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
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)
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. .
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
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)
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
M-cholinoblockersM-cholinoblockersAtropine sulfateAtropine sulfate, , Solutan, Solutan, Ipratropii bromidumIpratropii bromidum
(Atrovent)(Atrovent)
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)
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
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)
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