Drug therapy

Contents
• To prevent and treat inflammation
• Treat bronchospasm
• breathlessness
• Sputum clearance
• Inhibit coughing
• improve ventilation
• Reduce pulmonary HTN
Drugs to prevent inflammation
• They protect against allergic and exercise induced asthma

• They can be used prophylactically before exercise or allergen exposure

• Chromones
Sodium cromoglycate (Intal) Delivery
Inhalation
Nedocromil sodium (Tilade)
Drugs to treat inflammation
• Corticosteroids: reduce the inflammatory reactions that set off
bronchospasm, oedema and mucus hypersecretion.
• Benefits: decreased mucous secretion, decreased edema and reduced
reactivity
• Example:
• Beclomethasone (Becotide, Becloforte) Delivery:
• Prednisone Inhalation
• Hydrocortisone
• Prednisolone Delivery:
• Hydrocortisone IV or oral
Drugs to treat bronchospasm
• Β2- Agonists
Stimulates receptors on airway smooth muscle causing them to relax

Anticholinergics
Causes airway smooth muscles to relax by blocking stimulation from
cholinergic nerves

Xanthines
have anti-inflammatory effects and has effects on bronchial tree, resulting
in relaxation of smooth muscle.
 Drugs to treat breathlessness
• Sometimes the cause of breathlessness can be treated, e.g. bronchodilators
or steroids.
• Morphine increases the exercise tolerance that is limited by breathlessness,
reduces respiratory drive and oxygen consumption, lessens anxiety and, in a
proportion of patients, reduces breathlessness
Drugs to help sputum clearance
• Expectorants (Mucokinetics) are drugs believed to increase bronchial
secretion or reduce its viscosity, facilitating its removal by coughing.

• EXPECTORANTS: (MUCOKINETICS – secretion enhances):

• a) Secretion Enhancers: Sodium and Potassium citrate, KI,

Guaiphenesin (Glyceryl guaicolate), Vasaka, Ammonium chloride

• b) Mucolytics: Bromhexine, Ambroxol, Acetylcysteine, Carbocysteine

• Expectorants (Mucokinetics)
• 1. Increase Bronchial Secretion – Na and K citrate
• 2. Irritation of Bronchial mucosa – Iodides
• 3. Enhance Bronchial secretions (and mucociliary functions) –
Guaiphenesin, Vasaka
• 4. Ammonium salts – reflex stimulation of bronchial secretion
Drugs to inhibit coughing,
• ANTITUSSIVES
• Action via CNS
• Act by raising the threshold of cough centres
• by reducing cough impulse
• Uses:
• dry and non-productive cough
• Unusually tiring cough, disturbed sleep or hazardous – hernia, piles, cardiac
diseasead oculr surgery
• Ex: opioids(pholcodine, ethylmorphine) and non opioids(noscapine,
dextromethorphan), baclofen, Antihistamine(Promethazine), Bronchodilators
Drugs to improve ventilation
• Respiratory stimulants are medications used to stimulate respiration
post anesthesia or to treat respiratory conditions such as chronic
obstructive pulmonary disease (COPD), respiratory depression/failure,
and neonatal apnea. Respiratory stimulants improve the respiratory
drive and oxygen inflow as a result.
• Analeptics: respiratory depression, primarily as an anesthetic recovery
tool
• Ex: caffeine (coffee), theophyline (tea), theobromide (chocolate),
Doxapram
Drugs to reduce pulmonary hypertension
• Pulmonary hypertension is an elevation in pulmonary vascular
pressure that can be caused by an increase in pulmonary arterial
pressure or by increases in both pulmonary arterial and pulmonary
venous pressures.
• Anticoagulants - warfarin for prevention against in situ thrombosis
INR goal is
• Diuretics – for treatment of right heart failure
• Oxygen therapy – to maintain oxygen saturation at >90% at all times
• Calcium channel blockers(amlodipine, nifedipine, verapamil,
nicardipine)
AEROSO
LS
• An aerosol is a suspension of solid or liquid particles in gas.

• Effective aerosol therapy requires a device that quickly

delivers sufficient drug to the desired site of action with
minimal waste and at a low cost.

• The aim of aerosol therapy is to deliver a therapeutic dose of

the drugs to the desired site of action such as nose, throat,
airways, or deep lung.
• Medical aerosols are generated with nebulizers, and inhalers.

• Inhalers generate aerosolized medication from liquids or dry

powders for a single inhalation.

• Nebulizers produce finer aerosol particles from liquid-based

formulations over greater periods of time using compressed
gas or electricity.
INHALERS
• Inhaled therapy delivers an aerosolized drug, suspended as
fine liquid or solid particles in air, directly to the respiratory
tract.
Advantages:
• rapid onset of action
• local delivery to maximize the positive effects and minimize
adverse effects
• delivery of drugs that are not active by other routes
• Disadvantages are:
• less effective lung deposition with increased airflow
obstruction, in people with advanced COPD or acute
severe asthma
• reduced effectiveness in breathless people
INHALERS
• Pressurized inhalers deliver an aerosol by suspending
an active drug in a propellant.
• The traditional metered dose inhaler is portable and
cheap.
• Slow inhalation and end-inspiratory pause are advised
with pressurized inhalers.
• The pMDI is used to administer bronchodilators, anticholinergics, and
steroids.
• Anticholinergics: ipratropium and oxitropium
• Bronchodilators: salbutamol, tetrabutaline, salmeterol, bambuterol
• Dry powder inhalers draw air through dry powder to create an aerosol,
which is released on inspiration.
• They require minimal co-ordination.
• Disadvantages are that children under 6 years, breathless people and
those with bronchospasm may not be able to release the drug if they
are unable to generate the required flow,
• The powder is sensitive to moisture, so it is either stored in foil blisters
or patients advised not to exhale into the device.
• Clickhaler are as follows:
• Shake inhaler
• Remove mouthpiece cover
• Hold upright
• Press button until click heard.
• Breathe out
• Close lips around mouthpiece.
• Inhale deeply
• Remove device from lips, close lips
• Hold breath for 10 seconds
• Close mouthpiece cover.
• A spacer is a chamber between patient and inhaler that forms a
reservoir from which the patient can inhale the aerosol.
Advantages are the following:
• Propellants and large particles drop out in the chamber, thus
reducing the local side effects of steroids.
• Aerosol momentum is slowed
• Less co-ordination is required because the drug remains
suspended in the spacer until the patient breaths in
• Nebulisation transforms a solution of a drug into a fine mist for
inhalation.
• Nebulizers are used to convert liquids into aerosols of a size
that can be inhaled into the lower respiratory tract.
• This method delivers higher doses of a drug than can usually
be achieved by inhaler devices.
• The fine mist produced is breathed in during inspiration via a
close fitting face mask or mouth piece.
• The three categories of commonly used medical nebulizers include:

(1) pneumatic jet nebulizers,

(2) USNs,

(3) Vibrating mesh nebuliser

• Jet nebuliser: Uses an extrinsic gas flow forced through a narrow orifice
to create a pressure that draws a drug from a liquid as a mist.
• Ultrasonic nebuliser: Uses high piezoelectric crystal(frequency sound
waves) to produce small droplets from a liquid containing a drug as a
fine mist.
• The crystal transducer converts an electrical signal into high-frequency
acoustic vibrations.
• Vibrating mesh nebulisers use mesh deformation or vibration to push
the liquid drug through the mesh
• An annular piezo element, which is in contact with the mesh, is used to
produce vibration around the mesh, and the liquid drug is in direct
contact with the mesh