Respiratory system pharmacology

Prefusion: Perfusion is the passage of fluid through the

circulatory system or lymphatic system to the lungs.
“dulton’s law’
HOW? by the difference of pressure levels.

what affects profusion?

1-Edema
2-secretion
3-bronchospasm of smooth muscle

they Increase the resistance of airflow

decrease the ventilation and thus diffusion of gases.

who control this? smooth muscles that covers the

bronchis.

contraction > constriction.

Caption
 circulation where the blood and gas exchange happens between heart and lungs
( pulmonary circulation )
then from the heart to the whole body organs ( systemic circulation )

how to define if the problem is at the lungs part or the heart part ?
if the patient is having a problem expiration ( ‫ ) زـفير‬it’s a lung problem
if the patient is having a problem inspiration (‫ ) شــهيق‬it’s a heart problem

Upper Respiratory tract Infections

1- Viral Infections : rhinovirus “ the common cold “ affect mostly the nasopharyngeal
2- Acute Infections : Inflammation of the mucus membrane. sinusitis and acute laryngitis
3- Allergy : by pollens or foreign substances.
4- acute otitis media : it’s connected to the nasopharynx by the nasopharyngeal tube.
 HISTAMINE
histamine is a neurotransmitter that is linked to Allergy.

pollen

histamine release (From Mast Cells)

binds to H1 receptors in the lungs

Edema,rushing,vasodilation but bronchoconstriction

patient is not able to breath properly (‫) اـحـتقـاناـألنـف‬

how the work? mast cell stabilisers ( no release for Histamine)
Treatment of upper respiratory infections :
1- Anti-Histamine
2- Decongestant
3- Glucocorticoids
4-Antitussives
5- expectorants
Treatment of Allergey: Stopping the histamine ( ANTI-HISTAMINES)
H1,H2, H3,H4 ( not use pharmaceutically )
H2 : GIT mainly and heart.
H1: Allergy and ???
H1 Antagonists are two generations
first generation : can cross to the CNS ( adverse effect )
chlorphniramine/ diphenydramine.
second generation: can’t cross to the CNS ( safer )
Cetrizine/ loratadine.

uses: treat cold, allergy rxn.

side effects ( for the first gen) :
drowsiness,dizziness,sleepiness, drying effects.
contraindications :
GLUCOMA AND ASTHMA
 Epinephrine Vs Histamine
“ physiologic antagonist”
this means they stop each others work but each one on his own receptors

EPINEPHRINE HISTAMINE
BRONCHODILATION BRONCHOCONSTRICTION
 when we have upper respiratory infections/inflammation
vasodilatation

increases the permeability

more fluid to the tissue spaces

nasal swelling and congestion.

so ? we must stop the vasodilatation by using a substance that cause

( DECONGESTANT)
VASOCONSTRICTION

reduction in fluid secretion and decrease in the swelling and congestion

VASODILATION > BRONCHOCONSTICTION
VASOCONSTRICTION > BRONCHODILATION
Decongestants

Caption
 Decongestant
“ Alpha-Adrenergic agonists”
which means the stimulate a1 to do it’s job.
eg: Naphazoline, phenslpropanoalamine
uses:
common cold,hayfever,upper resp,sinusitis
Side Effects:
Increase blood pressure,hyperness
why? ^ Vasoconstriction
Contrandication:
Hypertension, cardiac disease, diabetes.

FREQUENT USE MAY CAUSE TOLERANCE OR REBOUND EFFECT

 Intranasal Glucocortoids (steriods)
“sone”

Anti-inflammatory not bronchodilator.

uses: seasonal allergies
with anti-histamine
Side Effects:
rare but may cause dryness for the nasal mucosa when prolonged use.
 Antitussives
we have two types of cough:
1- dry ( non-productive) bad.
2- wet ( productive ) good.

cough control center ( medulla )

the action of antitussives : to suppress non-productive irritating cough

Drugs:
Codeine : narcotics analgesics to control cough
Dextromethasone : narcotics antitussives

they work on medulla.

they reach CNS

Side effects:
drowsiness, sedation
 Expectorants

Actions: loosens bronchial secretion so they can be eliminated by coughing.

works together with the antitussive to eliminate non-productive cough.

Guaifenesin ( Most Common )

Hydration ( the best one) .
 Mucolytics
name: (Acetylcysteine)
Action Liquifies and loosens the mucus to be expectorated
used with bronchodilators

SPECIAL ACTION
ANTIDOTE FOR PARACETAMOL ( ACETOMENOPHIN )
 Lower Respiratory system disorders
(1) COPD : airway obstruction. due to: 1- chronic bronchitis 2- bronchiectasis
3- emphysema 4- asthma
(2) Restrictive lung disease : fluid accumulation in the lungs causing overall
decrease in lung capacity (pulmonary edema)
(3) Bronchial Asthma : chronic disease resulting in periods of bronchospasm.
 Sympathetic NS para-Sympathetic NS

“FIGHT OR FLIGHT” “REST&DEGIST”

dilate the bronchi to get more air to
the lugs
Beta-adrenergic receptors
B2 “ epinephrine”
INCREASES cAMP
Constrict the bronchi so more blood
goes to the GIT
Muscarinic receptors M3
“Acetylcholine”

Bronchodilation Bronchoconstriction
 how to treat lower respiratory disorders:
1- by bronchodilator ( beta agonists and methylaxanthine )
2- Anti-Inflammation ( use of luekotriens blockers and steriods and antibodies against
igE)
3- mucolytics
4- Prophylaxis for maintenance of therapy
 1- Beta 2 Agonists
works on the sympathetic nervous system increasing the cAMP
1- Metaproterenol ( some b1 but mainly b2 )
inhalation of oral
inhalation better why? Effective at less does , less side effects and drug directly to the
bronchial site.

Action: bronchodilation by relaxing smooth muscles

Side effects: nervousness,tremors.

epinephrine is also sympthomemtics for beta receptors but it’s non-selective thus we
don’t prefer it because of many side effects.
2- Albuterol ( more selective tp B2 receptors )
better than Metaproterenol
1- Longer onset
2- less side effects.

uses: acute and chronic asthma

 methylaxanthine
group family “ phylline”
increase cAMP
Aminophylline and theophylline and caffeine
uses: asthma and COPD
oral better than IV ( not safe )

avoid smoking or caffeine when prescribed these drugs

 STERIODS

Aspirin

Constriction
 2- Anti-inflammatory:
1- Leukotrines antagonists
family group “lukast”
eg: Zafirlukast, Montelukast
decrease the inflammatory response and thus decrease the effect of Luekotrines.

uses;
maintenance of asthma disease , prophylaxis

NEVER TO ACUTE ASTHMA

2-Glucosteriods.
family group “thasone”
dexamethasone, beclomethasone,prednisone

SE: impaired immune response, fluid retention, hyperglycaemia.

 3- OMALIZUMAB
synthesised antibody that is targeted against IgE
uses:
moderate to severe asthma
mechanism of action:

plasma cells
igE

stimulate histamine , prostaglandins, leukotriene

bronchospasm

uses: moderate to severe asthma from allergens which cannot be controlled by

Corticosteroids
SE: anaphylaxis,malignancy,headache..
 Prohylaxis
Cromolyn&Nedocromil
mechanism of action: mast cell stabilizers
 Treatment of Asthma:
Albuterol (B agonist)
Adrenaline(epinephrine)
Corticosteriods
Omalizumab

‫بــــاــلترتـيب‬

treatment of flu : chlorphamkin + phenylephrine + paracetamol + caffeine +

dexometfrn