URTIs PDF

URTIs Presented by: Dr Karishma Jeeboo Respiratory System The respiratory system consists of two parts: Upper respiratory tract : Composed of the Nose Mouth Pharynx Larynx Trachea Upper bronchial tree Lower respiratory tract made up of the Bronchi Alveoli Upper Respiratory Tract...

URTIs Presented by: Dr Karishma Jeeboo Respiratory System The respiratory system consists of two parts: Upper respiratory tract : Composed of the Nose Mouth Pharynx Larynx Trachea Upper bronchial tree Lower respiratory tract made up of the Bronchi Alveoli Upper Respiratory Tract Infections Common Cold – caused by viruses; histamine & prostaglandin release producing an inflammatory response Seasonal Rhinitis or Allergic Rhinitis – inflammation of the nasal cavity (common) Symptoms include itchy, watery eyes, runny nose and a non-productive cough that decreases QOL. Sinusitis - Inflammation of the mucous membrane of the sinuses. Severe pain and if left untreated can lead to infections. Pharyngitis and Laryngitis - Infections of the pharynx and larynx. Caused by common bacteria or viruses. frequently seen with influenza Lower Respiratory Tract Conditions responsible for many respiratory deaths, these disorders involve an alteration in the ability to move gases in and out of the respiratory system. Atelectasis: A collapsed or airless condition of the lung. Most commonly occurs as a result of airway blockage, which prevents air from entering the alveoli, keeping the lung expanded. Symptoms: Dyspnea, fever, cough, hypoxia and changes in chest wall movement. Treatment: Clearing the airways, delivering oxygen, and assisting ventilation Lower Respiratory Tract Conditions Pneumonia: Inflammation of the lungs caused by bacterial or viral tissue invasion. Patients complain of difficulty breathing and fatigue, and they present with fever, noisy breath sounds, and poor oxygenation Bronchitis: Acute bronchitis occurs when bacteria, viruses, or foreign material infect the inner layer of the bronchi. The person with bronchitis may have a narrowed airway during the inflammation, this condition can be severe, Chronic bronchitis is an inflammation of the bronchi that does not clear.  Lower Respiratory Tract Conditions Obstructive Pulmonary Disease: includes asthma, cystic fibrosis, COPD and RDS Asthma: Is characterized by reversible bronchospasm, inflammation, and hyperactive airways Etiology: Allergens, dust, fumes, exercise, emotions, inflammatory mediators (eg, leukotrienes) COPD (Chronic obstructive pulmonary disease): Chronic obstruction of airways, often related to cigarette smoking. Two related disorders cause it: Emphysema: loss of elastic tissue in the lungs, destruction of alveolar walls, air becoming trapped in the overexpanded alveoli, and inadequate gas exchange. Chronic bronchitis: Permanent inflammation of the airways with mucus secretion and edema. Lower Respiratory Tract Conditions Cystic fibrosis: Is a hereditary disease that results in the accumulation of copious amounts of very thick secretions in the lungs. The secretions obstruct the airways, leading to destruction of the lung tissue. Progressive disease. Respiratory distress syndrome(RDS): is frequently seen in premature babies who are delivered before their lungs have fully developed. Symptoms: atelectasis of the lungs, tachypnea, tachycardia  Drugs used in the treatment of upper respiratory tract diseases Antitussives Decongestants Antihistamines (H1 Blockers) Expectorants Antibiotics Antitussives Are drugs that suppress the cough reflex. Many disorders including common cold, sinusitis, pharyngitis, and pneumonia, are accompanied by an uncomfortable, unproductive cough Eg: Benzonatate, codeine, dextromethorphan, hydrocodone Mechanism of action: Act directly on the medullary cough centre of the brain to depress the cough reflex. They cross the placental barrier and enter breast milk. Use: to suppress non-productive cough Adverse effects: Drowsiness, dizziness, nausea, dry mouth, constipation. Antitussives Contra indications: CNS depression will increase if the drug is used with: Alcohol Narcotics Sedative-hypnotics Barbiturates Decongestants Nasal decongestants: ephedrine, oxymetazoline, phenylephrine, tetrahydrozoline, xylometazoline, pseudoephedrine. Mechanism of action: Stimulate  adrenergic receptors, causes vasoconstriction of the capillaries within the nasal mucosa Shrink the nasal mucous membrane by stimulating alpha receptors in the nasal mucous membranes, promoting drainage of the sinuses and improving airflow. Decongestants Advantages of nasal decongestants Prompt action (direct application)-10 min Fewer side effects than systemic decongestants Disadvantages of nasal decongestants Local irritation (Stinging/burning sensation, sneezing, dryness of nasal mucosa) Tolerance and rebound nasal congestion Use: nasal sprays that are used to relieve the discomfort of nasal congestion that accompanies the common cold, sinusitis and allergic rhinitis. Decongestants Contra indications: Caution should be used in patients with glaucoma, hypertension, prostate problems. Adverse effects: local stinging and burning, rebound congestion (longer use), Systemic absorption causes: increased B.P, urinary retention, sweating, palpitations. Decongestants Systemic decongestants( adrenergic agonist): Pseudoephedrine (actifed, Sudafed) Phenylephrine Ephedrine (both  and  effects) Decongestants Advantages of systemic decongestants Relieve nasal congestion for a longer period of time than nasal decongestant Disadvantages of systemic decongestants Vasoconstriction (increased B.P) Increased blood glucose levels (  stimulation) Adverse effects: rebound congestion (long term used), sympathetic effects (anxiety, restlessness, tremors, hypertension, arrhythmias, sweating) Contra indications: caution should be used in patients with any condition that might be exacerbated by sympathetic activity. e.g.: Hypertension, heart disease, diabetes Drug interactions: MAO inhibitors Antihistamines (H1Blockers) First generation drugs: Brompheneramine, buclizine, azelastine, chlorpheneramine, clemastine, cyclizine, cyproheptadine, dimenhydrinate, DPH, hydroxyzine, prometahazine, meclizine Second generation drugs: Fexofenadine(Allegra), loratidine(Claritin), desloratidine, cetirizine-weak sedative potential (Zyrtec) Mechanism of action: Block the effects of histamine at the H-1 receptor sites, decreasing the allergic response. They also have anticholinergic (atropine-like), antiadrenergic and anti serotonin effects. Antihistamines (H1Blockers) Use: allergic rhinitis, urticaria, prevention of motion sickness Adverse effects: drowsiness, sedation, anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision) Contra indications: Asthma attack, severe liver disease, neonates Expectorants Mechanism of action: Liquefy the lower respiratory tract secretions, Reducing the viscosity of these secretions and making it easier for the patient to cough them up. Facilitate the removal of mucus High doses causes emesis Use: dry cough, including the common cold, acute bronchitis, and influenza Adverse effects: Nausea, vomiting, anorexia, headache, dizziness, rash (occasionally) Examples Guaifenesin Ammonium chloride Mucolytics Belong to the class of mucoactive agents. exert their effect on the mucus layer lining the respiratory tract with the motive of enhancing its clearance. There are Classic Mucolytics and Peptide Mucolytics Classic - N – Acetylcysteine, Peptide - dornase alfa Others: Ambroxol, Bromhexine Homework In the case of infected sinuses, what are some of the bacteria cultures that can be found there? Pneumonia Bronchitis Pharyngitis and Laryngitis