1. AFAMS Respiratory System Drugs (Insert Dari) EO 003.01 Part 30

2. AFAMS Overview of Lesson (Insert Dari) Nasal Preparations Drugs for Obstructive Airway Disease - Adrenergic inhalants - Other drugs for obstructive airway disease. -Other systemic drugs for obstructive airway disease. Cough and Cold Preparations -Expectorants -Other cold combination products Antihistamines Insert Dari

3. AFAMS What I need to know as a pharmacy technician (Insert Dari) In this lecture we will cover the drugs listed in the ANA Formulary which are classified according to the ATC system under (R) Respiratory System Drugs For each of these medications/classes students must obtain an understanding of: (1) Mechanism of Action (2) Indications (Uses) (3) Efficacy (4) Side Effects Insert Dari

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6. Nasal Preparations (Insert Dari)

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8. Naphazoline Mechanism of Action (Insert Dari) Causes the blood vessels within the nasal mucosa to constrict. This decreases symptoms of runny nose and post nasal drip which can irritate the throat.

9. AFAMS Naphazoline : Indication (Uses) مورد استعمال It is used to ease allergy symptoms.

10. AFAMS Naphazoline : Side Effects عوارض جانبی Nervous and excitable Dry mouth. Nose irritation Bad taste in your mouth. This most often goes back to normal

11. AFAMS Naphazoline : Important Points (Insert Dari) How to properly use a nasal spray will be covered in more detail in EO 003.03. This medication is meant for short term use only, for 3-5 days.

12. AFAMS Important Points (Insert Dari) If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

13. AFAMS Drugs For Obstructive Airway Diseases (Insert Dari)

14. AFAMS Review of Obstructive Airway Disease (Insert Dari) (1)Asthma (2)Chronic Obstructive Pulmonary Disease (COPD)

15. AFAMS Asthma Inflammatory disease of the airways characterized by recurring symptoms, reversible airflow obstruction, and bronchospasm. Common symptoms include wheezing, coughing, chest tightness, and shortness of breath. Insert Dari

16. AFAMS Chronic Obstructive Pulmonary Disease (COPD) (Insert Dari) Often caused by smoking. Damage occurs to the airways and they are often blocked by mucous. The alveoli (air sacs) within the lungs also become damaged. Patients often have a bothersome cough and are short of breath. Insert Dari

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18. Adrenergic Inhalants : Salbutamol (Insert Dari)

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20. Salbutamol Mechanism of Action (Insert Dari) Relaxes bronchial smooth muscles = airway dilation (opening) allowing easier passage of air through the lungs.

21. AFAMS This drug is used to stop exercise-induced breathing problems It is used to open the airways in lung diseases where spasm may cause breathing problems Salbutamol: Indication (Uses) مورد استعمال

22. AFAMS Salbutamol: Side Effects عوارض جانبی Chest pain or pressure. A fast heartbeat. Very nervous and excitable.

23. AFAMS Salbutamol: Important Points (Insert Dari) Can be administered using an inhaler or a nebulizer. How to properly use an inhaler /nebulizer will be covered in more detail in EO 003.03. If you have severe breathing issues, do not run out of this drug. If you are not able to get the breathing attack under control. Get help right away.

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25. Inhaled Steroids : Beclomethasone (Insert Dari)

26. AFAMS Inhaled Steroids: Mechanism of Action (Insert Dari) Decreases inflammation within the airways allowing for easier passage of air into the lungs.

27. AFAMS Inhaled Steroids (Insert Dari) Indication It is used to treat asthma. Can also be used to treat chronic obstructive pulmonary disease (COPD). Side Effects Odd taste in the mouth. Can cause thrush infections. May cause slight irritation of the airways.

28. AFAMS Inhaled Steroids: Important Points (Insert Dari) Do not use this drug to treat an asthma attack – this is NOT a quick acting drug and will not help you when an attack occurs. This is a maintenance medication that is meant to be taken every day. It may take 2-4 weeks to see the full benefit of this medication

29. AFAMS Inhaled Steroids: Important Points (Insert Dari) If you have been taking this drug for many weeks, talk with your doctor before stopping. You may want to slowly stop this drug. Rinse your mouth out with water after using. This will help to avoid getting a thrush infection in your mouth.

30. AFAMS Anti-cholinergic Agent : Ipratropium Bromide (Insert Dari)

31. AFAMS Ipratropium Bromide Mechanism of Action (Insert Dari) Causes bronchodilation (opening of the airways).

32. AFAMS Ipratropium Bromide : Indication (Uses) مورد استعمال It is used to open the airways in lung diseases such as chronic obstructive pulmonary disease (COPD), where spasm may cause breathing problems

33. AFAMS Ipratropium Bromide: Side Effects عوارض جانبی Headache. Throat irritation. Nose stuffiness. Cough. Dry mouth

34. AFAMS Ipratropium Bromide : Important Points (Insert Dari) Can be administered using an inhaler or a nebulizer. How to properly use an inhaler /nebulizer will be covered in more detail in EO 003.03. If you have severe breathing issues, do not run out of this drug.

35. AFAMS Other Systemic Drugs For Obstructive Airway Diseases (Insert Dari)

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37. Aminophylline and Theophylline Mechanism of Action (Insert Dari) Both belong to a class of drugs called phosphodiesterase inhibitors. These medications cause bronchodilation which opens the airways allowing increased air flow within the lungs. Also increases mucous secretions.

38. AFAMS Aminophylline and Theophylline : Indication (Uses) مورد استعمال It is used to treat breathing problems such as asthma and chronic obstructive pulmonary disease. Generally used in more severe cases. Aminophylline can also be used as a mucolytic or expectorant in severe respiratory infections.

39. AFAMS Aminophylline and Theophylline : Side Effects عوارض جانبی Dizziness or passing out Nervous and excitable Upset stomach or throwing up

40. AFAMS Important Points (Insert Dari) This medication is administered intravenously, using a nebulizer and orally. If taken orally it should be taken with food to reduce stomach upset. Works fairly quickly, should feel some benefit shortly after taking this medication.

41. AFAMS Montelukast Mechanism of Action (Insert Dari) Helps to reduce airway inflammation and relaxes smooth muscle. Also helps to decrease the immune response associated with allergic rhinitis.

42. AFAMS Montelukast : Indication (Uses) مورد استعمال It is used to ease allergy symptoms This drug is used to stop exercise-induced breathing problems It is used to treat asthma.

43. AFAMS Montelukast : Side Effects عوارض جانبی Cough. Loose stools (diarrhea). Headache. Upset stomach or throwing up. Sore throat. Belly pain. Stuffy nose. Runny nose. Feeling tired or weak.

44. AFAMS Important Points (Insert Dari) Can take approximately a week to feel benefit from this medication. Very important that this medication is taken every day.

45. AFAMS Cough And Cold Preparations (Insert Dari)

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47. Expectorants, Excl. Combinations With Cough Suppressants (Insert Dari)

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49. Ambroxol Mechanism of Action (Insert Dari) Is a mucolytic agent. A mucolytic agent means that it helps to loosen and release mucous from the airways.

50. AFAMS Ambroxol : Indication (Uses) مورد استعمال Treatment of acute and chronic respiratory tract disorders associated with viscid mucus.

51. AFAMS Ambroxl : Side Effects and Important Points (Insert Dari) Side Effects May cause some minor GI upset. Important Points Not to be used during pregnancy.

52. AFAMS Other Cold Combination Preparations (Insert Dari)

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54. Paracetamol + Pseudoephedrine+Chlorphenaramine Mechanism of Action (Insert Dari) Paracetamol – reduces pain, fever and headache. Pseudoephedrine – is a nasal decongestant that relieves congestion. Chlorphenaramine – is an antihistamine that reduces runny nose and post nasal drip.

55. AFAMS Paracetamol + Pseudoephedrine + Chlorphenaramine Indications, Side Effects and Important Points (Insert Dari) Indication To help relieve symptoms associated with the common cold. Side Effects May cause drowsiness (chlorphenaramine) Can also keep patients awake (psuedoephedrine). Important Points Should be avoided in patient with uncontrolled hypertension. If symptoms do not improve within 5-7 days patients should see a doctor as they may require additional treatment.

56. AFAMS Antihistamines For Systemic Use (Insert Dari)

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58. Competes with histamine for H 1 -receptor sites on effector cells in the gastrointestinal tract, blood vessels, and respiratory tract; blocks chemoreceptor trigger zone, diminishes vestibular stimulation, and depresses labyrinthine function through its central anticholinergic activity Dimenhydrinate Mechanism of Action (Insert Dari)

59. AFAMS Dimenhydrinate : Indication (Uses) مورد استعمال It is used to help motion sickness It is used to treat upset stomach and throwing up.

60. AFAMS Dimenhydrinate : Side Effects عوارض جانبی Dizziness Feeling sleepy Dry mouth

61. AFAMS Dimenhydrinate : Important Points (Insert Dari) Patients should avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you. To lower the chance of feeling dizzy or passing out, patients should rise slowly over a few minutes when sitting or lying down. Be careful climbing stairs. Avoid other sedating medications, alcohol etc while taking this medication. Side effects tend to be more problematic in the elderly.

62. AFAMS Sedating Anti-histamines: Diphenhydramine Mechanism of Action (Insert Dari) Blocks the effect of histamine on cells in the gastrointestinal tract, blood vessels, and respiratory tract.

63. AFAMS Diphenhydramine: Indication (Uses) مورد استعمال It is used to stop coughing It is used to ease allergy signs It is used to ease cold signs It is used to help motion sickness It is used to treat hives It is used to treat itching It is used to treat swelling of the face, lips, tongue, or throat It is used to treat sleep problems

64. AFAMS Diphenhydramine: Side Effects مورد استعمال Feeling sleepy. Dizziness. Dry mouth. Thickening of mucus in nose or throat. Feeling nervous and excitable.

65. AFAMS Important Points (Insert Dari) Patients should avoid driving and doing other tasks or actions that call for you to be alert until you see how this drug affects you To lower the chance of feeling dizzy or passing out, patients should rise slowly over a few minutes when sitting or lying down. Be careful climbing stairs

66. AFAMS Important Points (Insert Dari) Do not use with other products that have diphenhydramine. Avoid beer, wine, mixed drinks, or other drugs and natural products that slow your actions Patients 65 or older, use this drug with care. They could have more side effects.

67. AFAMS Non-Sedating Anti-histamines Mechanism of Action (Insert Dari) Long-acting antihistamine with selective histamine blocking properties. Because these medications are selective, they tend to be less sedating. Include: Loratadine Chlorphenaramine

68. AFAMS Non-Sedating Anti-histamines: Indication (Uses) مورد استعمال It is used to treat symptoms of seasonal allergies.

69. AFAMS Non-Sedating Anti-histamines : Side Effects عوارض جانبی Generally very well tolerated, minor side effects include: Headache Dizziness Dry mouth

70. AFAMS Non-Sedating Anti-histamines : Important Points (Insert Dari) This medication needs to be taken regularly every day in order to work properly. Should start to see some benefit after a day or two and full benefit after a week.

71. AFAMS Questions? (Insert Dari)

72. AFAMS In-class Assignment (Insert Dari) This assignment will consist of 5 questions which are to be completed individually. Once complete the instructor will review the answers with the class. Insert Dari

73. AFAMS 1. Match the following drugs with their indication (Insert Dari) A)Salbutamol B)Inhaled steroid C)Non-sedating antihistamine D)Dimenhydrinate 1)Nausea and vomiting 2)Seasonal allergies 3)Asthma and COPD 4)Acute breathing attacks Insert Dari

74. AFAMS 1. Answer: Match the following drugs with their indication (Insert Dari) A)Salbutamol (4) acute breathing attack B)Inhaled steroid (3) asthma and COPD C)Non-sedating antihistamine (2) seasonal allergies D)Dimenhydrinate (1) nausea and vomiting Insert Dari

75. AFAMS 2. Which of the following is a nasal preparation on the ANA formulary that is used to treat allergies? (Insert Dari) A)Salbutamol B)Naphazoline C)Beclomethasone D)Ipratropium bromide

76. AFAMS 2. Answer: Which of the following is a nasal preparation on the ANA formulary that is used to treat allergies? (Insert Dari) A)Salbutamol B)Naphazoline C)Beclomethasone D)Ipratropium bromide

77. AFAMS 3. Which of the following is true regarding inhaled steroids? (Insert Dari) A)They act immediately B)They can be used to treat breathing attacks C)You should rinse your mouth out with water after using. D)They are taken orally.

78. AFAMS 3. Answer: Which of the following is true regarding inhaled steroids? (Insert Dari) A)They act immediately B)They can be used to treat breathing attacks C)You should rinse your mouth out with water after using. D)They are taken orally.

79. AFAMS 4. True or False? Montelukast can be used to treat asthma as well as allergic rhinitis? (Insert Dari)

80. AFAMS 4. True or False? Montelukast can be used to treat asthma as well as allergic rhinitis? (Insert Dari) Answer: True (Insert Dari)

81. AFAMS 5. Which of the following best describes a mucolytic agent? (Insert Dari) A)It helps to loosen and release mucous from the airways. B)It increases the production of mucous in the respiratory tract. C)It kills the cells that produce mucous. D)It prevents the production of mucous.

82. AFAMS 5. Answer: Which of the following best describes a mucolytic agent? (Insert Dari) A)It helps to loosen and release mucous from the airways. B)It increases the production of mucous in the respiratory tract. C)It kills the cells that produce mucous. D)It prevents the production of mucous.