NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2 Pharmacotherapy of Asthma Bronchodilators Name Name of drugs Short acting Alpha &

drugs: beta Terbutaline agonist: Albuterol Ephedrine Pirbuterol Stimulate b-adrenoreceptor stimulation b-agonist Long acting drugs: Salmetrol Formoterol Antimuscarinic Ipratropium (slow onset of action) Methylxanthines Theophuline Aminophyline Narrow therapeutic index, for chronic astma -oral & parenteral preparation : bronchodilation: inhibition of phosphodiesterase(PDE) which are found in bronchiol smooth muscle. : diaphragmatic contractility for improve lung ventilation. : contraction of cardiac muscle

MOA

Side effects ADRs

Bronchodilation, inhibit mediator from mast cell , mucociliary clearance Muscle tremor, tachycardia, hyperglycemia, hypokalemia, headache Hypersensitivity, hyperthyroidism, caution in patients with CVD.

: acethylcholine( Ach) causes bronchial constriction & narrowing airways. : antimuscarinic bind to the ach receptor preventing Ach from binding. : so, bronchoconstriction is prevented, airways dilate. Dry mouth, facial flushing, tachycardia, constipation, headache -

GI upset, arrhythmias, tachycardia, insomnia, nervousness. Caution in elderly.

Contraindication

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2 Prophylaxis Name Name of drugs Corticosteroid(anti-inflammatory) Beclometasone, hydrocortisone,prednisolone (first choice for moderate to severe asthma patient that need B-adrenegic agonist inhalation more that 2x/week) Decrese the number & activity of cell involve in airway inflammation Antileukotriene drug Montelukast,zafirlukast, zileuton -leukotriene is inflammatory of mediator:. -leukotriene associated with asthma: LTC4,LTD4,LTE4 -inhibit leukotriene binding to its receptor. -inhibit 5-lipoxygenase(important in synthesis) Cromones Cromolyn,nedocromil -no bronchodilator activity -good prophylactic antiinflammatory agent Prevent inflammatory mediators from mast cells

MOA

Side effects

Long term side effect: -Osteoporosis(negative calcium balance) -Increase appetite -Hypertension -Edema -Impaired wound healing (suppress immunity) -Oropharyngeal candidiasis ( oral fungal infection) -Dysphonia(hoarseness)

ADRs

Contraindication

- serum hepatic enzyme -GIT discomfort -headache -dry mouth -hypersensitivity reaction -

-bitter taste -throat irritation -cough -wheezing -

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2

Pharmacotherapy Of Chronic Obstructive Pulmonary Disease(COPD) Bronchodilator -B2 adrenoreceptor agonist (albuterol, salmeterol) :short & long acting drug to treat breathlessness in chronic bronchitis - Xanthine (see above) :effect on airways smooth muscle :can increase alertness, act on central nervous. : diaprgm contractility. Mucolytic drug -N-Acetylcysteine -Antimuscaranic drug(ipratropium) -Bromhexine Expectorant -Guaiphenesin -Potassium iodide, ammonium salt Antibiotics Use: inhibit growth of microorganism Usefull for chronic bronchitis patient because they commonly get bacterial infection colonizing the sputum. Corticosteroid -effective for short term -use 2 weeks when treating exacerbation of symptom. -Long term use as an inhaled corticosteroid. - severity of future symptoms. Oxygen therapy -O2 is important for better functioning of tissue body. - low O2 concentration can cause lung constriction to prevent blood travel to poorly ventilated part of lung that poor O2 exchange. - can increase lung pressure. - O2 from tanks or concentrator that inhaled through masks or cannula by COPD patients can relax blood vessel and blood pressure.

Use: fluid in lung and Use: break down mucus airways, help secretion to make it easier to to liquefy & thin. clear the lung &airways MOA: mucus secretion by antagonizing ACH on receptor in mucous gland. : bronchospasm associated with smoking & inhalation irritant.

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2

Pharmacotherapy Of Allergic Rhinitis Type of drugs Antihistamines Explanation -use in treatment of sneezing & watery rhinorrhea with allergy rhinitis -during allergy reaction in nasal mucosa, histamine is release, act on nasal mucosa via H1 receptors. - H1 receptors found in smooth muscle & respirotary tract. - Histamine cause: >vasodilation > vascular permeability(edema) >smooth muscle contraction (brochiol, GI) Agents -H1-receptor antagonist. -drug bind to receptor and suppress the effect of histamines. >first generation: Chlophenamine,cyclizine >second generation: Loratadine,terfenadine Levocabstine(topical only) MOA -compete with histamine on H1receptor sites on respiratory tract. -effective if taken prophylactically. Side effects Sedation, hypotension, drowsiness, dry mouth

a-Adrenergic Agonist -Nasal decongestant due to vasoconstriction effect. -Uses: >aerosol, rapid onset and less side effect. >orally, slow onset of action & more side effect. >frequently use with antihistamine.

Corticosteroid -administered using nasal spray -use only when symptoms cannot be controlled with other drug.

Cromolyn >prophylactic anti inflammatory agent. >prevent bronchospasm.

-phenylephrine -tramazoline -xylometazoline (longer acting)

-beclomethasone -flunisolide -fluticasone

-cromolyn sodium

ADRs: >rebound congestion: Increase congestion of prolong usage & drug use. >cardiovascular effect: Hypertension. >CNS effect:anxiety

ADRs: >nasal irritation >nose bleed >sore throat >candisiasis

-stabilize mast cells, prevent degranulation and mediator release. ADRs: less side effect because no systemic absorption. >bitter taste >sneezing >drying of nasal tissue.

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2 PHARMACOTHERAPY OF COUGH Type of drug Explanation Centrally acting drug Narcotic agents and their derivatives are the most commonly used cough suppressant. MOA: supressing the responsed of cough, elevate to cough. ADRs: GI disturbance(nausea, vomiting) Drowsiness Addictive, sedation Expectorant -bring up mucus and other material out from the lungs,bronchi, and trachea. -reduce viscosity of thick mucus, to move out from respiratory tract. Used:stimulate mucus secretion in dry irritated areas of respiratory tract and for individual experience unproductive cough. Agents: -Plant extract(liquorice) -chest rub, volatile oil(eucalyptus)=activate mucosal gland. -ammonium chloride ADVs: -may cause nausea,vomiting(gastric irritant) -diarrhea, dizziness Peripherally acting drugs Local anesthetics:applied to pharynx Agents: benzocaine, lidocaine, bupivacaine -to reduce cough during bronchoscopy. Mucolytics -react with mucus to make it more watery, cough more productive. -break down chemical structure of mucus molecule, become thinner and easier to cough. Agents: Bromhexine Hypertonic saline Acetylcysteine Locally acting drug -line the surface of the airways, reduce local irritation. Agents(simple lintus): Pectin, honey, glycerin >these demulcents will coat the throat and relive irritation.

Type of drug Explanation

Menthol inhalation -apply to cause sensation of coolness or warmth. -Anesthetic action, to ease coughing and soothe stuffiness from a cold.

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2 Pharmacotherapy Of Hyperlipidemia(Antihyperlipidemic Drugs)

Name of drug Agents

MOA

HMG-CoA reductase inhibitor(statins) Lovastatin(lovastin) Pravastatin(pravachol) Simvastatin(zochor) -LDL levels. - HDL levels. Inhibit HMG-CoA reductase, thus decrease the rate of cholesterol production.

Niacin/Nicotinic acid - LDL by 10-20% - HDL -can be use combination with statin Inhibits lipolysis in adipose tissue(prevent release of fatty acid), concentration of fatty acid available for synthesis of VLDL, LDL in the liver( hepatic lipoprotein synthesis)

Fibrates Clofibrate Fenofibrate gemfibrozil

Bile acids-binding Cholesterol resins absorption inhibitors Colesevelam Ezetimibe Colestipol ( increase HDL level) Cholestyramine (anion exchange resin) combine cholesterol with bile acid in small intestine to become insoluble, complexes excrete in stool. - LDL & cholesterol level. inhibit intestinal absorption of dietary & biliary cholesterol.

ADVs

-myopathy(muscle) -liver enzyme(kinase) -Insomnia -opthalmoplegia

-flushing -pruritus -blurred vision -hyperuricemia & gout -hypersensitivity -heart block -BP <90mmHg

-stimulate lipoprotein lipase activity. -break down cholesterol -inhibit triglyceride synthesis in liver - excretion of cholesterol into bile - release of fatty acid from adipose tissue. -GI(nausea,vomiting) -Lithiasis(formation gall stone) -rash -dizziness -pregnant women -lactating women -hepatic dysfunction -renal dysfunction -hypersensitivity

-GI(nausea, constipation) -headache -bleeding

Contraindication

-pregnancy -nursing mother -active liver disease -hypersensitivity

-biliary obstruction -hypersensitivity

-myaglia -back pain -CNS-dizziness, fatique -GI-diarrhea, abdominal pain -hepatic disease -hypersensitivity

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NUR HAZWANI BT SAMSUDIN, 2010698056, PH1103A2 Drug interaction -addictive cholesterol lowering with concurrent of bile acid. - risk of myopathy(fibrate, niacin,erythromycin) - anticoagulant action with warfarin. Take in the evening(night) -myopathy when take with HMG-CoA - hypotensive with alcohol -oral anticoagulant: (enhance) -myalgia &myositis use with HMG-CoA -absorption of fatsoluble vitamins. -affect absorption of concurrent administered drug. -additive cholesterol lower when take with fenofibrate / gemfibrozil. -cholestyramine, ezetimibe level - risk if take with cyclosporine can be given without regard to meal

Patients information

Take with food

Take 30 minutes before eating or with meal

all drug should take 1 hr before or 4-6 hour after administration

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