(rss used in treatment of — alae 5m 52h Ides dle ytash - modo = os CR <_spoe RY SO) Au ve Il - eae ly p52 eae rhe 8 Ue aa e aymetom CP ys ds diseose Cpye coed az mucus ble = Triggers Clay — 4g (ese! - 2gP9 pt Se > Respiratory tract xia oye —> Pevicoy jvum coll pty rth s Cus > Esophagus 2s lt > Draghragm goletivlesd| _» 3femach 3 all —_, Ear canel oo Bl aks ©Receptors = Sean ae 3h omy LI Sl Wo 29 C2 mechani cal receptors chemical vecepfors 2102 Bll Apsl - $s WW fees Soa a2 Sys athe Ho Sat lo 49 Ga Sough copteg <— et ce earl APP erent —— Foyle! ope tN pee SS ol nerves Bayly lye Uys ae C ough aK Sb araxl| ee a ¥t Joes 99 center Pape «Wiel Ji-g,y aa Jp ere ~ epCevent bola o los Ul neyves ay boty ot © diaphragm joledes Leu @ Lung oi! ® Infevcostal muscles aya Spall “ia 9 ets Ship ps Maal By oes “ 8 ONS aces Naja sslcenter cough ast 50 Ur aol)! 3) Cw Uh confYadion 2e9-e LD! x Sle Yio 20 of! Cpldil - Oiaphyagm muscles - Intercosfal muscles -~ Abdominal muscles Noisy lps gibt 048 contvachn abe | eExeation ——s oylaTeyy Phases. or stages of ‘Cough u ® Trritfotien —_, Gang en @ Inspration ——, — corgrtialoy @ compression —+ baip5\ ays @ Explusion—y lets Ml ales yn Fn Bat azn © Cola ss of wly— Common Causes common cold Upper respiratory tract mPechons > allergic Qhimitis —> smokin — chronic @ronchitis = Pulmonary Tuberculosis (78) —= Asthma Gastroesophageal ve lex — Pneumonia — f of cough JI Less,b ee oS aK Loo Cae § Two types of cough ductive vion Productive 2ompa 25 able a5 ° el awd @.sl was Gd AM AS ow E59 WA ists Cc» S2Hs C3 4a G__ll aoe acd Map Alas Souls “oo aalyl Clb Sie eel oil ic CHE Is anovmal secretion produced ee the surface cells in the MUCUS membrane XEN spa Arbpall LYS coe Aad shal oO & wall tap aol Aes) y ~ 09 8 Be Tus dg ae ® lLsning the respivatory Passages So produce Moderate amount of mucus to hel? mastuwze these lining sees ®@ Troe dust— microbes Jungs 3 S32) Oa eI (_oe lg JLall piss» poms ® Keep ay way mast )‘Mucus ComPesition ~weoley ——» 95% allo - GSlycop roles —> 2-3 %s - protegly cans —sol-05 -Lipigs ——> 03-03 % — Prolens -ONA Ts an abnormal mucus eel an abnormal viscous secretion cpus sali gs mucus aloja boas aoa LEH ard Lely cs Cough ee ray of sputum —>_ mucus expelled Crom the ony Was duving Cough ghiegm Upsi a pt Gl ol Bagel Ass sputum Do => Due to writalion -Trflammation of AW Passages » ©He Asis a5 Color — ComPosition According to Combsiton ube cates oh © Mucaus Sputum Produc of mucous Glands in cose of Acule_@y enchitis Coloy ——> -Colorless - Trons Pavent colar, = Gloss ike odsy ——> odoyvless Zedly oo 0H Consilency —> Tenacions cas @ Mucopurulent spufiam xs ah Conc) + (Push cage Ge —-> fii Fi 5 dies BPG AR mucus 2s asyje Pus cells @Joye os ESS 130 ~chyonic Ryonchits - Trachitis - Tuberculosis - ByYoncho Pneam gia Color ——> Glass -kkke with Yellow tut pus ells oapsgee 4 > of olan bus SAN | is pot os) cfs cells , @® Puromucus SP uum Csvapsl abst qaqa wo Jol a opt _ chyovic bron chits due te - Ppulmonory Abscess want eslor ——y Yellow - 4veemsh . odoy ——> unpleosant atlas consihency ——> Tacks Ln @@ Purlent Ss Sputum jolt Samp als No mucus PID vap Pus Sale Oue to ———> Pulmenory Abscess Lolyy ———> qyeenish yellow Pus loo F- ode + ——_ unp leogant consistency — Thick ® Mucous - Bloody Spution waa Al Mucus + streaks of Blood Que to — > Taf lam mation of upper respiratory duck - Pneumonia - Rroncheqenic tumay coloy —_> Gleas—like with Reb tf colorless odour ——> odoy les @© Mucopurulent bleedy sputum | >» Beto — _ Tubeycurlosis - Qronehectasis = Actinomy cosis - Bronchageni¢ tumor esloy ——> Glas like Glee + yellow Traces + Red tint brug sed i treatment of Cough 3 Types © Peripheral ackn BYU cent valha ackn Oru @ cert ally peripherally, etn lr ©© peripheval acting Drugs aryngeal \ ya ae . same Leents es cabodl colabule - ee - Glycerin -l ice — ec ee s apolar ellalleysr - Lozenqe mucy a | ex | — \inctus conforvting MA cay \odl o at = vasaks ~Ammorium chlovide = Ryomhedne _ sepium citrate ~ AmbroXol -kK 108% de n- Acdy| cee « uaiPenesin ~TPpeca cuonhsa ¢ JephPhoryngeal Oemulcenfs Alle bbls 2 mechanisms + Vy Dosa Ja + © f Flow of saliva which produces asoothing efPect on the Pharyngeal MUCOSA LU Yl Bae Coed 9 bl Cops —+~@® | Afferent impulses arising From the svvitates MUCSO Src ToN SN Acpol| = 1, Cuyl ge Jo AN os MG Mls Cough cordey- zh al bp — la 25 Si shy xp oe VY 92 o 5h hee ala al Bop Ce eer 5 + ud 7 Lozenges ls Cal by Yeh - cough drops opll 59 And i> os 5 de OS ale (P9251 Udo!) IEbHIG DMN ees el_E Kom les of hor ns eal Demulce nt OCinctusy ‘tis a thick liquid Preperation Confarning sucvese + medicinal substances > hos sopative — Demulcent Propevities airs © Grab a2, sl a an aa Mh NPI yo it mucelytics ale 2 Types K mucokcinetics a Set $l own Seal Dray. that LiqueFy the sputum By breaking down ws RN ays) Ce @2e2 I Ol are 6 Gayl mucin Gols pe _ G cop So hele eosily yemoval of secretions el Cy make sputum kss WiSCous 5Resengles 2 Hues) < acd cog teine —> sl - *romhexine - AmbyoYol - Sevvatio peptidase - Carbo cyst eine N- Acely! Cysteine Soasavedal | mucus — sputum AS3 A pe P (AIH) od AH 54 BU mucus ce > mucin polymer oH sH aa Hs oH mun Polymers aw manomers 029 and es oftWun Tab WMcalatics awd 25 55! 050 pa Gi ccy yb cos $ NS es Oisulhide bonds Ace pA bo yl mucn Jugs] mucofrofing —J “ot All eS ® oO N Acetyl cysteine | oH DisulPide SF a) Syl {> | Bon ds 7 Sos cP NYw 4 He NH sis ° Hy CéPolymerizatapy atte Sei 2 ai S n sulhur- Y's ee sulPhyt s whe cusfeine Ssrupfion bond 2 - = Oeqreddion 5 mucspolysacchanides chain of 5 Aone acts Bonds 5 3p papDose of N-Acehy Cysteine ol-o-3 mglkg orally Daily for 5 Dow ne longer Route} — Inhalation Tnstillation CEnhalsfony ‘le mi gf 20% selufin nebulization 2-20 ml of fo ‘/. Solution , Loy Vy & onset of Acton | minute maximum Peake — 3 6 _(o mines Qurton of Acton —> 9-3 hie Aceh cysteine CAH A095 aay AWlosive STISA__tay AntiotidonT. Antidote (HA dlod9 Solar cs NW eo WI Qe 2 Yly & foracefam ol = Acefominephen o> To reduce hepatic mjur with acefomine Phen over d&e °. -Acetl-cystemne a AP ay Nb gol Ofzep (8 asl Sa2— 2} os vs (Hl) Rronchiat Asthma tse r__ lin Bronchedilaty,- (i Ha! oF As it stimulates @renchosfasm AST stimulates Grenchesfosm A $e jay puse__, Cat). Peptic ule \ Ballaeys Cs Ogle ww Prey Nancy gall Cpa Cul putes ———_——_7 Category g othey mucel i Sodium Gi corbonale’ ne Aedylexpteine : pe als aw pb ip Cabsd wea -c as p52 cs Ul ZC SSAig JMS sbi ja 5 A Sod. bichon da Amine Acids of mucus @sodium bicorbonole dist upls the stab; tity ef the Amino Auds chains - S s : Noll C og rd | mengten ——_> od : Fe sab s s s ere Anine neal Bromhexine et = Leto pn} be 2 mechanisms 5 Lal © Depal meri Zation of mucopol acelent Wysosomal enzyme ep ant ary Gs Ss Byomhexine bberafs if Aol ala, mucoPrlysacchoriles de! e570 tes = @ Tnduces CoPous cater mucus Secretians (OL Lets bls jel jou Cambwrel 3 Ambrofal is the Acie metabolites of QomhexingPA sy 2, Ay Seledigs Ceybas Ota < s48 O8 allyl - Drug that Facilitate the yemoval of secrefions Prom the respivafary tree — f ciliary Ackwits T Bronchial seertions > Acts os hypovis coms agents 4 mucus Viscosity lars , mucociliary cleorance 4 Surface Tension of Bronch ral sputum mucokinefics reach with ¢_ apysdl mucus te mate + ore 0 * Kinesis = ¢ move ment sputum) — ‘ ao i oss “mucolinefics 3 x y mucus chemical PYoperities mucalyhes fieE xamples of Mucokinetics = phenesiny = Guaifenesin plant products —>(Gooiac Free) & @ronchial secretion * mucociliary function x Removal of secretions From the respiratory tract } viscosity of sputum to5 of Guoifenesn —s thy - less wvitant ems gee ~sale orug “C Guadocel? the same as CuarCenesin Amin onan chloridey alot} Vy 71 got Gs - as D pic LSp @ PPR Wo Yo be 2 Gi ey dn Gostric ivvifil — <— wlLiyie °@ st \ Ammonium aif writ dS! Stlaridg OTD sob cle lee fl Cee L453 of see ayoy"'9 = yeu Guida rePlexly enhances Bronchial secyelions ea) r avian se chloride * ocean aS Large Jeep ce ul 0 Couse Metabolic Acitosis Cl apse cis | Exon ee ds < Shed all Vol FN c SM Jal GO py & C18 ‘enol ’ Oiabeles (ep sad; Ame Cateye ties @ thy) DP Be Uy La Le Function B/N au 5G 9 Se tt) — as @ : To ineGS So Prolonged Use of Ammontum chloride Es Induce Goter ang hyfathyredisin : odin etait and _Poftassiun citrate) Qe 7 oe at 05d 2) Trine 2 lice Alles Bicordanafes es) J gmc lke Sp Allaine pH PH IG mucus aay) fog Dae —> plant dru, Brozilian eephaelic oslpp ier as ‘\Peca cuanha used also a& Avikemetic Brug,QECenbrally Acting Aniifassivery > OvEgs that inhibit the medullary Sough confer and there by inhibit the coughing veflex rpsllaAh Sy fe kod SN Urbicd a de 5S bs AN AUG pR Pee 3 W210 58 6 ron productive Cough = Ory Cough le 63 p74 oda panei Productive cough = wet cough Te prevent iwterfering with bods attempt fe vid Itself of mucus Cpls cg eal yt EOP 2LEN G> mucus Ga. @Cenilrally acting Cough supp yessanl Types Ari hisfinint ¢ -Codeing = Nos cap Ine ~chlorpheniranine = pholco done 2 Dextremethor phan ~piphen ly dyamine - morphine Eth morphing ~ PromethaZing | ~ Methadone (Codeine) —~ Codeine is the Cough medicine te which all other antitussive Drugs ort ComPared —> codeme 4s amnetly( mor Phine Rhos ole aM Ys pi Ge c cently JS3 codeme 1 ee Oe ms a Atha) (fae Cate J Ks © very efPective yy @) alt have adverse ef feckCodeine —s very effective But hag Adverse effects A; | > physi cal dependence > Respivotory depression > GCLT colic - conshPation as sf Ww intestinal mavanent —_— BM Ce GY Vso ill 05) + v0 Apt all Gy Hl -So these Drugs should be used for Severe distressin Cough which cannot be relieved by Drugs Geri) a Ge a) melabolization fe! lwer | - on AS) sa te, 7 morphine - por moe ie — Noy Codeine = hydrocodon e@ other coughclinical uses of Codeine QO Cough sup Pessant @_ Analgesi = Pam Killer Codeine — As > need large D oSe As Cough need Small Sup pressayj Dose Wet tins 298 lip * Codeine ani othe, opsids are Contya-wdicated mn Patients with Bronchial Asthma — As they couse histamine velease which yesult in Byonche spasm ably — lLaall ens They Ly muco cil i ary cleavance @te-5 of Co deine + 34 he} (10-20 m4 times Daily Miotisy [oem 0% cul as Codeine G Ths smalt dose cant act as analgesic but ach as cough suppressant 5 Add as anal qesic oot eadeng should be used Cautiously im Patients with Reduced hepatic Functions bab A a_i (The American Academy of pediatrics (pls Codeine (ie {9 Cupsl centrally cough suppressants SGbBles Jae ieee ct ZG @ Acc —ros iyo 2b —AS ols short teym 95 Ul wd)2 oPs BOW AGY wyall LSA cafes ( > Adding Expectorank 's very useful ag they dminsh the Cough by increasing the Fluid content in the respiratory tyad and hence calm the MUCOUS membyanes of the arvulhy | So the Patients to breath. Hydrocodone similar fe codeine in acton but it is more Potent —»> if is one of the mekbolites of Codeine metabo bsim in liver 6 how 83 (3ub| (225 YJ 29> “Ul 0 a0 (ab) Lear a cos fo! deb Ul cs helping codeine Hydrocodone Qe~ Avttussive action similoy to Codeine - Not analgesic ~Ne addicten habitily — long Quration of Action (Oose) —> 5S -lo mg three times Daily (Morphine) more addiction than Codeine ’ Fe I = Yd C9) Acar __y 2 yi) Severe distvessin Cough . yeas The same as morphine ome eG apt Tw 0 extvomethorphan Non oPoid Non Now cofic - synthetic comPoun) —> oid devvatives — No Addiction —No Analgesic efPect —~ No Const pation _ pet affect mucociliary Function=I Sib Las ap Oextyomethsyphan “Ys CH a Sah ¥ GZ oY! G8 dgiby a fp ad is necessary if cough +5 distur bin sleep or When Cough is hazardous en en ad Dose —_s Clo_ 25 ms three times (ail Adverse effeck Ato ia - O1ZZiness Ant histamin ic Drugs Palen Ye 5 UI 048) Op eo po AR ys LS V5 UI 09 Mechanism —> They cause ‘ENS Depression So Depvess CouCn ea Yr Va Fl 036 Buy —_—> | Gedy reflexes dhe No 55 So) Gell (be. Lae Subs 3 a) 3 These Orugs f thick ness of Secretions reek Mle Cp (a ¥ $101 -chlorphenivamne maleate E romp les - phenivomine maleate they Drugs TP Sal <_set V1 doch ge aly Prépherally Anesthetic Para~aming benZoic Acid ex ProCaine © the lungs ond Pleura responsible Pay the cough ref lex —> Cenf rally @@ also by Anesth efizing the stretchin yeeeptors in, the vespiratory Pedsages 5h Reduciny Cough reflex qi, peripherally oPoid Orugs Baila x9 A165. pos UY ade slits ¥l al Ad verse ePPects eee abe NEI (Ch Fecls ~ Constipation ~ Dizziness - Drowsiness ~ headache clmrcal uses — Severe Cough in Cancey Patients Dose loo ms 2 fimes Daily “sur FAS mp Sh> | sre pares - a ouble tablets ~ Suclxiny toblets @other Drugs synthetic centrally aching Se tttsiv: levodvopropizine Acting Peripher pot? 43 7 F used in patie nis with imal qnant tumor in lu O%e —+» 75 mj three times Qaily lauecine Centrally ackny ontitussive Dose —> Bo my three times Dail aes CHoguisteing) pe ripherally Acting Non Novcolic usged in > lung Cantey Dose —s loo my three times Daily UF 5299 ll aaD ert Bar ond — sop 3 wales! ay aps! JULY! Combinations Soe 91 5 x>c7b JS eas CLs ¢