Centrally acting antitussives

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Centrally acting antitussives

Post  counselor on Mon Oct 15, 2012 12:04 pm

Centrally acting antitussives


COUGH
The cough is a defense mechanism designed to protect the airway from inhaled pollutants and prevent the accumulation of mucus.

Cough is a symptom present:
1) in most of the diseases that affect the respiratory system (inflammation of the upper airways, tracheitis, bronchitis, asthma in children, bronchioloalveolar carcinoma).
2) in diseases affecting other organs (congestive heart failure evokes cough).
3) during pharmacological treatment with drugs that evoke cough (eg ACE inhibitors)

So you need to ask the patient:
if the cough persists for weeks
If you experience fever, fatigue, weight loss
If you develop chest pain
If you have mucopurulent sputum or sputum blood
If the subject is heart disease
If you are taking ACE inhibitors

If at least one answer is yes immediately medical advice.
If the answer is still no (and the cough is probably due to inflammation of the upper airways by cooling) the pharmacist must:


Giving advice nonpharmacological
Do not smoke
Avoid smoky environments
Humidify the air
Consult your doctor after a few days if the cough persists

Giving advice pharmacological
Before you give them, the pharmacist must always ask the patient what type of cough has
1) Dry cough, is characteristic of bronchitis, tracheitis, pharyngitis, pulmonary viral. It 'annoying and prevents sleep.
2) Productive cough. E 'due to the need to eliminate viscous mucus or fluid produced in excessive amounts (chronic bronchitis, chronic obstructive pulmonary)
3) whooping cough. Dry cough with access, typical pertussis.
4) Cough dim. Typical diseases of the vocal cords.



DRUGS antitussives


Belong to this class of drugs
• Codeine
• Dextromethorphan
• dimemorfan
• Levopropossifene
• noscapine
• Dexclorfeniramina
• Diphenhydramine
• Sodium Dibunato
• Butamirato
• clobutinol
• cloperastine
• Dropopizina
• Levodropopizina
• Morclofone
• Pentossiverina
• Ossolamina
• Pipazetato
• Prenoxdiazina


THERAPEUTIC USE

1. Drugs are recommended in case of dry cough.
2. Are contraindicated in case of productive cough is not rational to use them in case of chronic bronchitis, cystic fibrosis to determine the risk of retention of secretions and pneumonia risk
3. It is not rational to associate or expectorants, mucolytics or to
4. What sedative to choose?? In relation to effectiveness is to say that in general they are all little studied, except codeine and dextromethorphan. Dextromethorphan has less Charges of abuse of codeine.
5. The majority of antitussives gives sedation that can be a serious problem in people taking other sedatives, who are debilitated, to which is required vigilance and readiness.
6. Peripherally acting antitussives, levodropopizina and dropopizina give less sedation, but are probably less effective
7. Caution in diabetic syrups. Use tablets or solutions with saccharin as a sweetener
8. Under two years of age are recommended: cloperastine, Pentossiverina, Osseladina, Dibunato sodium. The tuaminoeptano seems to be better tolerated in children

Dextromethorphan
Pharmacodynamics
It has mild opioid action on the cough center. Effectiveness of slightly less than that of codeine

TOXICOLOGY
Poor risk of abuse
Small central depression with drowsiness.
At very high doses respiratory depression (but no known cases of death). The effect is antagonized by naloxone well)
May cause bronchoconstriction (rarely)
May cause gastrointestinal disturbances.

MUCOLYTICS

Belong to this class of drugs:
• Acetylcysteine
• Mecisteina
• Mesna
• Steproninum
• Tiopronina
• Telmesteina
• Bromesina
• Ambrossolo
• Carbossicisteina
• Domiodolo
• sobrerol

Pharmacodynamics
Reduce the viscosity of mucus, making it easier to eliminate.
They break the disulfide bonds of the bronchial mucus glycoproteins. Can also separate the fibrils of DNA and proteins (sputum mucopurulent).
Appear to stimulate the ciliary activity

TOXICOLOGY
Mild stomach discomfort (heartburn and epigastric pain) orally
Bronchospasm possible for inhaled administration

THERAPEUTIC USE
1. They are suitable for productive cough is characterized by viscous mucus
2. There is clear evidence of their effectiveness
3. It is not rational to associate them with antitussives, while it may be rational to associate them with chemo-antibiotics for infectious complications
4. Attention to subjects with gastroduodenal ulcer, in the case of oral administration.
5. The sobrerol gives less stomach problems other mucolytics.
6. Warning to asthmatics. In these patients, it is useful to the association with  2 adrenergic agonist


Expectorants

Belong to this class of drugs:
• balms, oils, essences and their active ingredients (Altea, licorice, camphor, creosote, eucalyptus, mint, eucalyptus, menthol, thymol, Balsam of Tolu
• Guaiacol
• Guaiacetisal
• Guaifenesin
• Guaimesal
• Sulfoguaiacolo

Pharmacodynamics
These drugs increase the volume of secretions in the respiratory tract thus facilitating the removal by ciliary activity and coughing.
Their effectiveness is not certain

THERAPEUTIC USE
1. Indications for Use uncertain.
2. It is not rational to associate them with antitussives,
3. Better should be avoided by people with gastric disorders, and peptic ulcer or a history.
4. Best to avoid essential oils and their active ingredients that can depress mucociliary activity.
5. Avoid essential oils and their active ingredients in children with a tendency to febrile seizures or epilepsy.
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