DRUGS EFFECTING DRUGS EFFECTING THE RESPIRATORY THE RESPIRATORY ORGANS FUNCTIONORGANS FUNCTION

In ambulatory settings a quantity of patients In ambulatory settings a quantity of patients with respiratory diseases is 25 % from all with respiratory diseases is 25 % from all patientspatients

Every 10th of hospitalized patients Every 10th of hospitalized patients

is a patient with respiratory pathologyis a patient with respiratory pathology

Chronic obstructive lung diseases Chronic obstructive lung diseases

((chronic obstructive bronchitis, pulmonary chronic obstructive bronchitis, pulmonary emphysema, bronchial asthma) are one emphysema, bronchial asthma) are one of the leading causes of morbidity and of the leading causes of morbidity and mortality in the worldmortality in the world

The level of mortality from obstructive lung The level of mortality from obstructive lung diseases is growing faster as compared to diseases is growing faster as compared to mortality from IHD and brain strokemortality from IHD and brain stroke

Drugs affecting the respiratory organsDrugs affecting the respiratory organs function function

ant cough drugsant cough drugs;;

expectorantsexpectorants;;

breathing stimulantsbreathing stimulants;;

drugs used for bronchial asthmadrugs used for bronchial asthma;;

drugs used for lung edemadrugs used for lung edema

Ant cough drugsAnt cough drugs

Drugs of Drugs of central central actionaction ( (depress central links of depress central links of cough reflexescough reflexes):):

а)а) narcotics (opioids)narcotics (opioids):: codeincodein, , dextromethorphandextromethorphan

bb) ) nonnarcotic (nonopioid)nonnarcotic (nonopioid):: glaucin glaucin hydrochloridehydrochloride ( (glauventglauvent), ), oxeladin citrate oxeladin citrate (tussuprex), butamirate cytrate (sinecod)(tussuprex), butamirate cytrate (sinecod)

Drugs of Drugs of peripheralperipheral action action ( (block sensitiveblock sensitive receptors of cough reflexogenic zonesreceptors of cough reflexogenic zones): ): prenoxdiazine (libexin, glibexin) prenoxdiazine (libexin, glibexin)

DextromethorphanDextromethorphan

During consumpt dextromethorphan Drugs recommended:During consumpt dextromethorphan Drugs recommended:

• • Drink lots of waterDrink lots of water • • Avoid drinking alcohol, because side effects Avoid drinking alcohol, because side effects

• • Avoid consuming stimulants, ex: caffeineAvoid consuming stimulants, ex: caffeine

Drugs for common coldDrugs for common cold

Acetaminophen (paracetamol) (antipiretic)Acetaminophen (paracetamol) (antipiretic) + phenilephrine (constricts the vessels)+ phenilephrine (constricts the vessels)+ chlorpheniramine (blocks H+ chlorpheniramine (blocks H11-histamine -histamine

receptors)receptors)+ dextromethorphan (ant cough of central + dextromethorphan (ant cough of central

action)action)

+ codeine+ codeine (ant cough of central action)(ant cough of central action)

Oxeladin citrateOxeladin citrate, Tussuprex , Tussuprex nonnarcotic (nonopioid)nonnarcotic (nonopioid)

Glaucin hydrochlorideGlaucin hydrochloride ( (glauventglauvent)) - nonnarcotic - nonnarcotic (nonopioid)(nonopioid)

+ + ephedrineephedrine + + Sage oilSage oil

LibexinLibexin

ExpectorantsExpectorants

Secrete-motor drugsSecrete-motor drugs ( (stimulate expectorationstimulate expectoration):):а) а) drugs of reflex actiondrugs of reflex action: : drugs of medical plantsdrugs of medical plants, , sodium benzoatesodium benzoate, , bronchicum elixirbronchicum elixir, , mucaltinmucaltinб) б) drugs of resorbtive and local actiondrugs of resorbtive and local action: : bromide -bromide -sodium and potassiumsodium and potassium, , ammonium chlorideammonium chloride, , sodium sodium hydrocarbonatehydrocarbonate, , ether oilsether oilsBronchosecretolytic drugs Bronchosecretolytic drugs ((mucolyticsmucolytics))::а) а) proteolytic enzymesproteolytic enzymes: : tripsintripsin, , chimopsinchimopsin, , chimotripsinchimotripsin, , desoxyribonuclease desoxyribonuclease б) б) mucolyticsmucolytics: : acetylcysteinacetylcystein, , carbocysteincarbocysteinв) в) drugs which increase surfactant production drugs which increase surfactant production ((bromhexin, ambroxol) bromhexin, ambroxol) or preparations of surfactantor preparations of surfactant (“Alveofakt”, “Ekzosurf”)(“Alveofakt”, “Ekzosurf”)

Drugs of medical plantsDrugs of medical plants

Althaea officinalisAlthaea officinalis

(marsh-mallow)(marsh-mallow)

ThermopsisThermopsis ViolaViola

(violet) (violet)

Drugs of medical plantsDrugs of medical plants

Ledum palustraeLedum palustrae

(Labrador tea, wild (Labrador tea, wild rosemary)rosemary)

Origanum vulgarisOriganum vulgaris(marjoram)(marjoram)

MucaltinMucaltin (Mucaltinum) ( (Mucaltinum) (Extr. Altheae + NaHCOExtr. Altheae + NaHCO33))

Crystal tripsinCrystal tripsin (Trуpsinum crystallisatum) (Trуpsinum crystallisatum) Ampoules -Ampoules - 0,005 0,005 gg andand 0,01 0,01 gg

AcetylcysteinAcetylcystein (Acetylcysteinum) (Acetylcysteinum) Forms of production:Forms of production: tablets - tablets - 0,1, 0,2 0,1, 0,2 andand 0,6, 20 % 0,6, 20 % solution for inhalation in ampoules –solution for inhalation in ampoules –

5 5 andand 10 10 mlml; 10 % ; 10 % solution for injection in ampoules -solution for injection in ampoules - 2 2 ml andml and 5 % 5 % solution in ampoules –solution in ampoules – 10 10mlml. .

BromhexinBromhexin (Bromhexinum) (Bromhexinum)

АmbroxolАmbroxol (Lasolvan) (Lasolvan)tablets -tablets - 0,03 0,03, syrup (100 ml), syrup (100 ml) ccааpsps.. - - 0,075, 0,075, ampamp. 0,75 % 2 . 0,75 % 2 mlml ( (i.v.i.v., , i.m.i.m.))

COUGHCOUGH

PRODUCTIVE PRODUCTIVE (with presence of sputum in bronchi)(with presence of sputum in bronchi)

Sputum with significant viscous-elastic propertiesSputum with significant viscous-elastic properties -- muco- and muco- and proteolytic drugsproteolytic drugs

Sputum with significant adhesive propertiesSputum with significant adhesive properties -- drugs which drugs which stimulate production of surfactantstimulate production of surfactant

Decreasing of speed of mucociliar transport with unchangedDecreasing of speed of mucociliar transport with unchangedproperties of sputumproperties of sputum - - drugs which stimulate cilia functiondrugs which stimulate cilia functionSignificant disorders of bronchial permeabilitySignificant disorders of bronchial permeability, , morphological morphological

changes ofchanges of bronchibronchi ( (atrophy of mucous membrane, bronchial atrophy of mucous membrane, bronchial stenosisstenosis), ), excessive production of mucusexcessive production of mucus -- alkali inhalationsalkali inhalations

Signs of allergic reaction with increased histamine activity Signs of allergic reaction with increased histamine activity -- antihistamine drugsantihistamine drugs

REHYDRANTS IN ALL CASESREHYDRANTS IN ALL CASES

COUGHCOUGH

NONPRODUCTIVE NONPRODUCTIVE ((Dry) Dry)

Cataral inflammationCataral inflammation ( (usually viralusually viral), ), reflector and reflector and central cough -central cough - anticough drugsanticough drugs

Signs of allergic reaction -Signs of allergic reaction - antihistamine drugsantihistamine drugs

Bronchospasm -Bronchospasm - broncholyticsbroncholytics

REHYDRANTS IN ALL CASESREHYDRANTS IN ALL CASES

Bronchial ectasiaBronchial ectasia

Stimulants of breathingStimulants of breathing ((analepticsanaleptics))

Analeptics of direct actionAnaleptics of direct action: : bemegrid, bemegrid, ethymisol, caffeineethymisol, caffeine

Analeptics of mixed actionAnaleptics of mixed action: : cordiamin, cordiamin, camphorcamphor, , carbon acidcarbon acid ( (carbogen – carbogen – mixture of Omixture of O22 and CO and CO22))

Analeptics of reflex actionAnaleptics of reflex action: :

lobelin, cytitonlobelin, cytiton

AethimizolAethimizol (Aethimizolum) (Aethimizolum)Sodium caffeine-benzoateSodium caffeine-benzoate (Coffeinum-natrii (Coffeinum-natrii

benzoas)benzoas)BemegridBemegrid (Bemegridum) (Bemegridum)

CordiaminCordiamin (Cordiaminum) (Cordiaminum)Camphor Camphor (Camphora)(Camphora)

DRUGS FOR BRONCHIAL DRUGS FOR BRONCHIAL ASTHMAASTHMA

To remove attack of bronchial To remove attack of bronchial asthma asthma

Broncholytic drugsBroncholytic drugs::AdrenomimeticsAdrenomimetics ( (αα,, ββ--adremonimeticsadremonimetics, , ββ--adrenomimeticsadrenomimetics, , ββ22--adrenomimeticsadrenomimetics))

MethylxantinesMethylxantinesCholinoblockersCholinoblockers ( (MM--cholinoblockerscholinoblockers, , ganglionblockersganglionblockers))

Antiallergics and drugs that reduce Antiallergics and drugs that reduce airway hyperresponsivenessairway hyperresponsivenessExpectorantsExpectorants

Beta-adrenomimeticsBeta-adrenomimetics

SalbutamolSalbutamol, , Ventolin,Ventolin, Berotek,Berotek, AsthmopentAsthmopent

MethylxanthinesMethylxanthinesTheophyllinTheophyllin (of prolonged action)(of prolonged action)

M-cholinoblockersM-cholinoblockersAtropine sulfateAtropine sulfate, , Solutan, Solutan, Ipratropii bromidumIpratropii bromidum

(Atrovent)(Atrovent)

KetotifenKetotifen

TiladeTilade ( (sodium nedocromilsodium nedocromil))

Inhaled corticosteroidsInhaled corticosteroids

BeclomethasoneBeclomethasone BudesonideBudesonide

Dexamethasone Dexamethasone Flunisolide Flunisolide Fluticasone Fluticasone

TriamcinoloneTriamcinolone

Administration corticosteroids by inhalation Administration corticosteroids by inhalation limits the systemic adverse reactions limits the systemic adverse reactions

associated with oral or parenteral therapy associated with oral or parenteral therapy

Administration of inhaled corticosteroidsAdministration of inhaled corticosteroids

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

PrednisolonPrednisolon, , HydrocortizoneHydrocortizone, , DexamethazoneDexamethazone

Leukotriene inhibitorsLeukotriene inhibitors

ZileutonZileuton - a 5-lipoxygenase inhibitor - a 5-lipoxygenase inhibitor

ZafirlukastZafirlukast - a leukotriene-receptor antagonista leukotriene-receptor antagonist

Leukotrienes attract cellular infiltrates producing Leukotrienes attract cellular infiltrates producing epithelial injury, abnormalities in neural epithelial injury, abnormalities in neural mechanisms, increases in airway smooth muscle mechanisms, increases in airway smooth muscle responsiveness, and airway obstructionresponsiveness, and airway obstruction

Molecular mechanisms of Molecular mechanisms of bronchodilatorsbronchodilators

Bronchodiliation

PDE3

DRUGS FOR LUNGS EDEMADRUGS FOR LUNGS EDEMA

Classification of lungs edema::

Cardiogenic Cardiogenic

Toxic Toxic

NeurogenicNeurogenic

Caused by prolonged inspire Caused by prolonged inspire resistanceresistance

Treatment measures for lungs edema

а) а) decreasing of hydrostatic pressure in pulmonary decreasing of hydrostatic pressure in pulmonary vessels vessels and decreasing of cardiac inputand decreasing of cardiac input bb) ) decreasing the volume of blood circulation decreasing the volume of blood circulation c) lungs dehydrationc) lungs dehydration dd) ) decreasing of permeability of alveolar-capillary decreasing of permeability of alveolar-capillary membranesmembranes ee) ) improvement of tissue oxygenationimprovement of tissue oxygenation, , renewing of renewing of respiratory ways penetrability,respiratory ways penetrability, removing the foam in removing the foam in alveolialveoli f) correction of acid-base and electrolyte balancef) correction of acid-base and electrolyte balancegg) ) removing of pain syndrome and acute disorders of removing of pain syndrome and acute disorders of heart rhythmheart rhythmg)g) increasing of contractive ability of myocardium and increasing of contractive ability of myocardium and removing of bronchial spasmremoving of bronchial spasm

Morphine Morphine hydrochloridehydrochloride

Fentanyl + DroperidolFentanyl + DroperidolNeuroleptics Neuroleptics

(Aminazinum, Droperidolum (Aminazinum, Droperidolum - with - with αα-adrenoblocker -adrenoblocker

activityactivity))

dilatation of peripheral vessels

GANGLIONBLOCKERSGANGLIONBLOCKERSHygroniumHygronium, , PentaminPentamin

dilatation of peripheral vessels

VasodilatorsVasodilatorsNitroglycerinNitroglycerin (Nitroglycerinum) (Nitroglycerinum)

NitromintNitromint

DiureticsDiureticsFurosemid Furosemid ((LazixLazix))

MannitMannit (the last is(the last is absolutely contraindicated for absolutely contraindicated for cardiogenic lung edema)cardiogenic lung edema)

Modified Bobrov’s apparatusModified Bobrov’s apparatus(Alcohol 55-90 % for inhalation with oxygen – to reduce (Alcohol 55-90 % for inhalation with oxygen – to reduce

the foam in alveoli)the foam in alveoli)

DimedrolDimedrol, , SuprastinSuprastin, , PrednisolonePrednisolone