Transcript Pharmaceutical guidelines of patients with pathology of breathing

Pharmaceutical guidelines of
patients with pathology of
breathing organs.
Symptomatic treatment of
COUGH
Cough is a forceful expulsion of air
from the lungs
It is normally a protective reflex for removing
foreign bodies, environmental irritants, or
accumulated secretions from the respiratory
tract.
The cough reflex involves central and
peripheral mechanisms. Centrally, the cough
center in the medulla oblongata receives stimuli
and initiates the reflex response (deep
inspiration, closed glottis, buildup of pressure
within the lungs, and forceful exhalation).
Peripherally, cough receptors in the pharynx,
larynx, trachea, or lungs may be stimulated by
air, dryness of mucous membranes, or excessive
secretions.
Cough
A cough is productive when secretions are expectorated;
it is nonproductive when it is dry and no sputum is
expectorated.
Cough is a prominent symptom of
 respiratory tract infections (the common cold, influenza,
bronchitis, pharyngitis, pneumonia)
 chronic obstructive pulmonary diseases (emphysema,
chronic bronchitis).
 asthma, acid reflux into the esophagus
(gastroesophageal reflux disease), sinusitis, postnasal
drip, bronchitis, cigarette smoking, tuberculosis,
hypersensitivity pneumonia (inflammation of the lung
from exposure to certain environmental chemicals), and
even lung cancer. Therefore, a persistent cough or a
cough that is associated with chest pain, fever, weight
loss, or blood-tinged or discolored sputum should be
evaluated by a doctor.
Cough

Dry
Laryngitis
Dry pleurisy
Smoking cough
In the beginning of
diseases:
Acute bronchitis
Pneumonia
Lung abscess
Tuberculosis
Lung cancer

Wet
Acute viral diseases
Bronchitis
Pneumonia
Tuberculosis
Bronchiectatic disease
Threatning symptoms
Cough with increasing intensity that lasting above week
 Cough accompanied by long steading (weeks)
hyperthermia 38 °C
 Cough accompanied by hyperthermia above 38 °C
during 3 days or more
 Cough accompanied by dyspnea and thorasic pain on
breathing
 Cough of pus
 Blood spitting
 Cough with pronounced dyspnea
 Cough and weakness and weight loss
 Excessive sweating, shivering
 Sudden attack of severe cough
 Severe cough during an hour without any interval
 Abundant expectoration of sputum

Antitussives
Antitussive agents suppress cough by depressing the
cough center in the medulla oblongata or the cough
receptors in the throat, trachea, or lungs.
 Centrally acting antitussives:
narcotics (eg, codeine, hydrocodone) and non-narcotics
(eg, dextromethorphan).
 Locally acting agents (eg, throat lozenges, cough drops)
may suppress cough by increasing the flow of saliva and
by containing demulcents or local anesthetics to
decrease irritation of pharyngeal mucosa.
 Flavored syrups are often used as vehicles for other
drugs.

Indication for use of antitussives
a dry, hacking, nonproductive cough that
interferes with rest and sleep.
It is not desirable to suppress a productive cough
because the secretions need to be removed.
Although antitussives continue to be used and
some people report beneficial effects, some
research studies indicate that cough medicines
are no more effective than placebos in children
or adults.
Expectorants
Expectorants are agents given orally to liquefy
respiratory secretions and allow for their easier
removal.
 Guaifenesin is the most commonly used
expectorant. It is available alone and as an
ingredient in many combination cough and cold
remedies, although research studies do not
support its effectiveness and many authorities
do not recommend its use.

Expectorants
Other expectorants (hot beverages,
potassium iodide, and ipecac) stimulate
production of watery mucus.
Mucolytics
Mucolytics are administered by inhalation
to liquefy mucus in the respiratory tract.
Solutions of mucolytic drugs may be
nebulized into a face mask or mouthpiece
or instilled directly into the respiratory
tract through a tracheostomy.
 Sodium chloride solution and
acetylcysteine (Mucomyst) are the only
agents recommended for use as
mucolytics.

Mucolytics


Acetylcysteine is effective
within 1 minute after
inhalation, and maximal
effects occur within 5 to
10 minutes. It is effective
immediately after direct
instillation.
Oral acetylcysteine is
widely used in the
treatment of
acetaminophen
overdosage
Mucolytics

expectorants like bromhexine or
ambroxole may effectively decrease
viscosity of bronchial secretions
Ambroxol

Ambroxol is a clinically proven systemically
active mucolytic agent. When administered
orally onset of action occurs after about 30
minutes. The breakdown of acid
mucopolysaccharide fibers makes the sputum
thinner and less viscous and therefore more
easily removed by coughing. Although sputum
volume eventually decreases, its viscosity
remains low for as long as treatment is
maintained.
Ambroxol (cont’d)
Indications
 All forms of tracheobronchitis, emphysema with
bronchitis pneumoconiosis, chronic inflammatory
pulmonary conditions, bronchiectasis, bronchitis
with bronchospasm asthma. During acute
exacerbations of bronchitis it should be given
with the appropriate antibiotic.
Contraindications
 There are no absolute contraindications but in
patients with gastric ulceration relative caution
should be observed.
Types of cough medications available OTC
for the temporary relief of cough due to a
cold
oral cough suppressants,
 oral expectorants,
 topical (externally applied) medicines

Oral cough suppressants

Codeine and hydrocodone are narcotic oral
cough suppressants that require a doctor's
prescription. Dextromethorphan is an oral cough
suppressant that is available OTC.
Dextromethorphan is chemically related to
codeine and acts on the brain to suppress
cough, but does not have the pain-relieving and
addictive properties of codeine.
Diphenhydramine is another non-narcotic
medication that acts on the brain to suppress
cough. It is also an antihistamine.
Oral cough suppressants
Dextromethorphan and diphenhydramine
can be used to relieve a dry, hacking
cough. They are not generally used to
suppress a productive cough
 Cough suppressants are sometimes used
to suppress even productive coughs if
they are especially bothersome and
prevent restful sleep.

Oral expectorants

Guaifenesin is an oral expectorant that is
believed to increase the leaking of fluid
out of the lung tissue and into the
airways. This action thins (liquefies) the
thick mucous in the airways and facilitates
the clearing of the mucous by coughing.
Clearing of mucous from the airways
decreases cough.
Topical medications

Camphor and menthol are topical cough
medications. Camphor and menthol
ointments are rubbed on the throat and
the chest as a thick layer. The anesthetic
action of their vapors is believed to relieve
cough. They are also available as products
for steam inhalation. Menthol is also
available as lozenges and compressed
tablets.
ANTICOUGH MEDICATIONS.
GUIDELINES
These drugs may relieve symptoms but do
not cure the disorder causing the
symptoms.
 An adequate fluid intake, humidification of
the environment, and sucking on hard
candy or throat lozenges can help to
relieve mouth dryness and cough.

ANTICOUGH MEDICATIONS.
GUIDELINES
The patient should take medications as
prescribed or as directed on the labels of OTC
preparations. Taking excessive amounts or
taking recommended amounts too often can
lead to serious adverse effects.
 The patient should take cough syrups undiluted
and avoid eating and drinking for approximately
30 minutes. Part of the beneficial effect of cough
syrups stems from soothing effects on
pharyngeal mucosa. Food or fluid removes the
medication from the throat.

Use in Children
Most infections are viral in origin and
antibiotics are not generally
recommended.
 For bronchitis, which is almost always
viral, antibiotics are not usually indicated
unless pneumonia is suspected or the
cough lasts 10 to 14 days without
improvement.

ANTICOUGH MEDICATIONS.
GUIDELINES (cont’d)
Adverse effects
Excessive suppression of the cough reflex
with antitussives(inability to cough
effectively when secretions are present):
This is a potentially serious adverse effect
because retained secretions may lead to
atelectasis, pneumonia, hypoxia, and
respiratory failure.

ANTICOUGH MEDICATIONS.
GUIDELINES (cont’d)
Adverse effects:
 Nausea, vomiting, constipation, dizziness,
drowsiness, pruritus, and drug
dependence: associated with narcotic
agents. When narcotics are given for
antitussive effects, however, they are
given in relatively small doses and are
unlikely to cause adverse reactions.
ANTICOUGH MEDICATIONS.
GUIDELINES (cont’d)

Drug interactions
Drugs that increase antitussive effects of
codeine: CNS depressants (alcohol,
antianxiety agents, barbiturates, and other
sedative-hypnotics) - Additive CNS
depression. Codeine is given in small
doses for antitussive effects, and risks of
significant interactions are minimal.
ANTICOUGH MEDICATIONS.
GUIDELINES (cont’d)
drug interactions
Drugs that alter effects of
dextromethorphan:
 MAO inhibitors - This combination is
contraindicated. Apnea, muscular rigidity,
hyperpyrexia, laryngospasm, and death
may occur.

ANTICOUGH MEDICATIONS.
GUIDELINES (cont’d)
Anticough agents that include codeine,
Dextromethorphan, butamirat are not
recommended for using in kids (to 2 years of
age), during pregnancy and lactation
 Agents that include glaucini hydrochloridum may
provoke decreasing of arterial blood pressure in
kids
 Anticough agents that include
Dextromethorphan may cause CNS and
breathing depression if using in hight doses or
for a long period
 Anticough agents that include butamirat,
dextromethorphan may cause weakness,
sleepiness, dizziness

Mucolytics & expectorants
GUIDELINES
Ambroxol is contraindicated in first term of
pregnancy
 Acetylcysteine may cause pulmonary hemorrage,
liver and kidney function disturbances, may
provoke attack of asthma in patients with BA
 Acetylcysteine solution don’t use in one syringe
with antibiotics
 Bromhexine and ambroxole may increase liver
transaminase activity

Mucolytics & expectorants
GUIDELINES (cont’d)
Bromhexine and ambroxole are not
combined with codeine including drugs
 Bromhexine and ambroxole stimuly
surfactant synthesis, making better
alveolar cells function, and help clearing
of mucous from the airways

Mucolytics & expectorants
GUIDELINES (cont’d)
Bromhexine don’t use in kids to 3 years age
 Expectorants don’t combine with drugs that
supress cough reflex
 Expectorants don’t combine with drugs that
dehydrate organism (diuretics, laxatives)
 Expectorants with reflective mechanism of
action (thermopsis) may provoke vomiting and
are contraindicated in patients with ulcer disease

Mucolytics & expectorants
GUIDELINES (cont’d)





Expectorants show their clinical efficiency on 6-7 days of
treatment
In the first 2-3 days of reception of expectorants a cough
and separation of sputum can increase: these phenomena
testify to efficiency of preparation
At presence of acute inflammatory process herbal
expectorants are preferable
At an overdose or prolonged reception of preparations,
containing iodides, the origin of iodism is possible: rrhinitis,
somnolence, swelling; hyperthyroidism - tachicardia, tremor,
insomnia, diarrhea are possible (more frequent at persons
after 40 years)
Plant decoctions and extracts render not only coughing up
action, but also the regenerations of the damaged mucous
membrane of bronchial tubes promote due to the contained
microelements, vitamins and biogenic stimulators