RESPIRATORY

PHARMACOLOGY
LECTURE
ANTI-TUSSIVES
Symptom of respiratory system:
Cough
no sputum---antitussives
sputum --- expectorants
Asthma ----- anti-asthmatic drugs
DEFINITION
ANTITUSSIVE:-
A drug that suppresses coughing possibly by reducing
the activity of the cough center in the brain.

EXPECTORANT:-
A drug that enhances the secretion of sputum.
MECHANISM OF COUGH
MECHANISM OF COUGH
CLASSIFICATION OF ANTI TUSSIVES
TWO MAJOR CLASSES
I) CENTRALLY ACTING ANTI TUSSIVES:
Further divided into
Narcotic Anti-tussives: codeine, hydrocodone and
oxycodone

Non narcotic Anti-tussives Dextromethorphan,

Noscapine, Propoxyphene
CLASSIFICATION OF ANTI TUSSIVES
II) PHERIPHERALLY ACTING ANTI-TUSSIVES
Further divided into

Mucosal Anesthetics: Benzonatate, Chlophedianol

Hydrating agents:- Steam, Aerosols

Miscellaneous:- Bromhexine
NARCOTIC ANTI-TUSSIVES
1) CODEINE
Selectively suppress cough center in medulla oblongata,
thus, reducing the cough threshold

Pharmacokinetics:
Well absorbed from oral and injection.
10% converted to morphine through demethylation.

Clinical Uses:
Dry cough
NARCOTIC ANTI-TUSSIVES
Side Effects:
Shortness of breath
Sedation
Euphoria
allergic reactions
constipation
NARCOTIC ANTI-TUSSIVES
2) HYDROCODONE
Antitussives agent
Analgesic agent
more potent than codeine
5mg of hydrocodone is equivalent to 30 mg of codeine
when administered orally
Is combined with an anticholinergic drug
(homatropine)
NARCOTIC ANTI-TUSSIVES
Side Effects;
Light-headedness
Sedation
Constipation
allergic reactions
NON NARCOTIC ANTI-TUSSIVES
1) DEXTROMETHORPHAN
Dextromethorphan is the most widely used cough
suppressant in the United States

 and may provide better antitussives effects than

codeine.

Its popularity may stem from the fact that it isn’t

associated with sedation, respiratory depression, or
addiction at usual doses.
NON NARCOTIC ANTI-TUSSIVES
2) BENZONATATE
Benzonatate acts by anesthetizing stretch receptors
throughout the bronchi, alveoli, and pleurae.

It needs to be swallowed whole; chewing or crushing it can

produce a local anesthetic effect in the mouth and throat,
which can compromise the airway.

Side Effects; Dizziness, Sedation, Headache, nasal

congestion, burning in the eyes rash, eruptions, or itching,
Chills, chest numbness
EXPECTORANT/MUCOLYTICS
ACETYLCYSTEINE:
This is the only mucolytic used clinically in the United
States for the patient with abnormal or thick mucus.

Pharmacodynamics
Acetylcysteine decreases the thickness of respiratory tract
secretions by altering the molecular composition of
mucus
It also irritates the mucosa to stimulate clearance and
restores glutathione,(a substance that plays an important
role in oxidation-reduction processes.)
EXPECTORANT/MUCOLYTICS
Pharmacokinetics
Inhaled Acetylcysteine is absorbed from the
pulmonary epithelium.

When taken orally, the drug is absorbed from the GI

tract.

Acetylcysteine is metabolized in the liver; its excretion

is unknown.
EXPECTORANT/MUCOLYTICS
Therapeutic uses
to treat the patients with abnormal or thick mucus
secretions, such as :
atelectasis (caused by mucus obstruction),
pneumonia,
bronchiectasis, or chronic bronchitis
 bronchitis
pulmonary complications related to cystic fibrosis
Antidote for acetaminophen toxicity
EXPECTORANT/MUCOLYTICS
EXPECTORANT/MUCOLYTICS
Side Effects
Bronchospasm
Drowsiness
nausea and vomiting
severe runny nose
stomatitis.

Contraindications ?