Principles Of Pharmacology For Respiratory Disorders PDF

PHARMACOLOGY AND TOXICOLOGY PRINCIPLES OF PHARMACOLOGY FOR R E S P I R AT OR Y D I S O R D ER S WO N G C H U N K E U N G 7 OCT 2024 1 WHAT IS RESPIRATORY MEDICATION? Respiratory medication is prescribed for management of patient with pulmonary d...

PHARMACOLOGY AND TOXICOLOGY PRINCIPLES OF PHARMACOLOGY FOR R E S P I R AT OR Y D I S O R D ER S WO N G C H U N K E U N G 7 OCT 2024 1 WHAT IS RESPIRATORY MEDICATION? Respiratory medication is prescribed for management of patient with pulmonary diseases Different respiratory medication is unique in their mechanism of action It is important to understand the implications of each unique respiratory medication to patient The ultimate goal is to provide effective and safe patient treatment and management https://pngimg.com/image/74907 2 DRUGS COMMONLY USED TO TREAT LUNG AND AIRWAY DISORDERS Cough suppressants Bronchodilators Expectorants Decongestants Antibiotics Anti-inflammatory drugs https://foto.wuestenigel.com/colorful-medicines-and-pills-with-a-cup-of-tea-and- lemons-concept-folk-medicine-and-traditional-medicine/ 3 COUGH SUPPRESSANTS Suppress the coughing reflex Usually narcotics acting on medulla oblongata of brain to prevent coughing Codeine is found in many preparations, including tablets and syrups BRONCHODILATORS Breathing difficulty in certain airway disorders Constriction of muscles surrounding the airways Bronchodilators relax the muscles and relieve the constriction 4 EXPECTORANTS AND MUCUS-PRODUCING DRUGS Increase the amount and thinning the bronchial secretions, Making coughs more productive Clearing the airways and eases breathing DECONGESTANTS Treat the allergies, sneezing and runny nose Reduce swelling and edema Causing local constriction of blood vessels 5 ANTIBIOTICS Prescribed when there is a true bacterial infection When infection worsens existing airway disease Antibiotic treatment may or may not be necessary for treating inflammatory airway diseases ANTI-INFLAMMATORY DRUGS Corticosteroids such as glucocorticoids prevent release of inflammatory chemicals Control inflammation of the airways Suppress the immune system 6 ASTHMA Noncommunicable disease Most common chronic disease of children Affecting both children and adults Asthma a chronic lung disease caused by inflammation and narrowing of small airways in the lungs Asthma symptoms may include combination of cough, wheeze, shortness of breath and chest tightness https://www.flickr.com/photos/54591706@N02/29251369035 7 TRIGGERS OF ASTHMA Allergic asthma is very common Though not all asthma caused by allergies Other types of asthma with different kinds of triggers exist Asthma may be triggered by: – Stress – Cold air – Exercise – Gastroesophageal reflux disease Some people have more than one kind of trigger for asthma 8 TRIGGERS OF ASTHMA (CONTINUE) Some more triggers of asthma: Pollution Smoking Bacteria and viruses Genetic Pets Household chemicals Dust https://www.allergyclinical.com/asthma-care/ 9 FACTS OF ASTHMA Asthma may change over time, need to consultant doctor for tracking the symptoms and modifying the asthma medications when necessary Types and doses of asthma medications required depend on symptoms and age https://foto.wuestenigel.com/hand-schreibt-asthma-auf-ein-whiteboard/ 10 DRUGS FOR TREATING ASTHMA Most common treatment for asthma Inhalers - Devices for breathing in medicine Tablets and other treatments may be needed if the asthma is severe. Adopt a personal action plan advised by the doctor https://nagpurtoday.in/wp-content/uploads/2013/05/asthma-img-1.jpg 11 DRUGS FOR TREATING ASTHMA What is an asthma inhaler: A device containing a medicine Take by inhaling (breathing in) Main used for treatment of asthma Control asthma symptoms Medicine of inhaler goes straightly into the airways Require much smaller dose medicine taken as liquid or tablet or by mouth https://www.wikidoc.org/index.php/Asthma_medical_therapy 12  DRUGS FOR TREATING ASTHMA Generic name and brand name of medicine Many types of inhalers – Official name of drug/medicine is called generic name – Different companies may use the same generic medicine for producing different brands Compositions usually contain: – Corticosteroid – Bronchodilator https://www.wikidoc.org/index.php/Asthma_medical_therapy 13  DRUGS FOR TREATING ASTHMA What medicine is present inside the asthma inhalers? Medicine inside inhalers mainly divided into: Relievers (short-acting bronchodilators) Preventers (steroid inhalers) Long-acting bronchodilators https://www.wikidoc.org/index.php/Asthma_medical_therapy 14  DRUGS FOR TREATING ASTHMA Short-acting bronchodilators - Relievers Dilate (widen) the bronchi (airways) Ease symptoms of breathlessness and feeling of tight- chested quickly Relaxes the airway muscle and opens the airways wider Two main reliever medicines, with various brands from different companies: – Salbutamol Brands such as Airomir®, Asmasal®, Salamol®, Salbulin®, Pulvinal Salbutamol® and Ventolin® – Terbutaline Brand name such as Bricanyl® https://www.wikidoc.org/index.php/Asthma_medical_therapy 15  DRUGS FOR TREATING ASTHMA Preventers (Steroid inhalers) Steroid preventer medications suggested for patients regularly using reliever inhalers Steroids reduce the inflammation in the airways, prevent them from becoming narrow Commonly to be taken twice per day and sometimes more frequently Needs 7-14 days to build up its effect and may not immediately relief the symptoms Common steroid preventer medications include Beclometasone, Budesonide, Ciclesonide, Fluticasone and Mometasone, etc https://www.wikidoc.org/index.php/Asthma_medical_therapy 16  DRUGS FOR TREATING ASTHMA Long-acting bronchodilators Work in similar way to relievers, includes long-acting bronchodilator. Salmeterol and formoterol used commonly Added alongside the steroid inhaler using two separate asthma inhalers or in one combined inhaler Examples of combination inhalers are: – Fostair® (formoterol and beclometasone) – Seretide® (salmeterol and fluticasone) – Symbicort® (formoterol and budesonide) https://www.wikidoc.org/index.php/Asthma_medical_therapy 17 SIDE EFFECT OF USING ASTHMA INHALERS Side effect of using asthma inhalers is small when comparing with liquid or tablets medicines Some people may have side effects such as: – Sore throat – Cough – Oral thrush (Fungal infection causing white patches, soreness and redness in mouth) 18 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Group of lung conditions causing breathing difficulties, it includes: – Emphysema – Damage to the air sacs in the lungs – Chronic bronchitis – Long-term inflammation of the airways https://images.squarespace- cdn.com/content/v1/5e9e7873f15ec443bd66cd3c/1601241609055- VABM12M4GGLWCCSJXUP9/Healthy+vs+COPD+lungs+960px.jpg 19 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) - SYMPTOMS Shortness of breath – Especially when active Persistent chesty cough with phlegm Chest infections Persistent wheezing Chest tightness Fatigue Weight loss 20 CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) – RISK FACTORS 21 TREATMENT OF COPD No optimal cure for COPD Treatment help controlling the symptoms and slowing the condition progression Treatments such as: – Inhalers and tablets: Making the breathing easier – Stopping smoking: Vital for the patients – Pulmonary rehabilitation: Programme of exercise and education organized by health https://www.seasonsalf.com/coping-with-copd-the-complete-guide-to- care workers your-treatment-options/ – Surgery or a lung transplant: Option for a small number of patient 22 STOP SMOKING AND COPD COPD may be caused by smoking, It is an incurable disease that worsens with time Quitting smoking is the most effective way to prevent COPD getting worse Giving up smoking can help prevent further damage to lungs and airways Patients commonly need an oxygen machine to assist with breathing in daily https://technofaq.org/posts/2019/06/useful-tips-to-stop-harmful-smoking-habit/ activities for maintaining normal oxygen blood levels 23 SHORT-ACTING BRONCHODILATOR INHALERS FOR COPD The first treatment used for most people with COPD Used when there is feeling of breathless up to a maximum of 4 times a day The device delivers medicine directly into the lungs when breathing in The inhaler contains bronchodilators – Make the breathing easier by relaxing and widening the airways Two types of short-acting bronchodilator inhaler: – Beta-2 agonist inhalers – Such as salbutamol https://smw.ch/index.php/smw/article/view/3479 and terbutaline – Antimuscarinic inhalers – such as ipratropium 24 LONG-ACTING BRONCHODILATOR INHALERS FOR COPD For patients experience symptoms regularly despite using short-acting bronchodilators Commonly each dose lasts for at least 12 hours Using inhaler once or twice a day Two types of long-acting bronchodilator inhaler: – Beta-2 agonist inhalers: Such as salmeterol, formoterol and indacaterol Relaxation of bronchial smooth muscle, bronchodilation, and increased airflow – Antimuscarinic inhalers: Such as tiotropium, glycopyronium and aclidinium https://smw.ch/index.php/smw/article/view/3479 Cause the airways to widen by blocking the cholinergic nerves 25  For patients experience symptoms of breathless STEROID INHALERS even when using a long-acting inhaler FOR COPD Or develop frequent flare-ups (exacerbations): Worsening of a disease or an increase in its symptoms Including a steroid inhaler as part of treatment Exacerbations commonly caused by a bacterial or viral lung infection May also be triggered by agents that make it difficult for breathing, such as air pollution or smoking Inhalers contain corticosteroid help to reduce the inflammation in the airways Commonly prescribed in combination with long- https://smw.ch/index.php/smw/article/view/3479 acting medicine 26 THEOPHYLLINE TABLETS OR CAPSULES FOR COPD For patients experience symptoms that are not controlled with inhalers Theophylline usually taken twice a day as tablets or capsules Exactly how theophylline works is unclear Seems to reduce swelling (inflammation) in the airways and relax the muscles lining them Required to perform regular blood tests during treatment to check for the theophylline level in blood https://thuocdantoc.vn/wp-content/uploads/2019/02/theophyline.jpg Doctor will determine the best dose of medicine to control the symptoms 27 POSSIBLE SIDE EFFECTS OF THEOPHYLLINE Slow, fast or irregular heartbeat Pounding or rapid pulse Fainting Chest pain or discomfort Increase in urine volume Persistent vomiting 28 STEROID TABLETS FOR COPD Patients particularly bad flare-ups (exacerbations) - Worsening of a disease or an increase in its symptoms Prescribed a short course of steroid tablets – Normally a 5-day course of treatment is recommended – Reduce the inflammation of airways Troublesome side effects for long-term use of steroid tablets: – Weight gain – Mood swings – Weakened bones (osteoporosis) 29 MUCOLYTIC MEDICINES FOR COPD For patients with persistent chesty cough and lots of thick phlegm May need to take a mucolytic medicine called carbocisteine – Mucolytic medicines make the phlegm thinner and easier to cough up – Carbocisteine comes as tablets or capsules – Commonly taken 3 or 4 times a day If carbocisteine does not help the symptoms: – An alternative mucolytic medicine called acetylcysteine is available in market – Acetylcysteine is a powder that need mixing with water for taken 30 ANTIBIOTICS FOR COPD May be a need to prescribe a short course of antibiotics for signs and symptoms of chest infection, such as: – More breathless – More coughing – Change in colour of the sputum (such as becoming yellow, green or brown) and/or – Change in consistency of the sputum https://live.staticflickr.com/65535/49648845527_35b0eb7848.jpg (such as becoming thicker) 31  DRUGS FOR TREATING COUGH Dry cough - A preparation containing an antitussive such as dextromethorphan Chesty cough - A preparation containing an expectorant such as guaifenesin Antitussives – Cough suppressants and help suppress the urge to cough – Coughing is an innate reflex - Automatic instinctive unlearned reaction to a stimulus – Coughing is part of the immune system's response for getting rid of foreign objects – Antitussives prevent cough by working on a part of the brain controlling the action Expectorants – Expectorants thin mucus – Making it easier to cough up mucus during a productive cough – Expectorant to be used when having a cough that produces thick mucus 32 ANTIBIOTICS Antibiotics for adults aged 18 years and over First choice: Doxycycline - 200 mg on the first day, then 100 mg once a day for 4 days (5-day course in total) Alternative first choices: Amoxicillin - 500 mg three times a day for 5 days OR Clarithromycin - 250 mg to 500 mg twice a day for 5 days OR Erythromycin - 250 mg to 500 mg four times a day or 500 mg to 1,000 mg twice a day for 5 days 33 SIDE EFFECTS OF TAKING TOO MUCH COUGH MEDICINE? Symptoms include Drowsiness Dizziness Blurred vision Coma Constipation Seizures Bluish-colored fingernails and lips Slow and labored breathing, shallow breathing, no breathing (especially in young children) 34 WHAT ARE THE ALLERGIC RESPIRATORY DISORDERS? Allergic respiratory diseases (ARD) Includes asthma, chronic rhinosinusitis and allergic rhinitis, etc Asthma It is a chronic lung disease affecting people of all ages. It is caused by inflammation and narrowing of small airways in the lungs Chronic rhinosinusitis It is the swelling of the lining of the sinuses because of inflammation Allergic rhinitis Inflammation with redness and swelling of the inside of the nose 35 DRUGS FOR TREATING ALLERGIC RESPIRATORY DISORDERS What is the cure for respiratory allergies? There may be no cure for respiratory allergies Avoiding the allergic triggers should be a good way Medications, such as anti-histamines, are available to help control symptoms https://www.verywellhealth.com/respiratory-allergies-symptoms-causes-and-treatment-5206183 36 DRUGS FOR TREATING ALLERGIC RESPIRATORY DISORDERS Antihistamine for respiratory allergies Antihistamines block the chemical histamine of immune system, which is the key in allergic reactions Common used antihistamines includes – Cetirizine (Zyrtec) – Desloratadine (Clarinex) https://thuocdantoc.vn/wp-content/uploads/2018/12/zyrtec.jpg – Fexofenadine (Allegra) – Levocetirizine (Xyzal) – Loratadine (Claritin) 37 DRUGS FOR TREATING ALLERGIC RESPIRATORY DISORDERS Medicine for allergy cough Antihistamines blocks the action of histamine that causes allergic symptoms Antihistamines provide relief from an allergy cough. Commonly used medications include fexofenadine (Allegra) and loratadine (Claritin) Can antibiotics cure allergic cough? – It is not recommended to use antibiotics for uncomplicated acute bronchitis https://c1.staticflickr.com/3/2947/15312609008_7c9f2843bb_b.jpg 38 DRUGS FOR TREATING ALLERGIC RESPIRATORY DISORDERS Medicine for allergy cough (Continue) Expectorants – Example: Guaifenesin – Help clear mucus or phlegm from the chest in a cold or flu – Works by thinning the mucus or phlegm in the lungs https://thuocdantoc.vn/wp-content/uploads/2019/01/Mucinex-la-thuoc-gi-1.jpg Decongestions – Example: Pseudoephedrine – Provide short-term relief for blocked or stuffy noses – Reducing the swelling of the blood vessels in the nose and open the airways https://www.delphispharma.com/wp- – Ease symptoms for conditions for colds and flu content/uploads/2018/08/Pseudoephedrine-HCL.jpg 39 DRUGS FOR TREATING ALLERGIC RESPIRATORY DISORDERS Medicine for allergy cough (Continue) Theophylline A bronchodilator Make breathing easier through relaxing the muscles in the lungs and widening the airways Guaifenesin is present in some medications that also contain bronchodilators such as https://thuocdantoc.vn/wp-content/uploads/2019/02/theophyline.jpg theophylline 40 TOXICITY OF THEOPHYLLINE Toxic levels are considered to be higher than around 20 µg /mL However, adverse effects may be evident within the normal therapeutic range, particularly in elderly patients Severe complications including cardiac dysrhythmias (an abnormal or irregular heartbeat), seizures (uncontrolled burst of electrical activity in the brain which may cause changes in behavior, movements, feelings and levels of consciousness) https://s3.amazonaws.com/static.wd7.us/b/b0/Theophylline2DCSD.png Death can be observed with levels of around 80-100 µg /mL 41 RECOMMENDED THERAPEUTIC PLASMA LEVEL FOR THEOPHYLLINE The reference range of theophylline in the treatment of acute bronchospasm (the muscles that line the bronchi tighten) in adults is around 10-15 µg/mL. The reference range of theophylline in the treatment of neonatal apnea (absence of breathing in a neonate for a period of >15 seconds) is around 6-11 µg/mL. Neonate or a newborn infant, is a child under 28 days of age 42 WHY BLOOD TEST FOR THEOPHYLLINE IS NECESSARY? Help the doctor determine the correct dose and see if the patient has too much theophylline in the body. Too much theophylline can be life-threatening Theophylline levels need to be monitored because of the narrow therapeutic window of theophylline and its many side effects When the difference between the minimum efficacious concentration and the minimum toxic concentration is small, the therapeutic window will be referred to as narrow Doctor commonly monitor the following in the patient: – The heart rate of the patient – The Central Nervous System effects such as headache, insomnia and irritability, etc – The respiratory rate 43  HOW TO TEST FOR THEOPHYLLINE? The theophylline test Used to monitor the amount of theophylline in the blood It is usually requested as a trough level Measured just before the next dose When the blood concentration is expected to be at its lowest level 44 METHOD OF ANALYSIS OF THEOPHYLLINE? High performance liquid chromatography (HPLC) method with ultraviolet detection (272 nm) Simple, sensitive and selective laboratory method of testing Developed by scientist for the https://pharmasciences.in/principle-of-hplc/#google_vignette quantification of theophylline in plasma 45 CHARACTERISTICS OF HPLC Uses in Pharmacology Quantitative analysis of drug and separate the components of a mixed drug substance Principle Distribution of drug sample between a mobile phase and a stationary phase Depending on chemical structure of the drug sample, the molecules are delayed passing through the stationary phase named column Time the sample spends on the stationary phase determined by the intermolecular interactions, or polarity between the molecules and the packing material of column Different elements of drug sample are eluted at different times intervals Sample ingredients are separated and detected by a detector 46  DAD DETECTOR Also called photodiode-array (PDA) One of the most popular detection techniques for HPLC Other UV detection methods collect data at only one wavelength In contrast, DAD simultaneously collects data at multiple wavelengths The molecular structure of target analytes absorb light at different wavelengths on the electromagnetic spectrum DAD allows for tunability of the detection wavelength allowing for detection of thousands of target analytes. 47  ADVANTAGES OF HPLC A powerful technique for separating nearly any soluble compound Including vitamins, amino acids, and other biological compounds for analysis Comparing target peaks to certified reference standards ensures accurate signal identification Computational mathematics quantifies the target analyte based on peak size Less expensive Reuse of cleaned columns possible Further sample testing is possible Since HPLC testing with DAD does not destroy analytical samples 48 TUTORIAL What is Asthma? https://www.youtube.com/watch?v=batzSytA1Y0 How chronic obstructive pulmonary disease (COPD) develops https://www.youtube.com/watch?v=iYjKZHmzWEA Climate change, air pollution, allergic respiratory diseases: Call to action for health professional https://www.youtube.com/watch?v=yEmMOn09uoE 49 PRINCIPLES OF PHARMACOLOGY FOR RESPIRATORY DISORDERS 50