anti asthma and anti tussives

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this ppt is about treatment to asthma ,anti tussives

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INTRODUCTION Respiratory System Types of Diseases ANTI-ASTHMATICS Asthma Drugs For Asthma ANTI-TUSSIVES Cough Drugs For Cough CONTENTS: 1 2 3

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Human Respiratory System Figure 10.1

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Components of the Upper Respiratory Tract Figure 10.2

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Components of the Lower Respiratory Tract Figure 10.3

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Gas Exchange Between the Blood and Alveoli Figure 10.8A

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Respiratory Cycle Figure 10.9

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Regulation of Breathing Figure 10.13

VARIOUS TYPES OF DISEASES :

VARIOUS TYPES OF DISEASES

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BRONCHIAL ASTHMA CHRONIC OBSTRUCTIVE PULMONARY DISEASE. ALLERGIC RHINITIS COUGH DISEASES OF RESPIRATORY SYSTEM

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ASTHMA: Asthma is defined as chronic obstructive disease of air ways. It is characterized by variable and re occuring symptoms, reversible air flow obstruction and bronchiospasm .

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C.O.P.D: It is a progressive disease that makes it hard to breathe. Chronic bronchitis , which involves a long-term cough with mucus. Emphysema , which involves destruction of the lungs over time. CAUSES : Smoking . In rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.

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A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions. A cough is a forceful release of air from the lungs that can be heard. Coughing protects the respiratory system by clearing it of irritants and secretions. COUGH:

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ALLERGIC RHINITIS : Allergic rhinitis characterized by itchy, watery eyes, runny nose and a non-productive cough, is an extremely common condition that significantly decreases patient-reported quality of life.

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asthma asthma asthma asthma asthma

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Do u know about asthma……

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Asthma is chronic lung disease Asthma Asthma causes resistance, or obstruction, to exhaled air, it is called an obstructive lung disease

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Ipratropium bromide Tiotropium bromide Theophylline Aminophylline Salbutamol Terbutaline Bambuterol Salmeterol Anti-cholinergics Methyl xanthines β2-sympathomimetics BRONCHODILATORS-Sub classification

SYMPATHOMIMETICS::

SYMPATHOMIMETICS: Adrenergic drugs cause bronchodilation through

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A highly selective β 2 agonist Inhaled salbutamol produces bronchodilation with in 5min and the action lasts for 2-4hrs. Oral salbutamol acts for 4-6hrs ,is longer acting and safer than isoprenaline. Oral bio-availability is 50%. This is biscarbamate ester prodrug of terbualine slowly hydrolyzed in plasma and lungs by pseudo cholinesterase to release the active drug over 24hrs. reversible inhibition of pseudo cholinesterase occurs in a dose dependent manner First long-acting selective β 2 agonist with a slow onset of action . It is more β 2 selective than salbutamol not used in acute symptoms. SALBUTAMOL BAMBUTEROL SALMETEROL

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PALPITATIONS ANKLE EDEMA NERVOUSNESS RESTLESSNESS MUSCLE TREMORS SIDE EFFECTS OF SYMPATHOMIMETICS:

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S A L B U T A M O L T E R B U T A L I N E S A L M E T E R O L Comparision of side effects of β 2- sympathomimetics

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METHYLXANTHINES Mostly used in COPD. Theophylline is one of the three naturally occurring methylated xanthine alkaloids caffeine, Theophylline and Theobromine

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MECHANISM OF ACTION: 3 distinct actions of methylxanthine are:

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b. Inhibition of phosphodiesterase: ATP or GTP c AMP or c GMP Phosphodiesterase 5-AMP or 5-GMP The concentration of cyclic nucleotide is increased . bronchodilation , cardiac stimulation and vasodilation occur when cAMP level rises in the concerned cells. INHIBITION OF PHOSPHODIESTERASE BY THEOPHYLLINE

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Pharmacological actions of Methyl Xanthines C.N.S C.V.S Sk.MUS SO.MUS KIDNEY M.CELL G.I.T

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Caffeine Theophylline } Caffeine is more active than theophylline in producing effects like caffeine 150-250 mg produces 1. a sense of well-being , 2.alertness, 3.beats boredom, 4.allays fatigue, 5.dullness. Higher doses cause: 1. nervousness, 2.restlessness, 3. insomnia, 4.excitement, 5.tremors, 6. delirium , 7.convulsions. C.N.S stimulants ACTIONS ON C.N.S:

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Stimulate heart and increase myocardial contractions . THEOPHYLLINE : causes Tachycardia caffeine : DECREASES in HEART RATE On cardio vascular system :

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Caffeine enhances contractile power of skeletal muscles . AT LOW DOSE: twitch response to nerve response is augmented. AT HIGH DOSE: It increase releases of calcium from sarcoplasmic reticulum. AT TOXIC DOSE: contracture is produced. ACTIONS ON SKELETAL MUSCLES:

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ACTIONS ON STOMACH: Methylxanthines enhance 1.Secretion of acid. 2.Secretion of pepsin in stomach.

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ACTION ON SMOOTH MUSCLES : All smooth muscles are relaxed .

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ACTIONS ON MAST CELLS: THEOPHYLLINE decreases release of histamine and mediators from mast cells

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ACTIONS ON KIDNEY: METHYL XANTHINES are mild diuretics act by inhibiting tubular re absorption of Na+ and water.

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Drugs that inhibits the metabolism of theophylline: Erythromycin Ciprofloxacin Cimitidine Theophylline Theophylline enhances the effects of: Furosemide Sympathomimetics Digitalis DRUG INTERACTIONS:

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ANTI-CHOLINERGICS Atropinic drugs cause bronchodilation by blocking cholinergic constrictor tone, act primarily in larger airways. Inhaled Ipratropium bromide is less efficacious than sympathomimetics. Combination of inhaled ipratropium with β 2 agonist produces more marked and longer lasting bronchodilation used in severe asthma .

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LEUKOTRIENE ANTAGONISTS Cystenyl leukotrienes are important mediators of bronchial asthma.so leukotriene antagonists are used. MONTELUKAST AND ZAFIRLUKAST They competitively antagonize cysLT, receptor mediated broncho constriction, increased vascular permeability and recruitment of eosinophil.

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Mast cells are found throughout the body, including in the airways in the lungs. They can release substances that result in inflammation, causing the symptoms of asthma. Mast cell stabilizers prevent the mast cells from releasing the substances that cause inflammation. MAST CELL STABILIZERS:

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MAST CELL STABILIZER ALLERGEN MAST CELL & IgE binding MAST CELL DEGRANULATION HISTAMINE PAF Eosinophil Chemotactic factors Phospholipase A2 production Arachidonic acid production Cycloxygenase metabolism Lipoxygenase metabolism prostaglandins Thromboxanes Leukotrienes Anti histamines corticosteroids NSAIDs

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It is a synthetic chromone derivative which inhibits degranulation of mast cells by trigger stimuli. Release of mediators of asthma like histamine, LTs, interleukins etc. is restricted. It is an antihistaminic (H1) with some cromoglycate like action; stimulation of immunogenic and inflammatory cells and mediator release are inhibited . It is not bronchodilator, but produces sedation. SODIUM CROMOGLYCATE KETOTIFEN

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CORTICOSTEROIDS Gluco corticoids are not bronchodilators. They benefit by reducing bronchial hyper reactivity, mucosal edema and by suppressing inflammatory response. The exact mechanism of action of corticosteroids is not fully understood, but it is believed to involve an inhibitory effect on leukocyte recruitment into the airways.

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ANTI-IgE ANTIBODY Omalizumab: It is a humanized monoclonal antibody against IgE. Administered i.v or s.c it neutralizes free IgE in circulation without activating mast cells and other inflammatory cells .

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CHOICE OF TREATMENT: MILD EPISODIC ASTHMA: Inhaled short acting β 2 agonist at onset of each episode. MILD CHRONIC ASTHMA: Regular inhaled low dose steroids, Alternatively inhaled cromoglycate MODERATE ASTHMA WITH FREQUENT EXACERBATIONS: Increasing doses of inhaled steroids + inhaled long acting β 2 agonist. Leukotriene antagonists & Theophylline are used as alternative drugs. SEVERE ASTHMA: Regular high dose inhaled steroids + inhaled long acting β 2 agonist twice daily. Leukotriene antagonists are used as alternative drugs.

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A S T H M A COUGH

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ANTI TUSSIVE DRUGS

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COUGH A cough is a sudden and often repetitively occurring reflex which helps to clear the large breathing passages from secretions, irritants, foreign particles and microbes .

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DRUGS FOR COUGH: 1.Pharyngeal demulcents: lozenges, cough drops, linctuses containing syrup,Glycerine ,liquorice . 2.EXPECTORANTS(MUCO KINETICS): BRONCHIAL SECRETION ENHANCERS : sodiumcitrate, potassiumcitrate, balsum of tolu, vasaka, 3.ANTI TUSSIVES (COUGH CENTRE SUPRESSANTS) (a)OPIOIDS: codeine, pholcodeine. ( b)NONOPIOIDS: Nocsapine, dextromethorphan, chlophedianol. (c)ANTI HISTAMINES: chlorpheniramine, diphenhydramine, promethazine. 4. ADJUVANT ANTI TUSSIVES : Salbutamol, terbutalin .

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CODEINE: An opium alkaloid qualitatively similar to morphine but less potent. It is more selective for cough centre and it is treated as the the standard anti tussive, suppresses cough for about 6 hrs. It suppresses coughing by direct action on the cough center in the brain, The anti tussive action is blocked by Naloxone indicating that it is exerted through opioid receptors in brain.

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Codeine may be habit-forming and should be used only by the person it was prescribed for. Codeine should never be given to another person, especially someone who has a history of drug abuse or addiction. Do not drink alcohol while you are taking this medication. Dangerous side effects or death can occur when alcohol is combined with codeine . Remember codiene:

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Side effects of Codiene Light-headedness Dizziness Nausea Vomiting Shortness of breath Sedation. Euphoria Other side effects: Allergic reactions, Constipation, Abdominal pain, Rash Itching.

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Non opioids: A synthetic compound; the d-isomer has selective anti tussive action while l-isomer is analgesic. Action in similar to codeine. A cough suppressant which affects the signals in the brain that trigger cough reflex Is technically not considered an opiate because it does not bind to traditional opiate receptors and is not addictive or analgesic. Is the safest antitussive and is reported to be more efficacious than codeine. DEXTROMETHORPHAN:

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NOSCAPINE (NARCOTINE) An opium alkaloid of the benzoisoquinoline series. Action is similar to codeine it depresses the cough but has no narcotic, analgesic or dependence including properties. Particularly used in spasmodic cough. SIDE EFFECTS Headache, nausea, causes bronchoconstriction in asthmatics by releasing histamine.

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VISULIZE ACTIVITIES WITH TIMELINES! TYLENOL TUSERAN CODATE VICKS VAPOUR 44 ROBITUSSIN CODAMOL NOVA HISTINE DM ROBITUSSIN-AC BALMIMIL DM CODEPHOUS CODIENE DEXTRO METHORPHAN BRAND NAMES FOR DIFFERENT DRUGS:

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TO INHIBIT THE BINDING OF HISTAMINES ANTI HISTAMINES ARE USED.

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They produce cough relief due to their sedative and anti-cholinergic actions, but lack selectivity for the cough centre. Chlorpheniramine, diphenhydramine promethazine are commonly used. Second generation antihistamines like fexofenadine, loratadine are ineffective . ANTI HISTAMINES

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If you are pregnant or breastfeeding, talk to your doctor before taking this medicine. Talk to your doctor if you have ever had asthma, emphysema, diabetes, heart disease, seizure disorders, an overactive thyroid, chronic bronchitis, or a liver disease before you take this medicine. Call your doctor if your cough does not improve or last longer than 7 days. Call your doctor if your cough gets worse, if you cough up yellow mucus, or if you have a fever, rash, sore throat, vomiting, or continuing headache with the cough. WARNINGS WHILE USING ANTI TUSSIVES DRUGS.

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POSSIBLE SIDE EFFECTS OF ANTI-TUSSIVES Drowsiness Dizziness Constipation stomach upset Nervousness or restlessness Rashes & itching Severe drowsiness

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Bronchospasm can induce or aggravate cough. Stimulation of pulmonary receptors can trigger both cough and broncho constriction, especially in individuals with bronchial hyper reactivity. Bronchodilators should be used only when an element of bronchoconstriction is present and not routinely. BRONCHO DILATORS (ADJUVANT- ANTI TUSSIVES)

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TARGET GPAT

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A 12-year-old girl with a childhood history of asthma complained of cough, dyspnea, and wheezing . Her symptoms became so severe. Physical examination revealed diaphoresis, dyspnea, tachycardia, and tachypnea. Her respiratory rate was 42 breaths per minute, pulse rate 110 beats per minute, and blood pressure 132/65 mm Hg. Which of the following is the most appropriate drug to rapidly reverse her bronchoconstriction? A. Inhaled cromolyn. B. Inhaled beclomethasone. C. Inhaled albuterol. D. Intravenous propranolol.

REASON::

REASON: Cromolyn can be used prophylactically to reduce the inflammatory response but is ineffective in relieving acute symptoms. Inhaled beclomethasone will not deliver enough steroid to fully combat airway inflammation. Inhalation of a rapid-acting β 2 agonist, such as albuterol, usually provides immediate bronchodilation. Propranolol is a β 2 -blocker and would aggravate the patient's bronchoconstriction.

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Side effects: CONCLUSION There are many drugs available in market for the treatment of asthma. Inspite of side effects ,the above drugs what I have discussed are proved to be effective .There are no drugs available for the complete cure or treatment of asthma .These only give some kind of relaxation depending upon the situation.

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REFERENCES:

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My sincere thanks to DR.P.SRINIVASA BABU GARU M.PHARM.,PH.D. My special thanks to my guide, MR.E.TAMIL JOTHI sir M.PHARM.,(PH.D). Mrs.B.Deepthi mam M.PHARM.(PH.D) My heart full thanks to all my friends…………. Sadhana gopichand sasidhar amarendra kumar dinesh Nithya mounica SCREEN PLAY,DIRECTION By SRIRAM ALAPATI

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