RESPIRATORY DRUGS
Anti-Asthmatic Drugs
•Classified as:
• Adrenergic Agonist or sympathomimetics.
1. Bronchodilators: • Methylxanthines
2. Anticholinergic.
3. Mast cell stabilizers
4. Corticosteroids.
5. Anti-histamines.
Bronchodilators: Adrenergic agonist or
sympathomimetics
•Mechanism of action: They
causes widening of the
airway by relaxing
bronchial smooth muscles
by stimulate beta receptors.
Drug examples & Doses
S. No. Drugs Doses
1 Salbutamol 2-4 mg orally
2 Terbutaline 5mg orally.
3 Formoterol 80 mcg B.D. orally
4 Albuterol 200-400 mcg inhaled every 6 hrly.
Indications/uses
•Relieving the distress of asthma.
•Bronchospasm or
broncho- constriction.
Contraindications/ Precautions.
•Patient with uncontrolled
arrythmias.
•Prolonged use of albuterol may
cause hypokalemia.
Adverse Effects
•Nervousness.
•Anxiety.
•Tremor.
•Headache.
•Palpitations.
•Tachycardia.
Bronchodilators: Methylxanthine
•Mechanism of action: These drugs
are weakCNSstimulants that are
powerful smooth muscle relaxants
thus they relax the smooth muscle of
bronchi. They also havediuretic
effect.
Drug examples & Doses
S. No. Drugs Doses
1 Theophylline 200-400 mg TDS orally.
2 Etiophylline 250 mg TDS IV/IM
3 Aminophylline 250-500mg TDS IV slow.
Indication/Uses
•To treat and prevent bronchospasm.
•To treat asthma,
bronchitis, emphysema.
Contraindications/ Precautions
•Hypersensitivity to any xanthine.
•Infection or irritation of rectum
•Give cautiously in neonates, in elderly
patients, heart disorders hepatic disorders.
Adverse effects •Diarrhea.
•Respiratory arrest.
•Headache. •Irritability.
•Anxiety. •Insomnia.
•Nausea. •Vomiting.
•Seizures. •Peptic ulcer.
•Abdominal Cramping. •Epigastric pain.
•Tachycardia.
Anticholinergic
Already Explained
Mast cell Stabilizers – Introduction
•Mast cell stabilizers works to prevent
allergy cells called mast cell from breaking
open and releasing chemicals that help to
cause inflammation.
•They are not effective once the allergic
reaction has occurred and mediators are
released from mast cells. So they are useless
during asthmatic attack. They are used in the
prophylaxis of asthma.
Mechanism of action
•They inhibit mast cell activity, thus
prevent the release ofallergic
mediators like histamine, serotonin,
prostaglandins, cytokines. These
chemical are essential for an
inflammation and allergic reactions.
Drug examples and Doses
S. No. Drug Doses
1 Cromolyn 20mg 4times a day
sodium (Nebulization solution)
2 Sodium 20mg 6hrly
cromoglicate
3 Ketotifen 1-2mg OD or BD
Indication / uses
•Prevent asthma symptoms from occurring or
prophylaxis to asthmatic attack.
•To decrease inflammation or bronchospasm.
•To decrease allergic reactions.
•Rhinitis
Contraindications/ precautions
•Hypersensitivity.
•Precautiously with renal
dysfunction, hepatic dysfunction.
•Lactation, Cardiac arrhythmias.
Adverse effects •Throat irritations.
•Nasal irritations.
•Wt. Gain.
•Headache.
•Drowsiness.
•Dry mouth.
•Dizziness.
Anti-Inflammatory Drugs (Cortico-steroids)
•These drugs have anti-
inflammatory as well as anti-
allergic actions thus they are
effective in bronchial asthma.
Mechanism of
action
•They prevent the release of or
counteract the bronchial mediators
(Histamine) that cause tissue
inflammation responsible for
edema and airway narrowing.
Drug example and dose
S. No Drugs Doses
1 Prednisolone 5-60mg per day in divided dose.
2 Beclomethasone 100μgm (microgram) 6hrly by aerosol
Dipropionate inhalation.
3 Budesonide 400 μgm (microgram) daily in divided dose.
4 Fluticasone 100-250μgm (microgram) BID by aerosol
5 Betamethasone 200μgm (microgram) 6hrly by aerosol.
Valerate
Indication/uses
•Chronic bronchitis.
•Allergic Rhinitis.
•Respiratory inflammatory disorders.
•Bronchial asthma.
•Prophylaxis in exercise induced asthma.
•Allergic reaction.
Contraindications/precautions
•Acute bronchospasm.
•Use cautiously in patients who are
immunosuppressed and in those taking
prednisone or other corticosteroids.
•Use very cautiously in patients with viral
respiratory infections.
Adverse effects
•Hoarseness.
•Candida infections.
•Oropharyngeal irritation.
•Bronchospasm after inhalation
of dry powder.
Antihistamines
•Antihistamines are the drugs
usedin the treatment od
allergic disorders and some
other conditions.
Mechanism of action
•These drugs block the effect of histamine and its
receptors. They also provide some sort of sedation.
There are four types of antihistamines drugs.
1. Highly sedatives.
2. Moderate sedatives.
3. Mild sedatives.
4. Non sedatives.
Drug Example & Doses
S. No Drugs Doses
Highly Sedative
1 Diphenhydramine 25-50mg
2 Promethazine 25-50mg
3 Hydroxyzine 25-50mg
Moderate Sedatives
4 Medizine 25-50mg
5 Buclizine 25-50mg
6 Phenivamine 25-50mg
7 Cyproheptadine 4mg
contd
S. No. Drugs Doses
Mild Sedatives
8 Chlorpheniramine 2-4mg
9 Cyclizine 50mg
10 Triprolidine 2.5-5mg
Non Sedatives
11 Astemizole 10mg
12 Cetrizine 10mg
13 Lovatadine 10mg
14 Fexofenadine 120-180mg
Indications/Uses
•Allergic reactions (Hay fever, rhinitis, asthma,
Anaphylaxis).
Contraindications/precautions
•Hypersensitivity.
•Lactation.
•Hypokalemia.
•Neonate.
•Coma.
•Special precautions in acute asthma and
pregnancy, elderly, epilepsy.
Adverse effects
• Drowsiness in common.
• Dryness of mouth.
• Blurring of vision. Due to anticholinergic effect
• Urinary retention.
• Constipation.
• Delirium.
• Convulsions.
• Severe toxicity may causes death to cardiac and respiratory
failure.
Mucolytics
•These drugs reduced the
viscosity of sputum that leads
to easily expel the sputum.
Mechanism of action
•Decrease mucous viscosity
by breaking or altering
mucoproteins present in
sputum.
Drug example & Doses
S No. Drugs Doses
1 Acetylcysteine 2.5 ml of 10-20% solution given
by inhalation or nebulization
2 Bromhexine 8-16 mg TDS.
Indications/uses
•To treat abnormal viscid, or thick
and hard mucus.
•As an antidote for acetaminophen
overdose(acetylcysteine).
Decongestants
•A Decongestant drugs used
to relieve nasal congestion
in upper respiratory tracts.
Mechanism of action
•Decongestants are sympathomimetic drugs
that act by stimulating the α (alpha) –
adrenergic receptors. The decongestant
effect due to vasoconstriction of the blood
vessel in the nose sinuses etc. the
vasoconstriction effect reduces swelling or
inflammation and mucous formation in the
nasal passage and make it easier to breath.
Drug examples and doses
S. No. Drugs Doses
1 Oxymetazoline 0.05% solution or nasal spray.
hydrochloride
2 Phenylephrine 10 mg
hydrochloride
3 Pseudoephedrine 60 mg.
hydrochloride
Indications /uses
•For temporary relief of nasal congestion due
to common cold.
•Sinusitis.
•Upper respiratory tract allergens.
•To promote nasal and sinus drainage.
Adverse Effects
•Arrhythmias.
•Tachycardia.
•Insomnia.
•Palpitation.
•Hypertension.
•Drowsiness.
•Hypersensitivity reactions including rash.
Drugs for cough
•The drug which used in cough are:
1. Antitussive.
2. Expectorants.
3. Bronchodilators.
Antitussives (Cough center suppressant)
a) Opioids – Codeine, pholcodine.
b) Non opioids – Noscapine,
dextromethorphan.
c) Antihistamine – Chlorpheniramine
diphenhydramine.
Expectorants
a) Bronchial secretion enhances – sodium
or potassium citrate, potassium iodide,
ammonium chloride.
b) Mucolytes – bromhexine ambroxol,
acetylcysteine.
Bronchodilators – already explained
•Salbutamol,
Terbutaline.
Antitussives – Introduction
•They are used to suppress dry cough
mostly because their aim to control
rather than eliminate cough. These
are also called cough center
suppressants.
Mechanism of action
•These are the drugs that act in
the CNS to increase threshold
of cough center.
Drug example & Doses
S. Drugs Doses
No
1 Codeine (Opioids) 15-60mg up to every 4 hrs
2 Noscapine (Non opioids) PO 15-30 mg itramin maleate
3 Dextromethorphan (Non 10-30mg PO 4-8hrs max.
opioids) 120/day
4 Chlorpheniramine 4 mg PO 4-6 hrly
(Antihistamine)
5 Diphenhydramine 25 mg PO 4hrly not to exceed
(Antihistamine) 150 mg / day.
Indications/uses
•Dry & unproductive cough.
•Allergic cough.
•Spasmodic cough.
•Constipation.
Adverse
•Drowsiness.
Effects •Dryness of mouth.
•Irritability.
•Respiratory depression in higher doses.
•Addiction.
•Vertigo.
•Nausea, Headache.
Contraindication/precautions
•Respiratory Depression.
•Asthmatics.
•Convulsion disorder.
•Contraindicate while driving.
•Obstructive airway disease.
Expectorants – Introduction
•These drugs help in removal of
secretions of respiratory tract and
mucolytic agents produce liquification of
mucous making expectoration easier.
Mechanism of action
•They increase bronchial secretions or
reduce its viscosity, sodiumand
potassium citrate increase bronchial
secretion by salt action also these
drugs stimulate gastric mucosa or
directly acting on mucous membrane
of lungs to increase the secretion of
mucous.
Indications/uses
•Chronic productive cough.
•Thick mucous production.
•Combinations with antitussives drugs for
relieving cough.
Adverse effect
•Allergic reactions / hypersensitivity.
•Lacrimation.
•Gastric irritation.
