OBAT Gangguan Sal Nafas, Astma dan Batuk PAKSON.pptx

8/21/2019 OBAT Gangguan Sal Nafas, Astma dan Batuk PAKSON.pptx

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OBAT PADA GANGGUAN SISTEMPERNAFASAN dan Astma


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Infeksi saluran pernafasan atas (ISPA)

termasuk flu, rinitis akut, sinusitis, tonsillitis

akut dan laryngitis akut. Pilek adalah tipe infeksi saluran nafas atas

yang paling sering ditemukan.


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Saluran Pernapasan

Saluran pernapasan dibagi dalam 2 golongan

utama:

1. saluran pernapasan atas, terdiri dari lobang

hidung, rongga hidung, faring, laring

2. saluran pernafasan bawah terdiri dari trachea,

bronchi, bronchioles, alveoli dan membran

alveoulerkapiler


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Gangguan Saluran pernafasan () :

Saluran pernafasan atas

Jenis-jenis infeksi saluran pernafasan atas :batuk pilek, faringitis, sinusitis, dan toksilitis.

Saluran pernafasan bawahJenis infeksi saluran pernafasan bawah : asma,

bronchitis kronik, emfizema, bronkioklialis.


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Obat Saluran Pernafasan. Antihistaminika.

Semua antihistamin memberikan manfaat potensial pada terapi alerginasal, rhinitis alergik.

Antihistamin

mengurangi rasa gatal pada hidung yang menyebabkan penderitabersin banyak obat-obat flu yang dapat dibeli bebas mengandungantihistamin, yang dapat menimbulkan rasa mengantuk.

Antikolinergik

Sifat antikolinergik pada kebanyakan antihistamin menyebabkan mulutkering dan pengurangan sekresi, membuat zat ini berguna untukmengobati rhinitis yang ditimbulkan oleh flu.


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Bronchial Asthma

Therapeutic management:

- Allergic control to prevent attacks.

- Drug therapy:

B- adrenergic, Theophyllin, & corticosteroids

preparations + chest physiotherapy (only in

between attacks).


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Difenhidramin( Benadryl )

D : PO : 25-50 mg, setiap 4-6 jam

D : PO, IM, IV : 5 mg/kg/h dalam 4 dosis

terbagi, tidak lebih dari 300 mg/hari

D : IM:IV: 10-50 mg dosis tunggal

Batuk Karena Alergi


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Klorfenilamin maleat

DWS: PO : 2-4 mg, setiap 4-6 jam

Anak: 6-12 thn: 2 mg, setiap 4-6 jam

Anak: 2-6 thn: PO, 1 mg, setiap 4-6 jam


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Antihistamin lain

Fenotiasin

Prometazine

Timeprazine

Turunan piperazine

hydroxyzine


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Mukolitik

Mukolitik berkerja dengan mencairkan dan mengencerkan secret

mukosa yang kental sehingga dapat dikeluarkan.

Efek samping yang paling sering terjadi adalah mual dan muntah,

maka penderita tukak lambung perlu waspada. Wanita hamil

dan selama laktasi boleh menggunakan obat ini.

Contoh obat : ambroxol, bromheksin.

Dosis:

* ambroksol: dewasa dan anak-anak >12 thn, sehari 3 x 30 mg

untuk 2-3 hari pertama. Kemudian sehari 3 x 15 mg.

Anak-anak 5-12 thn, sehari 2-3 x 15 mg

Anak 2-5 thn, sehari 3 x 7,5 mg (2,5 ml sirop)

Anak

* bromheksin: oral 3-4 dd 8-16 mg (klorida)

anak-anak 3 dd 1,6-8 mg.


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InhalasiInhalasi adalah suatu cara penggunaan adrenergika dan

kortikosteroida yang memberikan beberapa keuntungan.Efeknya lebih cepat, dosisnya jauh lebih rendah dan tidakdiresorpsi ke dalam darah sehingga resiko efek sampingnyaringan sekali. Dalam sediaan inhalasi, obat dihisap sebagaiaerosol (nebuhaler) atau sebagai serbuk halus (turbuhaler).

Inhalasi dilakukan 3-4 kali sehari 2 semprotan, sebaiknya padasaat-saat tertentu, seperti sebelum atau sesudahmengelularkan ternaga, setelah bersentuhan dengan zat-zat yang merangsang (asap rokok, kabut, alergan, dan saatsesak napas).

Contoh obat : minyak angin (aromatis), Metaproterenol

dosis: isoproterenol atau isuprel: 10-20 mg setiap 6-8 jam(dewasa). 5-10 mg setiap 6-8 jam.


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Kromoglikat

Kromoglikat sangat efektif sebagai obat pencegah serangan asmadan bronchitis yang bersifat alergis, serta konjungtivitis atau rhinitisalergik dan alergi akibat bahan makanan. ]

Efek samping berupa rangsangan lokal pada selaput lender tenggorokdan trachea, dengan gejala perasaan kering, batuk-batuk, kadang-

kadang kejang bronchi dan serangan asma selewat. Wanita hamildapat menggunakan obat ini.

Contoh obat :

Natrium kromoglikat dipakai untuk pengobatan, pencegahan padaasma bronchial dan tidak dipakai untuk serangan asma akut.

Metode pemberiannya adalah secara inhalasi dan obat ini dapatdipakai bersama dengan adrenergic beta dan derivat santin. Obai initidak boleh dihentikan secara mendadak karena dapatmenimbulkan serangan asma.,


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Kortikosteroid

Kortikosteroid berkhasiat meniadakan efek mediator, sepertiperadangan dan gatal-gatal.

Penggunaannya terutama bermanfaat pada serangan asma

akibat infeksi virus, selain itu juga pada infeksi bakteri untukmelawan reaksi peradangan. Untuk mengurangi hiperreaktivitas bronchi, zat-zat ini dapat diberikan per inhalasi atauperoral.

Penggunaan oral untuk jangka waktu lama hendaknya

dihindari, karena menekan fungsi anak ginjal dan dapatmengakibatkan osteoporosis.

Contoh obat : hidrokortison, deksamethason, beklometason,budesonid.


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Antiasma dan BronkodilatorTeofilin

Terdapat bersama kofein pada daun the dan memiliki sejumlah

khasiat antara lain spamolitis terhadap otot polos khususnya

pada bronchi, menstimuli jantung dan mendilatasinya serta

menstimulasi SSP dan pernapasan. Reabsorpsi nya di usus tidak

teratur. Efek sampingnya yang terpenting berupa mual dan

muntah baik pada penggunaan oral maupun parienteral. Padaoverdosis terjadi efek sentral (sukar tidur, tremor, dan kompulsi)

serta gangguan pernapasan juga efek kardiovaskuler.

Dosis: 3-4 dd 125-250 mg microfine (retard)

Teofilin dapat diberikan dengan cara injeksi dalam bentukaminofilin, suatu campuran teofilin dengan etilendiamin.

Stimulan adrenoseptor, contoh obat salbutamol, terbutalin sulfat,

efedrin hidroklorida.

b b b k


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Obat-obat batukAntitussiva (L . tussis = batuk) digunakan untuk pengobatan batuk

sebagai gejala dan dapat di bagi dalam sejumlah kelompok dengan

mekanisme kerja yang sangat beraneka ragam, yaitu :

Zat pelunak batuk (emolliensia, L . mollis = lunak ), yang

memperlunak rangsangan batuk, melumasi tenggorokan agar

tidak kering, dan melunakkan mukosa yang teriritasi. Banyak

digunakan syrup (thyme dan althea), zat-zat lender (infus

carrageen)

Ekspektoransia (L . ex = keluar, pectus = dada) : minyak terbang,

guajakol, radix ipeca (dalam tablet / pelvis doveri) dan ammonium

klorida (dalam obat batuk hitam, Sehingga mempermudah

pengeluarannya ketika batuk.Mukolotika : asetilsistein, bromheksin, dan ambroksol, zat-zat ini

berdaya merombak dan melarutkan dahak ( L . mucus = lender,

lysis = melarutkan),


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Zat pereda : kodein, noskapin, dekstometorfan,dan pentoksiferin , obat-obat dengan kerjasentral ini ampuh pada batuk kering yang

mengelitik. Antihistaminika : prometazin, difenhidramin, dan

klorfeniramin. Obat ini dapat menekan perasaanmengelitik di tenggorokan.

Anastetika lokal : pentoksiferin. Obat inimenghambat penerusan rangsangan batuk kepusat batuk.


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Penggolongan lain dari antitussiva menurut

tempat kerja:

Zat-zat sentral SSP

Menekan rangsangan batuk di pusat batuk (medula),dan mungkin juga bekerja terhadap pusat saraf lebihtinggi (di otak) dengan efek menenangkan.

Zat adiktif : Doveri , kodein, hidrokodon dan normetadon.

Zat nonadiktif : noskapin, dekstrometorfan, pentoksiferin.

Zat-zat perifer di luar SSP

Emolionsia, ekspektoransia, mukolitika, anestetika localdan zat-zat pereda.


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Beta1,2 selekstif pada pengobatan

astma


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Obat Gangguan Saluran Nafas

GENERIC: Albuterol

BRAND: Proventil, Ventolin

CLASS: Sympathomimetic


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Albuterol

Actions

1. Agonist for Beta 2 adrenergic receptors; relaxing bronchial

smooth muscle which results in bronchodilation

2. Minimal cardiac side effects


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Albuterol

Indications:

1. Treatment of bronchospasm associated with asthma,

chronic bronchitis and emphysema

2. Prevention of exercise-induced bronchospasm


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Albuterol

Contraindications:

1. Hypersensitivity to sympathomimetics

2. Cardiac dysrhythmia

3. Tachycardia and tachydysrhythmias


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Albuterol

Adverse Reactions:

1. Excessive use may cause paradoxical bronchospasm and

arrhythmias

2. Tachycardia, palpitations, angina, PVCs, hypotension, andhypertension

3. Tremors

4. Hyperglycemia

5. Peripheral vasodilation6. Nervousness

7. Nausea/Vomiting


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Albuterol

Precautions:

1. Diabetes

2. Hyperthyroidism

3. Cerebrovascular disease

4. Seizure disorders


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Albuterol

Dose:

1. 2 inhalations with metered-dose inhaler, q 4-6 hours

2. 3 ml premixed bullet in nebulizer


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Albuterol

Incompatible/Reactions:

1. Tricyclic antidepressants/monoamine oxidase inhibitors

(MAOIs), may increase the effect of this drug

2. Other sympathomimetics3. Beta blockers inhibit the effects


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Albuterol

Notes:

Onset: 5-15 minutes

Peak: 30 minutes2 hoursDuration: 3-4 hours

1. Can be delivered by inhaler and nebulizer

2. Metabolized in the liver and excreted in the urine


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Epinephrine

BRAND: Adrenalin

CLASS: Sympathomimetic/Catecholamine


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Epinephrine

Action:

1. Direct effect on alphaand betaadrenergic receptor sites

2. Effects include:

Alpha: bronchial, cutaneous, renal and visceral arteriolarconstriction

Beta 1: positive inotropic and chronotropic actions,

increases automaticity

Beta 2: bronchial smooth muscle relaxation and dilation ofskeletal vasculature

3. Inhibits the release of histamine


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Epinephrine

Indications:

1. Cardiac arrest in general

2. Ventricular fibrillation

3. Asystole4. Pulseless electrical activity

5. Infusion for profound hypotension associated with

bradycardias, in combination with other pressors

6. Bronchospasm and bronchoconstriction of bronchialasthma and some forms of COPD

7. Anaphylaxis


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Epinephrine

Contraindications:

1. Uncorrected tachydysrhythmias

2. Underlying cardiovascular disease or hypertension3. Glaucoma

4. Hypersensitivity to catecholamines

5. Hypothermia


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Epinephrine/Adverse Reactions

Hypertension

Ventricular arrhythmias

Pulmonary edema

Tachycardia Palpitations

Anxiety

Psychomotor agitation

Nausea/Vomiting

Pupil dilation

Angina

Nervousness

Headache

Dizziness

Tremors Hallucinations

Cerebral hemorrhage

Anorexia


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Epinephrine

Precautions:

1. Due to the possibility of cardiovascular disease, epinephrine

should be administered with caution in patients over 35

years of age (with respiratory problems or if they are

conscious)

2. The patient should be carefully monitored for changes in

pulse, blood pressure, and ECG after administration of

epinephrine.

3. Because of its strong inotropic and chronotropic effects,

epinephrine causes an increased myocardial O2 demand


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Epinephrine

Precautions:

4. Hypovolemia (replenish volume first)

5. Diabetes mellitus

6. Hyperthyroidism7. Prostatic hypertrophy

8. Must be protected from light

9. Tends to be deactivated by alkaline solutions (sodium

bicarbonate)10. Do not use with MAOIs or tricyclic antidepressants due to

the danger of hypertensive crisis


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Epinephrine

Dose:

1. Cardiac dosage: 1:10,000

a. 1 mg q 3-5 minutes (until the heart restarts)

b. Intermediate: 2-5 mg q 3-5 minutesc. Escalating: 1 mg3 mg5 mg; 3 minutes apart

d. High: 0.1 mg/kg q 3-5 minutes

2. Infusion: Mix 1 mg in 250 ml and run at 2-10 mcg/min

3. Anaphylaxis and Asthma: .1-.5 mg (1:1,000) SQ or IM


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Epinephrine


1. Potentiates other sympathomimetics

2. Patients on MAOIs, antihistamines, and tricyclicantidepressants may have heightened effects

3. Sodium bicarbonatedeactivates epinephrine

4. Nitrates

5. Lidocaine

6. Aminophylline

7. Dont mix the above drugs in the same syringe with epi; butcan use in the same IV linejust flush between meds


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Epinephrine

Notes:

ONSET: Immediate

PEAK: Minutes

DURATION: Several minutes


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Isoetharine

BRAND: Bronkosol, Bronkometer



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Isoetharine

Actions:

1. Beta 2 agonist (slight specificity); relaxes smooth muscle of

bronchioles, vasculature, uterus


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Isoetharine

Indications:

1. Relieve bronchospasm associated with asthma, chronic

bronchitis, and emphysema


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Isoetharine

Contraindications:


2. Cardiac dysrhythmias3. Tachycardia and tachydysrhythmias


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Isoetharine

Adverse Reactions:

1. Dose-related tachycardia, palpitations, tremors,

nervousness, peripheral vasodilation, nausea/vomiting,

transient hyperglycemia, life-threatening arrhythmias;

multiple excessive doses can cause paradoxical

bronchoconstriction

2. Angina

3. Hypertension

4. Headache, dizziness, anxiety, restlessness, hallucinations


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Isoetharine

Precautions:

1. Use with caution in patients with diabetes,

hyperthyroidism, cardiovascular and cerebrovascular

disease

2. Seizure disorders

3. Isoetharine contains acetone sodium bisulfite; a sulfite that

may cause allergic-type reactions, including anaphylactic

symptoms in certain susceptible individuals


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Isoetharine

Dose:

ADULT

1-2 inhalations with metered-dose inhaler3-7 inhalations, via hand nebulizer q 4 hours

PEDIATRIC

Not recommended in children less than 12 years


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Isoetharine


1. Additive adverse effects with other beta agonists


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Isoetharine

Notes:

ONSET: Immediate

PEAK: 5-15 minutes

DURATION: 1-4 hours

M l S lf


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Metaproterenol Sulfate

BRAND: Alupent, Metaprel



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Actions:

1. Agonist for Beta 2 adrenergic receptorsacts directly on

smooth muscle


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Indications:

1. Relieve bronchospasm of COPD and Asthma


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Contraindications:


2. Hyperthyroidism3. Cerebrovascular or cardiovascular disorders

4. Tachycardia and tachydysrhythmias

M t t l S lf t


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Adverse Reactions

Dose-related tachycardia

Palpitations

Nervousness

Peripheral vasodilation

Excessive uselethal

arrhythmias, paradoxical

bronchospasm

Hypertension

Tremors, headache,

dizziness, anxiety,

hallucinations

Nausea/vomiting


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Precautions:

1. History of cardiovascular disease or hypertension

2. Seizures


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Dose:

ADULT:

2-3 inhalations, q 3-4 hoursMetered-dose inhaler or nebulizer

PEDIATRICS:

Not recommended in children under 12 years


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1. Beta blockers

2. MAOIs, tricyclic antidepressants3. Potentiates other beta agonists


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Notes:

ONSET: 1 minute

PEAK: 1 hour

DURATION: 1-5 hours with single dose

2-5 hours with repeated dose

GENERIC Terbutaline Sulfate


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GENERIC: Terbutaline Sulfate

BRAND: Bricanyl, Brethine



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Terbutaline Sulfate

Actions:

1. Beta 2 agonisthas an affinity for beta 2 receptors of

bronchial, vascular, and uterine smooth muscle

2. At increased doses, beta 1 effects may occur


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Terbutaline Sulfate

Indications:


bronchitis and emphysema (prevalent in patients over theage of 40 or with coronary artery disease)

2. Used in-hospital to stop pre-term labor


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Terbutaline Sulfate

Contraindications:



4. Glaucoma


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Terbutaline Sulfate

Adverse Reactions:

1. Tachycardia, tremors, palpitations, nervousness and

dizziness2. Angina, PVCs, hypotension, and hypertension

3. Headache, anxiety, hallucinations

4. Nausea, vomiting

5. Bronchospasm


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Terbutaline Sulfate

Precautions:

1. Used with caution to patients with a history of

cardiovascular disease or hypertension2. Seizure disorders

3. Thyroid disease

4. Diabetes


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Terbutaline Sulfate

Dose:

ADULT:

0.25 mg SQ; repeat in 15-20 minutes2 inhalations separated by a 60 second interval with a metered

dose inhaler

4mg/7ml nebulizer mix


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Terbutaline Sulfate


1. Alkaline solutions

2. Degrades when exposed to light for long periods of time


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Terbutaline Sulfate

Notes:

ONSET: 15 minutes

PEAK: 30-60 minutes

DURATION: 90 minutes4 hours

Theophylline Ethylenediamine


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Theophylline Ethylenediamine

BRAND: Aminophylline

CLASS: Methylxanthine Spasmolytic


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Theophylline

Actions:

1. Beta 2 agonist; directly relaxes bronchial smooth muscle

2. Dilates pulmonary and coronary arterioles, decreasing

pulmonary hypertension and increasing coronary blood

flow

3. Slight positive chronotropic and inotropic effects

4. Strengthens diaphragmatic contractions by affecting

intracellular calcium

5. Mild diuretic


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Theophylline

Actions:

6. Stimulates CNS vomiting centers

7. Respiratory center stimulant

8. Stimulates vagal and vasomotor centers in the braincanlead to decreased heart rate, vasoconstriction in the brain

depends on CNS or peripheral predominance


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Theophylline

Indications:


bronchitis, emphysema, and pulmonary edema2. Management of CHF and pulmonary edema


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Theophylline

Contraindications:

1. Hypersensitivity to xanthene compounds (e.g. caffeine)


Theophylline


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Theophylline

Adverse Reactions

Nausea/vomiting

Hypotension

Irritability

Tachycardia

Angina

Flushing

Diarrhea

Increased respiratory rate

Cardiac arrhythmias

Tremors

Seizures

Palpitations

Hypertension

Anorexia


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Theophylline

Precautions:

1. Caution if patient is already taking theophylline-containing

medications

2. Caution to patients with a history of cardiovascular disease

or hypertension

3. Thyroid disease

4. Active peptic ulcer

5. Hypotension may occur following rapid administration6. May oppose the effects of beta blockers


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Theophylline

Dose:

ADULT:

Loading dose of 6 mg/kg IV infusion over 20 minutesLoading dose of 1 mg/kg IV infusion over 20 minutes if the

patient has had theophylline products in the last 35 hours


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Theophylline


1. Incompatible with most drugs

2. Simetidine, propranolol, erythromycin, and troleandomycinmay increase the effects of the drug

3. Barbiturates, phenytoin, and smoking may decrease blood

levels

4. May increase the effects of anticoagulants


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Theophylline

Notes:ONSET: 15 minutes:

PEAK: 30 minutes1 hour

DURATION: Averages 5 hours

1. Common forms or oral aminophylline include:

* Marax * Primatene

* Quibron * Slo-Phyllin

* Slobid * Somophyllin

* Tedral * Theo-Dur


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Respiratory Medications

Respiratory meds are used for several purposes, themost obvious is the treatment of asthma. Class

includes:

1. Cough suppressants

2. Nasal decongestants

3. Antihistamines


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Antiasthmatic Medications

Asthma has two basic pathophysiologies:1. Bronchoconstriction

2. Inflammation

Treatment is aimed to relieve bronchospasm and

decrease inflammation.

Specific approaches are categorized as beta 2selective sympathomimetics, nonselectivesympathomimetics, methylxanthines,anticholinergics, glucocorticoids and leukotrieneantagonists.

f


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Beta 2 Specific Agents

Albuterol (Proventil, Ventolin) is the prototype of this class.

1. These agents relax bronchial smooth muscle, resulting in

bronchodilation and relief from bronchospasm.

2. These agents are first line therapy for acute shortness of

breath.

3. Administered via metered dose inhaler or nebulizer.

4. Overall, these agents are very safe.

l h


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Nonselective Sympathomimetics

Stimulate both beta 1 and beta 2 receptors, as well as alphareceptors.

Rarely used to treat asthma because they have the undesired

effects of increased peripheral vascular resistance and

increased risks for tachycardias and other dysrhythmias. Agents include: epinephrine, ephedrine, and isoproterenol

Epinephrine is the only nonselective sympathomimetic in

common use today.

h l hi


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Methylxanthines

CNS stimulants that have additional bronchodilatoryproperties.

Used only when other drugs such as beta 2 specific agents are

ineffective.

Possibly block adenosine receptors.

Prototype is theophylline, taken orally.

Aminophylline, an IV medication, is rapidly metabolized into

theophylline and, therefore, has identical effects.

Chief side effects: nausea/vomiting, insomnia, restlessness,

and dysrhythmias

A i h li i


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Anticholinergics

Ipratropium (Atrovent) is an atropine derivative given bynebulizer.

Because stimulating the muscarinic receptors in the lungs

results in constriction of bronchial smooth muscle,

ipratropium, a muscarinic antagonist, causes bronchodilation. Ipratropium is inhaled, and has no systemic effects.

Has an additive effect when used with beta 2 agonists.

Most common side effect is dry mouth

Gl i id


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Glucocorticoids

Anti-inflammatory properties.

Lower the production and release of inflammatory substances

such as histamine, prostaglandins, and leukotrienes, and

reduce mucus and edema secondary to decreasing vascular

permeability. May be inhaled or taken orally, as well as IV.

Prototype of inhaled glucocorticoid is beclomethasone.

Prototype of oral glucocorticoid is prednisone.

Administered as preventative care.

Gl i id


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Glucocorticoids

When inhaled they cause few side effects.

Side effects are due mostly to direct exposure on the

oropharynx, and gargling after taking the drug can decrease

the side effects.

Side effects from the IV administrations ofmethylprednisolone in emergencies are not likely

Long periods of administration can lead to adrenal

suppression and hyperglycemia.

Another anti-inflammatory agent used is cromolyn (Intal), aninhaled powder.

Gl ti id


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Glucocorticoids

Cromolyn is the safest of all antiasthma agents.

Only side effects are coughing or wheezing due to local

irritation caused by the powder.

Often used for preventing asthma in adults and children.

L k t i A t i t


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Leukotriene Antagonists

Leukotrienes are mediators released from mast cells uponcontact with allergens.

Contribute powerfully to both inflammation and

bronchoconstriction

Can either block the synthesis of leukotrienes or block theirreceptors.

Zileuton (Zyflo) is the prototype of those that block the

synthesis of leukotrienes

Zafirlukast (Accolate) is the prototype of those that block theirreceptors

DRUGS USED FOR RHINITIS AND


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COUGH

Rhinitis: (inflammation of the nasal lining) comprisesa group of symptoms including nasal congestion,itching, redness, sneezing, and rhinorrhea (runnynose).

Allergic reactions or viral infections may cause it Drugs that treat the symptoms of rhinitis and cold

are commonly found in over-the-counter remedies.

Nasal decongestants, antihistamines, and coughsuppressants are available in prescriptionmedications.

N l D t t


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Nasal Decongestants

Nasal congestion is caused by dilated and engorged nasalcapillaries.

Drugs that constrict these capillaries are effective nasal

decongestants.

Main pharmacologic classification in this functional category isalpha 1 agonists

Alpha 1 agonists may be given either topically or orally

Examples of agents: phenylephrine, pseudoephedrine, and

phenylpropanolamine, (administered in drops or mist)

A tihi t i


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Antihistamines

Arrest the effects of histamine by blocking its receptors.

Histamineis an endogenous substance that affects a wide

variety of organs systems.

Noted for its role in allergic reaction.

Histamine binds with H1 receptors to cause vasodilation and

increased capillary permeability (vasculature)

In the lungs, H1 receptors cause bronchoconstriction

In the gut, H2 receptors cause an increase in gastric acid

release

Histamine also acts as a neurotransmitter in the CNS.

A tihi t i


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Antihistamines

Histamine is synthesized and stored in two types ofgranulocytes; tissue-bound mast cells and plasma-bound

basophils

Both types are full of secretory granules, which are vesicles

containing inflammatory mediators such as histamine,leukotrienes, and prostaglandins, among others.

When cells are exposed to allergens, they develop antibodies

on their surfaces.

On subsequent exposures, the antibodies bind with theirspecific allergen.

A tihi t i


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Antihistamines

Secretory granules then migrate towards the cells exteriorand fuse with the cell membrane. Causing them to release

their contents.

Histamines are useful in our immune systems.

When our immune systems overreact do allergies such as hayfever or cedar fever send us running for the antihistamines

Typical symptoms of allergic reaction include most of those

associated with rhinitis.

Severe allergic reactions (anaphylaxis) may cause hypotension

Antihistamines


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Antihistamines

Antihistamines are at best only a secondary drug for treatinganaphylaxis.

Just as there are H1 and H2 histamine receptors, there are H1

and H2 histamine receptor antagonists.

Most old antihistamines were H1 receptor antagonists, newerantihistamines are H2 receptor antagonists.

Chief side effect is sedation (H1), newer generation do not

cause this sedation effect (H2).

First generation medications: alkylamines (chlorpheniramine[Chlor-Trimeton]), ethanolamines (diphenhydramine

[Benadryl])

Antihistamines


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Antihistamines

Other first generation antihistamines: clemastine (Tavist), andphenothiazines (promethazine [Phenergan]).

Some antihistamines also have significant anticholinergic

properties: promethazine and dimenhydrinate (Dramamine),

used for motion sickness. Second generation antihistamines include: terfenadine

(Seldane), loratadine (Claritine), cetirizine (Zyrtec, and

fexofenadine (Allegra).

These agents do not cross the blood-brain barrier andtherefore do not cause sedation.

Cough Suppressants


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Cough Suppressants

Coughing is a complex reflex that depends on functions in theCNS, the PNS, and the respiratory muscles.

It is a defense mechanism that aids the removal of foreign

particles like smoke and dust.

In general, treating a productive cough is not appropriate, as itis performing a useful function.

An unproductive cough, usually results from an irritated

oropharynx and can be troublesome.

The three classifications of cough suppressants include onethat is supported by evidence and two that are not.

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Cough Suppressants

Antitussives1. Suppress the stimulus to cough in the CNS.

2. This functional class includes two specific pharmacologic

types:

a. Opioids

b. Nonopioids

3. Two most common opioid antitussives are codeine and

hydrocodone

4. Both inhibit the stimulus for coughing in the brain but also

produce varying degrees of euphoria

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Cough Suppressants

5. The nonopioid antitussives do not have the potential forabuse.

a. Dextromethoraphan

b. Diphenhydramine

c. Benzonatate (Tessalon) Expectorants: intended to increase the productivity of

cough

Mucolytics:make mucus more watery and easier to coughup

Little data supports the effectiveness of either of theseapproaches to cough suppression

OBAT Gangguan Sal Nafas, Astma dan Batuk PAKSON.pptx

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