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Respiratory - Coggle Diagram
Respiratory
Tuberculosis
Mycobacterium Tuberculosis
Use of drug combinations: To delay the emergence of resistance. to enhance antimycobacterial efficacy
First line drugs
Isoniazid (INH/H)
MOA: Inhibit the synthesis of mycolic acid- interfere cell wall formation
ADE: Hepatitis, Peripheral neuropathy
Rifampicin/ Rifabutin (R)
MOA: Inhibits RNA synthesis of mycobacteria
ADE: Hepatitis, Flue-like syndrome (malaise, headache, fever, chills), Orange colour to urine, sweat, tears (Harmless) , GI disturbance, hypersensitivity reactions
Pyrazinamide (PZA/Z)
ADE: Hepatitis, hyperuricemia, gi disturbacne, arthralgia, fever, malaise
Ethambutol (E)
MOA: Inhibits arabinosyl transferase, which is involved in the synthesis of arabinogalactan- a component of the mycobacterial cell wall
ADE: Optic neuritis, Arthralgia, Fever, GI upset
Streptomycin (S)
Second Line drugs
Amikacin
Linezolid
Fluoroquinolones
Delamanid
Bedaquiline
DOT Regimen:
Initial Intensive Phase: 2HRZE daily
Continuation phase: 4HR daily
total 6 months
noncompliant patients
COPD
Risk factors: Cigarette Smoking, air pollution, occupational exposures (coal dust), infections, genetic factors
Bronchodilators Salbutamol (albuterol), Ipratropium
Anti-inflammatory agents ( reduce the frequency and severity of exacerbations)- steroids
Antibiotics : cefuroxime
Roflumilast
Selective PDE-4 inhibitor leads to accumulation of intracellular cyclic adenosine monophosphate (cAMP) in lung tissue
as an adjunct to bronchodilators for patients with severe COPD and frequent exacerbations
Cough
Stimulants
Mucolytics
Expectorants
Guaifenesin, Acetylcysteine & Bromhexine
To enhance the clearance of mucus, to reduce its viscosity
Depressants/ Antitussive agents
Opoids
Methadone
Codeine
MOA: decrease sensitivity of cough center in CNS to peripheral stimuli, decrease mucosal secretion bronchioles
ADE: constipation, nausea, rarely produces serious dependence compared to morphine
Dextromethorphan
directly suppress the cough center
less constipation than codeine
ADE: slight drowsiness, High dose: Abuse potential, hallucinations, confusion, excitation, seizure, coma (high dose)
Pholcodine
Non-opoids
Diphenhydramine
Drowsiness ,v, blurred vision, fatigue
Benzonatate
Noscapine
Asthma
Chronic inflammatory disorder of the airways recurrent, reversible bronchospasm
Sympathomimetic agents
Reliever / bronchodilators
selective B2 agonist (Inhalation, oral)
Short -acting: salbutamol, terbutaline
MOA:
to prevent exercise induced asthma
Acute Attack (Nebulizer)
Long acting: salmeterol, formoterol
MOA:
adjunct with glucocorticoids
Not for acute asthma
Asthma prophylaxis
Maintenance therapy
MOA: Stimulation of B2 receptor: Vasodilation, decreased peripheral resistance, bronchodilation increased muscle and liver glycogenesis increased release of glucagon, relaxed uterine smooth muscle
ADE: fine tremor (hand), headache, palpation, tachycardia, arrhythmias
Non selective alpha and beta agonists
Adrenaline (SC)
acute asthma
ADE: Tachycardia, arrhythmia, worsen angina pectoris
Xanthine derivatives (Oral, parenteral): Aminophylline
MOA:
Theophylline
less effective than B2 agonists
Acute severe asthma (iv) , long term therapy (oral)
ADE: CVS, CNS, GIT
Muscarinic receptor antagonist ( Anticholinergics) (Inhalation)
Ipratropium, tiotropoium
MOA: competitive antagonist of Ach at muscarinic receptors- bronchodilation and decrease in mucus secretion
Uses:Not first line drug for asthma as adjunct to B2-agonist in acute severe asthma , usefl to patient intolerant of inhaled B-agonist agents, important tole in treatment COPD
ADE: dry mouth, glaucoma (elderly)
Inhaled anti-inflammatory agents
corticosteroids
MOA: broad anti inflammatory effect, inhibit PGs and leukotriene synthesis, inhibit release of mediators: reduce edema and inflammatory, decrease hyper responsiveness of the airway smooth muscle
Uses: Severe acute attack, moderate asthma, non-acute asthma
Aerosol treatment- decrease systemic adverse effects
ADE: Oropharyngeal candidiasis, hoarseness of voice, osteoporosis, pu, growth retardation in children , muscle weakness, glaucoma, glucose intolerance *DM), depression/ euphoria, hypertension
Cromolyn sodium
Leukotriene inhibitors
Leukotriene receptor antagonist
Zafirlukast, Montelukast
MOA: Inhibit response to inhaled allergen, relax airway
ADE: Increased liver enzymes
Leukotriene synthesis inhibitor
Zileuton
MOA:
Anti Ig E monoclonal antibody
Omalizumab
decrease the release of mediators of the allergic response
ADE: injection site reactions (redness, stinging, bruising and induration, anaphylactic reaction, arthralgias, fever, and rash, high cost