medical pres.pptx

7/29/2019 medical pres.pptx

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2/21

COUGH

Cough is a sudden and often repetitively occurring reflex which

helps to clear the large breathing passages from secretions,

irritants, foreign particles and microbes.

COLDThe common cold is a viral infectious disease of the upper

respiratory tract which affects primarily the nose. Symptomsinclude coughing, sore throat, runny nose, sneezing,and fever which usually resolve in seven to ten days, with somesymptoms lasting up to three weeks.

Usually referred to as the flu or influenza is a highly infectiousrespiratory disease. The disease is caused by certain strains ofthe influenza virus. When the virus is inhaled, it attacks cells inthe upper respiratory tract, causing typical flu symptoms suchas fatigue, fever and chills, a hacking cough, and body aches.

FLU


3/21

BRONCHOCONSTRICTIONBronchoconstriction is defined as the narrowing of the airways

in the lungs (bronchi and bronchioles). Air flow in air passagescan get restricted due to 3 factors:

A spasmodic state of the smooth muscles in bronchi and bronchioles

An inflammation of the airways

Excessive production of mucus due to an allergic reaction or irritationcaused by mechanical friction of air (due to shear stress), overcooling ordrying of airways.


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TRIGGERING AGENTS:

INFLAMMATORY FACTORS: Allergens, respiratory

infections(flu ,cold), work IRRITANTS: cold air, sudden temperature changes, stress

exercise strong odor.

OTHERS: smoking, medications like ACE inhibitors, food

additives, gastric reflux, pollutants . Fumes. ( epoxyresins, plastic,)Organic and chemical dust.

(Woodworkers, cotton , platinum)Gases( like toluene,

nitrous oxide),Food processing, Chemical processing,

Textile, plastics and rubber manufacture


5/21

PATHOPHYSIOLOGICAL FEATURES:

Airway hyperresponsiveness (contract too much ,

too easily spontaneously, in response to exogenous

and endogenous stimuli)

Air flow obstruction

Inflammation

Mucous hypersecretion

Airway remodeling ( in some patients


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PATHOPHYSIOLOGY OF COUGH:MEDIA


7/21

MEDIATORS RELEASED:

MEDIATORS EFFECTS

1) Leukotrines Bronchoconstriction

Increased vascular permeability

Increased mucous secretion

1) Platelet activating factor Aggregation of platelets

Release of histamine1) Histamine

( is not consider important

mediator as anti histamine do no

provide benefit )

Bronchoconstriction

Increased mucous secretion

1) Prostaglandin D2 Bronchoconstriction

Increased vascular permeability


8/21

TREATMENT OF COUGH COLD AND FLU:

TREATMENT STRATEGY:

Decrease mucous secretion

Bronchodilation

Decrease inflammation


9/21

ALLOPATHIC TREATMENT:

Mucokinetics

are a class of drugs which aid in the clearance ofmucus from the airways, lungs, bronchi, and trachea.Such drugs can be further categorized by theirmechanism of action.

expectorants

mucolytic agents

An expectorant (from the Latin expectorate, to expel fromthe chest) works by signaling the body to increase theamount or hydration of secretions, resulting in more yetclearer secretions and as a byproduct lubricating theirritated respiratory tract. One expectorant guaifenesin is

commonly available in many cough syrups. ADRs:nausea, vomiting, dizziness,itching,kidney stones byguaifenesin


10/21

A mucolytic agent : Acetylcystein,tyloxapolis an agent which dissolves thick mucus and is usuallyused to help relieve respiratory difficulties. It does so bydissolving various chemical bonds within secretions,which in turn can lower the viscosity by altering themucin-containing components. Acetylcystein reducesdisulfide linkage of mucoproteins.

Expectorant increases bronchial secretions andmucolytics help loosen thick bronchial secretions.Expectorants reduce the thickness or viscosity ofbronchial secretions thus increasing mucus flow that canbe removed more easily through coughing, Mucolyticsbreak down the chemical structure of mucus molecules.The mucus becomes thinner and can be removed moreeasily through coughing.

ALLOPATHIC TREATMENT: (CONT)


11/21

ANTI-TUSSIVE DRUGS:

BRANDS AVAILABLE: Delsym (dextromethorphan) ,

Tessalon (benzonatate ) , Robitussin DM

( dextromethorphan/guaifenesin)

Centrally acting: Codeine phosphate, morphine,

dextromethorphane ,antihistamines like diphenhydramine. ACTIONS: Depression of modularly centres or associated

higher centres and Increased threshold of cough centre.

Peripherally acting: Tincture benzoin and menthol

ACTIONS: Interruption of tussle impulses from respiratorytract, having soothing effect.

ADRs: Headache, Dizziness, Pruritis, Nasal Congestion

,burning of eyes & tightness in chest.


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SYMPATHOMIMETIC DRUGS :

BETA 2 AGONISTS:salbutamo/albuterol,terbutaline

salmeterol, formeterol

AVAILABLE BRANDS:ventoli(salbutamol),

aerolin(salbutamol)

ACTIONS: Inhaled beta2-agonists are bronchodilator

medications by increasing level of c AMP in and around

the tightened airways so that the airways reopen.

Used in acute excerbations for relieving symptoms of

coughing and wheezing.

ADRs: in high dose also act on beta-1 & gives

palpitation, muscle tremors, tachysardia , Restlessness

Headache.


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CORTICOSTEROIDS(GLUCOCORTICOIDS):

AVAILABLE BRANDS:

Oral: prednisolone(deltacotril) , Dexamethasone(decadron)

IV:Hydrocortisone(cortef 100mg)

Inhaler:Betamethasone , Beclomethasone(bekson , betatec)

ACTIONS: anti-inflammatory action by decreasingthe

release of mediators ,mucus production,permeability of vessels so, relieve smooth musclesspasm (bronchospasm).

ADRs:oral thrush, stomach irritation ,nausea,insomnia, muscle weakness, tachycardia, high B.P.


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MAST CELL STABALIZERS:CROMOLYN,

NEDOCROMOLYN

AVAILABLE BRANDS:

cromolin(sodium cromoglycate),cromogol(sodium

cromoglycate)

ACTIONS:Inhibit degranulation of mast cells &inhibit release of mediators e.g:histamine , cytokine

etc. ,causing inflammation.Pre-treatment block

allergen or exercise induced bronchoconstriction.

ADRs.: cough , throat irritation,bitter taste


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METHYLXANTHINES:

AVAILABLE BRANDS

theophylline (quibron), aminophyline(amphyll)

ACTIONS: It block the Phosphodiesterase enzyme

that convert cAMP to 5-AMP, so increase cAMP andgives bronchodilation.

It is less recommended to use because of

NTI(naarrow therpeutic index)

ADRs:Insomnia Upset stomach,Gastroesophadealreflux symptoms


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LEUKOTRINES ANTAGONISTS:

AVAILABLE BRANDS:

montelukast (myteka), zafrilukast

ACTIONS:By selectively block csyteinyl

leukotriene receptor so, relax airway smoothmuscles.

ADRs: GI upsets, headache,


17/21

ANTICHOLINERGICS:

AVAILABLE BRANDS

Ipratropium(atem), tiotropium(spiriva), atropine

ACTIONS:It blockM3 muscarinic receptors located onsmooth muscle cells and submucosal glands leading to areduction in smooth muscle contraction and mucus secretion,

thus producing a bronchodilatory effect. ADRs:Dry mouth and throat irritation, sedation, blurred

vision.

ANTI IGEMAB(OMALIZUMAB)

ACTIONS:A recombinant DNA derived from monoclonal Ab

bind to IgE Ab leads to decrease binding of IgE to receptors onbasophil & mast cells,

ADRs:wheezing, tightness in your chest, trouble

breathing;hives or skin rash;feeling anxious or light-headed,

fainting;


18/21

CUFFIX AS A TREATMENT OF COUGH

COLD AND FLU:

DISCRIPTION: Cuffix cough syrup is a brownish

yellow viscous liquid with palatable taste.

COMPOSITION:

const i tuent Quant i ty in each 5mlEphedra gerardiana 66.6mg

Adhatoda vasica 83.3mgGlycyrrhiza Glabra 83.3mgHyssopus officinalis 83.3mgPapaver somniferous 83.3mgZizyphus vulgaris 83.3mgHyoscyamus niger 83.3mg


19/21

INDICATIONS:

Cuffis syrup is indicated in the treatment of

Cough Cold

Flu

Sore throat

Chest congestion

Stuffed nose

SPECIFICATIONS:

Established safety and efficacy

Fast onset of action

Long duration of action

Non drowsy formula helps you to actively fight against thesymptoms of cold and flu.

Natural and effective broad spectrum coverage

So safe that Cuffix can b given to children with no side effects.


20/21

CLINICAL PHARMACOLOGY:

Cuffix syrup completely relief the symptoms of cough , cold and flu bymultiple mode of actions.

ADHATODA VASICA: it contain vasicin inhibit 5HT receptors thusinhibiting histamine induced bronchoconstriction as well as act amucolytic when it act on mucous formative stage on the glands within themucus secreting cell depolymerasing and hydrolyzing fiber ofmucopolysaccharides resulting in the decreased viscosity and elasticityof tracheal mucus.

EPHEDRA GIARDIANA: it contains ephedrine which causes indirectstimulation of adrenergic receptors to increase the activity ofnorepinephrine at post syneptic beta 2 receptors and they causebronchodilaion and relaxation of smooth muscles of airways.

GLYCYRRHIZA GLABRA: it contains glycyrrhizin which inhibitphospholipase A2 inhibiting the inflammatory process and also act asantileukotrienic agent.

PAPAVER SOMNIFERRUM: it contain codein and morphine which areopiod receptor agonists suppress cough reflex by direct action on coughcenter.

HYOCYAMUS NIGER: it contains hyocyamine and scopolamine whichare potent ACH inhibitor and inhibit the ACH induced bronchoconstrictionand mast cells degradation which release histamine.


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PHARMACOKINETICS:

Cuffix cough syrup is 75% absorbed orally and

plasma half life is 3-11 hours.

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