DRUGS EFFECTING THE RESPIRATORY ORGANS FUNCTION

 In ambulatory settings a quantity of patients with respiratory diseases is 25 % from all patients  Every 10th of hospitalized patients is a patient with respiratory pathology  Chronic obstructive lung diseases (chronic obstructive bronchitis, pulmonary emphysema, bronchial asthma) are one of the leading causes of morbidity and mortality in the world  The level of mortality from obstructive lung diseases is growing faster as compared to mortality from IHD and brain stroke

Drugs affecting the respiratory organs function ant cough drugs; ant cough drugs; expectorants; expectorants; breathing stimulants; breathing stimulants; drugs used for bronchial asthma; drugs used for bronchial asthma; drugs used for lung edema drugs used for lung edema

Ant cough drugs Drugs of central action (depress central links of cough reflexes):  а) narcotics (opioids): codein, dextromethorphan  b) nonnarcotic (nonopioid): glaucin hydrochloride (glauvent), oxeladin citrate (tussuprex), butamirate cytrate (sinecod) Drugs of peripheral action (block sensitive receptors of cough reflexogenic zones): prenoxdiazine (libexin, glibexin)

Dextromethorphan During consumpt dextromethorphan Drugs recommended: Drink lots of water Drink lots of water Avoid drinking alcohol, because side effects Avoid drinking alcohol, because side effects Avoid consuming stimulants, ex: caffeine Avoid consuming stimulants, ex: caffeine

Drugs for common cold Acetaminophen (paracetamol) (antipiretic) + phenilephrine (constricts the vessels) + phenilephrine (constricts the vessels) + chlorpheniramine (blocks H 1 -histamine receptors) + dextromethorphan (ant cough of central action) + codeine (ant cough of central action)

Oxeladin citrate, Tussuprex nonnarcotic (nonopioid)

Glaucin hydrochloride (glauvent) - nonnarcotic (nonopioid) + 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 increase surfactant production (bromhexin, ambroxol) or preparations of surfactant (“Alveofakt”, “Ekzosurf”)

Drugs of medical plants Althaea officinalis (marsh-mallow)ThermopsisViola(violet)

Drugs of medical plants Ledum palustrae (Labrador tea, wild rosemary) Origanum vulgaris (marjoram)

Mucaltin (Mucaltinum) (Extr. Altheae + NaHCO 3 )

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) tablets - 0,03, syrup (100 ml) cаps. - 0,075, amp. 0,75 % 2 ml (i.v., i.m.)

COUGH PRODUCTIVE (with presence of sputum in bronchi) Sputum with significant viscous-elastic properties - muco- and proteolytic drugs Sputum with significant adhesive properties - drugs which stimulate production of surfactant Decreasing of speed of mucociliar transport with unchanged 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 Signs of allergic reaction with increased histamine activity - antihistamine drugs REHYDRANTS IN ALL CASES

COUGH NONPRODUCTIVE ( Dry) Cataral inflammation (usually viral), reflector and central cough - anticough drugs Signs of allergic reaction - antihistamine drugs Bronchospasm - broncholytics REHYDRANTS IN ALL CASES

Bronchial ectasia

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)

Ketotifen Tilade (sodium nedocromil)

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

Leukotriene inhibitors 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

Molecular mechanisms of bronchodilators

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) removing of pain syndrome and acute disorders of heart rhythm g) increasing of contractive ability of myocardium and removing of bronchial spasm

Morphine hydrochloride Fentanyl + Droperidol Neuroleptics (Aminazinum, Droperidolum - with α-adrenoblocker activity) dilatation of peripheral vessels

GANGLIONBLOCKERS Hygronium, Pentamin dilatation of peripheral vessels

Vasodilators Nitroglycerin (Nitroglycerinum) Nitromint

Diuretics Furosemid (Lazix) Mannit (the last is absolutely contraindicated for cardiogenic lung edema)

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

Dimedrol, Suprastin, Prednisolone