Respiratory Drugs Kuliah

RESPIRATORY DRUGS
dr. SUFI DESRINI M.Sc
http://www.freesfx.co.uk
@ www.iloveppt.org
Learning Objectives
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Types of cough
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The physiology of mucus and sputum
production in the respiratory system
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The physiology of mucus and sputum production in
the respiratory system
SPUTUM PRODUCTION
SPUTUM PRODUCTION
Mucoactive agents
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Classic mucolytics
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N-acetyl cysteine (NAC)
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NAC decreased airway inflammation
Reducing lysozyme and Inhibiting neutrophils and

lactoferrin concentrations monocytes chemotaxis
in smokers and oxidative
burst responses in vitro
Reducing the activation Inhibiting the adherence

and number of bacteria to ciliated
of neutrophils and epithelial cells in vitro
macrophages
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There is good evidence of prove that oral

NAC has stabilized disease in idiopathic
pulmonary fibrosis
And may also reduce exacerbation rates in
chronic bronchitis
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Other Mucolytics (Classic )
Erdosteine and fudosteine :
Erdosteine :
an antioxidant with mucolytic properties and
also reduces bacterial adhesiveness
A small randomized controlled trial showed

fewer exacerbations, reduced hospitalization
time and improved quality of life in patients
with COPD that were treated with erdosteine
when compared with placebo
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Other Mucolytics (Classic )
Fudosteine is a cysteine with greater bio-

availability than NAC.
It reduces hypersecretion by down regulation of
mucin gene expression
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Peptide Mucolytic
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PULMOZYME
Current Recommendations for Clinical
Use of Mucolytic Drugs
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Current Recommendations for Clinical
Use of Mucolytic Drugs
GG
Mekanisme kerjanya
GG memiliki aktivitas sebagai ekspektoran dengan
meningkatkan volume dan mengurangi kekentalan
sputum yang terdapat di trakhea dan bronki. Dapat
meningkatkan reflek batuk dan memudahkan untuk
membuang sputum.
Akan tetapi bukti objektif masih sedikit.
Dose : Oral 200400 mg/4 hours, max dose
2400 mg/d
adult : 3 x12 tab
Mucokinetics
These agents act on cilia and increase

mucociliary clearance
Mucokinetic medication includes
bronchodilators, tricyclic nucleotides and
ambroxol
Surfactants also promote cough clearance of
mucous by decreasing the surface adhesion
between mucous and airway epithelium
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Mucokinetics
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Mucokinetics
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AMBROXOL
Mucoactive drugs and their potential
mechanisms of action
Mucoactive drugs Potential mechanism of action

Expectorants: Increases secretion volume and/or
Hypertonic saline hydration
Guaifenesin Stimulates secretion and reduces
mucus viscosity
Mucoregulators: Metabolism of mucus producing
Carbocysteine cells, antioxidant and antiinflammatory
Anticholinergic agents effects, modulates mucus production.
Glucocorticoids Decreases secretion volume
Macrolide antibiotics
Reduces airway inflammation and
mucin secretion.
Reduces airway inflammation and
mucin secretion
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Mucolytics: Breaks disulphide bonds linking
N-Acetylcysteine mucin polymers
N-Acystelyn Antioxidant and anti-inflammatory
Erdosteine
effects.
Dornase alfa
Increases chloride secretion and
Gelsolin
Thymosin 4 breaks disulphide bonds
Dextran Modulates mucus production and
Heparin increases mucociliary transport
Hydrolyses the DNA in mucus and
reduces viscosity in the lungs
Severs actin filament cross-links
Severs actin filament cross-links
Breaks hydrogen bonds and
increases secretion hydration
Breaks both hydrogen and ionic
bonds
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Mucokinetics:- Improves cough clearance by

Bronchodilators increasing expiratory flow
Surfactants Decreases sputum/mucus
Ambroxol adhesiveness
Stimulates surfactant production and
inhibits neuronal sodium channels
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BRONCHODILATOR
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INTRODUCTION
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INDICATION
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BETA-AGONISTS
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SHORT-ACTING
Albuterol/salbutamol
Bambuterol
Fenoterol
Isoetherine
Isoproterenol
Levalbuterol
Metaproterenol
Terbutaline
Tornalate
Pirbuterol
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LONG-ACTING
Formoterol
Salmeterol
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EPINEPHRINE
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ISOPROTERENOL
A potent bronchodilator
Inhalation : 80-120 mcg maximal
bronchodilation within 5 minutes
Duration of action : 60-90 minutes
United Kingdom, 1960 an increase in the
asthma mortality use of high dose oh inhaled
isoproterenol
Now rarely used for asthma
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BETA-2 SELECTIVE DRUGS
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BETA-2-SELECTIVE DRUGS
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METHYLXANTHINE DRUGS
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METHYLXANTHINE DRUGS
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ANTIMUSCARINIC AGENTS
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TUBERCULOSIS DRUGS
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INTRODUCTORY
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BIG PROBLEM
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TB TREATMENT
The aims of TB treatment are:
To cure the patient and restore quality of life
and productivity;
To prevent relapse of TB;
To reduce the transmission of TB to others;
To prevent the development and transmission
of drug resistant TB.
( "Treatment of Tuberculosis guidelines", WHO, Geneva, 2011, 29 www.who.int/tb/en/)
RCOMMENDED DOSES OF FIRST LINE
ANTI-TB DRUGS FOR ADULTS
Drug Daily 3 times per week
Dose & range Maximum (mg) Dose & range Daily maximum
(mg/kg BW) (mg/kg BW) (mg)
Isoniazid 5 (4-6) 300 10 (8-12) 900
Rifampicin 10(8-12) 600 10 (8-12) 600
Pyrazinamide 25 (20-30) - 35 (30-40) -
Ethambutol 15 (15-20) - 30 (25-35) -
Streptomycin 15 (12-18) 15 (12-18) 1000
Patients aged over 60 years may not be able to tolerate more than 500750 mg daily, so
some guidelines recommend reduction of the dose to 10 mg/kg per day in patients in this
age group (2). Patients weighing less than 50 kg may not tolerate doses above 500750
mg daily (WHO Model Formulary 2008, www.who.int/selection_medicines/list/en/)
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New patients with pulmonary TB
WHO no longer recommends omission of ethambutol during the intensive phase of treatment for
patients with non-cavitary, smear-negative PTB or EPTB who are known to be HIV-negative. In
tuberculous meningitis, ethambutol should be replaced by streptomycin.
H = isoniazid, R= rifampicin, Z = pyrazinamide, E= ethambutol, S = streptomycin
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Dosing frequency for new TB
patients
Dosing frequency Comment
Daily Daily optimal

Daily 3 x per week Acceptable alternative
for any new TB patient
receiving directly
observed th/
3 x per week 3 x per week Acceptable alternative
provided that the patient
is receiving directly
observed therapy and is
not living with HIV or
living in an HIV-
prevalent setting
Note: Daily (rather than three times weekly) intensive-phase dosing may help to prevent
acquired drug resistance in TB patients starting treatment with isoniazid resistance
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Second-line agents
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ISONIAZID
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ISONIAZID
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ISONIAZID
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ISONIAZID
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ISONIAZID
RIFAMPIN
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RIFAMPIN
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RIFAMPIN
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ETHAMBUTOL
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ETHAMBUTOL
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ETHAMBUTOL
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PIRAZYNAMIDE (PZA)
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PZA
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PZA
STREPTOMYCIN
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STREPTOMYCIN
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STREPTOMYCIN
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STREPTOMYCIN
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Thank You

Respiratory Drugs Kuliah

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Respiratory Drugs Kuliah

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RESPIRATORY DRUGS

dr. SUFI DESRINI M.Sc

Reducing lysozyme and Inhibiting neutrophils and

Reducing the activation Inhibiting the adherence

There is good evidence of prove that oral

A small randomized controlled trial showed

Fudosteine is a cysteine with greater bio-

These agents act on cilia and increase

Mucoactive drugs Potential mechanism of action

Mucoactive drugs Potential mechanism of action

Mucokinetics:- Improves cough clearance by

( "Treatment of Tuberculosis guidelines", WHO, Geneva, 2011, 29 www.who.int/tb/en/)

Isoniazid 5 (4-6) 300 10 (8-12) 900

Rifampicin 10(8-12) 600 10 (8-12) 600

Pyrazinamide 25 (20-30) - 35 (30-40) -

Ethambutol 15 (15-20) - 30 (25-35) -

Streptomycin 15 (12-18) 15 (12-18) 1000

Daily Daily optimal

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