Jelie Rose Peruelo BSM 3

Activity 1.

Respiratory System and its function.

2. Drugs acting on the Upper Respiratory Tract:

1. Antitussives

Act centrally to suppress the medullary cough center or locally to increase secretion and
buffer irritation to act as local anesthetics.

Indicated for common cold, pharyngitis and pneumonia with unproductive cough.

Contraindicated to postoperative patients (abdominal/thoracic surgery), asthma,

emphysema and those with history of addition to narcotics.

Examples Dextromorphan (Benylin), Robitussin DM

2. Decongestants (Symphatomimetic amines)

Drugs that cause local vasoconstriction and decrease blood flow to the irritated and
dilated capillaries of the mucous membrane lining the nasal passages thus causing shrinking of
the mucous membranes and a reduction in fluid secretion.

Example Ephedrine, Phenylephrine

3. Antihistamines (H1 Blockers)/ H1 antagonists

Competes with histamine for receptor sites/ blocks the effects of histamine bringing
relief of patients suffering for itchy eyes, swelling, congestion and drippy nose.

Example Diphenhydramine (Benadryl) Promethazine (Phernegan) Loratidine ( Claritin )

3. Mucolytics

Works to break down mucus in order to aid in the high risk respiratory patients in
coughing up thick, tenacious secretions.

Example Acetylcysteine (Mucomyst)

4. Expectorants

Loosen bronchial secretions so they can eliminated with coughing.

Example Guiafenesin (Robitusin)

3. Drugs acting on the Lower Respiratory Tract

I. Symphatomimetics: Alpha and Beta- Adrenergic Agonists

a. Non selective adrenergic drugs- beta 1 (cardiac) and beta 2 (respiratory) activities
(epinephrine SQ, IM)

b. Non selective Beta Adrenergic drugs

- Exhibit both beta 1 and beta 2 agonist activity wherein their main action is on the
bronchial smooth muscle as well as the heart. Isoproterenol (Isuprel) SL Inhalation IV

c. Selective Beta 2 receptor drugs (cathecholamine Beta 2 receptor)

- Since it possess a weak beta 1 response, less risk of cardiotonic side effects. It relaxes
bronchial smooth muscle relieving bronchospasms increasing vital capacity and
decreasing resistance of bronchial smooth muscle relieving bronchospasms increasing
vital capacity and decreasing resistance of bronchial airways. Isoetharine (Bronkosol)-
inhalation.
d. Non cetacholamine Beta 2 receptor drugs

- They are longer acting and they have fewer cardiovascular side effects. Albuterol
(Proventil, Ventolin- inhalation. Syrup, tablet.

II. Bronchodilators / Antiasthmatics / Xanthines / Methylxanthines

- Stimulates the central nervous system and respiration, dilate coronary and pulmonary
vessels and causes diuresis.

Example Aminophylline, Theophylline (Theodur)- Increase the level of cyclic AMP.

III. Anticholinergic Bronchodilator

- Indicated for patients who are not able to tolerate the sympathetic effects of
sympothomimetics, dilates bronchioles.

Example Ipatropium Bromide (Atrovert) -aerosol

IV. Glucocorticoids (Steroids)

- Used in the treatment of respiratory disorders especially asthma.

Example Dexamethasone (Decadron), Prednisone Hydrocortisone, Beclomethasone Flunisolide

(aerobid)-aerosol inhalers.

v. Cromolyn Sodium (Intal)

- Used as prophylaxis of asthma, does not have bronchodilator or anti-inflammatory

properties but acts inhibiting the release of histamine. (inhalation).

VI. Mucolytics

VII. Antimicrobials
Activity 2

1. Types of Anti-Bacterial

a. Penicillin
- natural antibacterial agent obtained from the mold genus Penicillin.
- “miracle drug” during world war I
- Indicated for the treatment of streptococcal infections including pharyngitis, tonsillitis,
scarlet fever, endocarditis. High Doses are used to treat meningococcal meningitis.
Example Ampicillin, Amoxicillin, Ciclacillin

b. Cephalosporins
- They have beta lactam structures and act by inhibiting the bacterial enzyme that is
necessary for cell wall synthesis.
- Nephrotoxicity is associated with the use if cephalosporins particularly in patients with
renal insufficiency.
Examples Cephalexin, Cefadroxil, Cefotaxime, Ceftriaxone

c. Macrolides
- Bactericidal and bacteriostatic. Interferes with protein synthesis is susceptible bacteria.
- Indicated for treatment of pelvic inflammatory disease, intestinal amoebiasis.
Examples Erythromycin (E-mycin), Azithromycin (Zithromax).

d. Tetracyclines
- They were the first broad- spectrum antibiotics effective against gram (-) and gram (+)
bacterias and many other organisms such as myobacteria, rickettsiac, spirochetes
Example: Tetracycline ( Terremycin ) – shot acting. Doxycycline ( Vibramycin ) – long
acting.

e. Lincosamides
- Inhibit bacterial protein synthesis and have both bacteriostatic and bactericidal actions,
depending on drug dosage.
Example: Clindamycin, Lincomycin
f. Aminoglycosides – bacteria
- Group of powerful antibiotics used to treat infections.
- Adverse effects include ototoxicity – irreversible deafness, confusion, numbness, tingling
and weakness, palpitations, hypo or hypertension.
Examples:
 Amikacin (Amikin)- for short term use only because of potential nephrotoxity and
ototoxicity.
Gentamycin (Geramycin) – used orally for hepatic coma.
Kenamycin (Kantrex) – used for hepatic coma
Neomycin – milder, used to suppress GI bacteria preoperatively.
Streptomycin – very toxic to the 8th cranial nerve and kidney. Used as combination
therapy for Tuberculosis.

g. Fluroguinolones
- New class of antibiotics in which the mechanism of action is to interfere with the
enzyme DNA Gyrase, which is needed to synthesize bacterial DNA.
- Useful in the treatment of UTI, bone and joint infections, bronchitis, pneumonia,
gastroenteritis and gonorrhea.
Example:
Ciprofloxacin (Ciprobay) – for UTI
Cinoxacin (Cinobac) – acute and chronic UTI’s.
Levofloxacin (Levox, Levaquin) – respiratory tract infection.
Gatifloxacin (Tequin) – for respiratory, UTI’s prostatitis and skin infections.
Trovafloxacin (Trovan) – to treat acute sinusitis, chronic bronchitis.

h. Peptides
- 2 groups as antibiotics
 Polymyxines (Aerosporins)
o Useful when bacterial is resistant to other antibacterial drugs.
o Can caused nephrotoxicity and neurotoxicity (numbness, tingling of
extremeties, paresthesia and dizziness).
 Beacitracin (Bacitracin – USP) – available in ointment form.

2. Antituberculosis Drugs
 Mycobacterium Tubercle Bacillin
- Causative organism for tuberculosis
- Slow-growing treatment must be continued for 6 to 2 years.
 Primary Anti TB drugs (First line drugs)
- More effective and less toxic.
a. Isoniazid (INH)
- May be used at any age and among pregnant women.
 - Side effects: peripheral neuritis, hepatotoxicity.
- Administer Vitamin B6 (Pyridoxine) to prevent peripheral neuritis
- Used as prophylaxis for 6 months to 1 year.
b. Streptomycin
- Side effects: ototoxicity, nephrotoxicity.
c. Rifampicin
- Side effects: red orange color to body secretions, hepatotoxicity, nausea and
vomiting, thrombocytopenia.
d. Ethanbutol
- Side effects: optic, neuritis, skin rush

Second line Anti – TB drugs: Pyrazinamide, Kanamycin, Ethionamide

3. Autonomic Nervous System

- Functions primarily as a regulatory system for maintaining the internal environment of
the body at an optimal level.
- This system automatically controls the function of smooth muscle cardiac muscle and
glandular secretions which interact in many vital physiologic tasks.

Subdivisions of the ANS.

1. Sympathetic Nervous System

- Adrenergic system
- Norepinephrine – is the neurotransmitter
- Adrenergic Drugs / Sympathomimetics – mdrugs that mimic the effect of
norepinephrine because they initiate a response at the adrenergic receptor
sites.
- Sympatholytics / adrenolytics – drugs that block the effect of
norepinephrine
2. Parasympathetics Nervous System
- Cholinergic system
- Acetylcholine
- Cholinergic drugs / parasympathomimetics – drugs that mimic acetylcholine
because they initiate a cholinergic response.
- Parasympatholytics anticholinergic – drugs that block the effect of acetylcholine.
Activity 3.

1. 3 Categories of Adrenergics

a. Direct Acting Sympathomimetics

o Binds directly to the receptor and cause a response.

b. Indirect Acting Sympathomimetics

o Stimulates or causes the release of cathecolamines from the storage sites in the nerve
endings which binds with the receptor to cause a response.

c. Mixed – Acting Sympathomimetics ( indirect and dual acting ).

o Both directly stimulates the receptor by binding to it and indirectly stimulating the
receptor by causing the release of the neurotransmitter stores in vesicle of the nerve
endings.

2. Common side effects and adverse reactions of sedative- hypnotics

o Hangover – residual drowsiness resulting in impaired reaction time.

o REM Rebound – results in vivid dreams and nightmares.
o Tolerance – there is a need to increase the dosage over time to obtain the desired effect.
o Excessive Depression – lethargy, sleepiness, lack of concentration, confusion and
psychological depression.
o Respiratory Depression – high doses can suppress the respiratory center in the medulla.

3. Advantages of balanced anesthesia

o Minimize cardiovascular problems

o Decrease amount of general anesthesia needed
o Reduces possible post anesthetic nausea and vomiting
o Increase recovery from anesthesia of organ function
o Increases recovery from anesthesia
o Fewer side effects

3. Stages of anesthesia

o Analgesia- begins with consciousness and ends with loss of consciousness. This is
induction stage.
o Excitement or delirium – loss of consciousness caused by depression of the cerebral
cortex.
o Surgical – procedure is performed.
 - Anesthesia deepens, respirations become more shallow and respiratory rate
is increased.
o Medullary Paralysis – toxic stage of anesthesia
o Respiration are lost
o Circulatory collapse occurs
o Ventilator assistance is necessary