prednisolon, Hydrocortizone, Dexamethazone.

Potential role in the treatment of asthma Zileuton - a 5-lipoxygenase inhibitor Zafirlukast - a leukotriene-receptor antagonist Leukotrienes attract cellular infiltrates producing epithelial injury, abnormalities in neural mechanisms, increases in airway smooth muscle responsiveness, and airway obstruction Leukotrienes attract cellular infiltrates producing epithelial injury, abnormalities in neural mechanisms, increases in airway smooth muscle responsiveness, and airway obstruction

DRUGS FOR LUNGS EDEMA

: Classification of lungs edema: CardiogenicToxicNeurogenic Caused by prolonged inspire resistance

Treatment measures for lungs edema а) decreasing of hydrostatic pressure in pulmonary vessels and decreasing of cardiac input b) decreasing the volume of blood circulation b) decreasing the volume of blood circulation c) lungs dehydration c) lungs dehydration d) decreasing of permeability of alveolar-capillary membranes d) decreasing of permeability of alveolar-capillary membranes e) improvement of tissue oxygenation, renewing of respiratory ways penetrability, removing the foam in alveoli e) improvement of tissue oxygenation, renewing of respiratory ways penetrability, removing the foam in alveoli f) correction of acid-base and electrolyte balance f) correction of acid-base and electrolyte balance g) removal of pain syndrome and acute disorders of heart rhythm g) strengthening of contractive ability of myocardium and fighting with bronchospasm

Morphine hydrochloride (Morphini hydrochloridum)

GANGLIONBLOCKERS Hygronium, Pentamin

Vasodilators Nitroglycerin (Nitroglycerinum) Nitromint

Diuretics Furosemid (Lazix), Mannit

Modified Bobrov’s apparatus (Alcohol % for inhalation with oxygen – to reduce the foam in alveoli)

Dimedrol, Suprastin, Prednisolone