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Patho-pharmacology-II

Unit 2-B
Respiratory system and diseases related
to this system
Younas Masih
Lecturer: New Life College Of Nursing
Karachi

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Pneumonia
• Pneumonia is an infection of the lungs
• It is usually caused by bacteria or a virus, and
is often triggered by a cold or t
• Anyone can develop pneumonia, but young
people and the elderly are often worst
affected .

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Causes
Pneumonia can be caused by many types of germs,
including:
• Bacterial. The most common bacteria is
Streptococcus pneumoniae (pneumococcus).
There are many other types of bacteria that
cause pneumonia.
• Virual. Such as the flu virus, are also a common
cause of pneumonia.
• Fungal. Pneumonia caused by fungal infections
are relatively uncommon.
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Causes
• Pneumonia is an infection that causes inflammation
of the air sacs in one or both lungs.
• It is most commonly caused by one of the viruses or
bacteria present in the air we breathe.
• Usually our bodies immune system is able to fight off
these germs. But sometimes our immune system is
overwhelmed, such as during a cold or a bout of the
flu.
• When infection sets in, the air sacs in one or both
lungs fills with pus and fluids, making breathing
difficult.
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Risk factors

• Recently having had a cold or the flu


• Having a chronic lung conditions
• Having a weakened immune system
• Drinking excessive alcohol or smoking
• Being a patient in hospital

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Risk Factors
In children, the risk of pneumonia is increased by:
• premature birth
• poor nutrition
• low birth weight
• reduced rates of breastfeeding
• exposure to tobacco smoke
• lack of insulation and heating
• living in damp, mouldy and/or overcrowded
conditions
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Patho-physiology of pneumonia

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Signs and symptoms
The most common symptoms of pneumonia include:
• Cough (often with yellow or green coloured phlegm) fever,
which may be mild or high shaking chills
• Shortness of breath
• Increased effort required to take a breath
• Low energy and fatigue
• Loss of appetite
• Headache
• Chest pain that gets worse when you breathe deeply or cough
• Bluish tinge to skin, lips and nail beds. This is a sign that the
lungs are unable to deliver enough oxygen to the body. If this
occurs seek medical assistance straight away.

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Asthma
• Asthma is a chronic disorder of the airways
that causes episodes of airway obstruction,
bronchial hyper responsiveness, and airway
inflammation that are usually reversible
• “a chronic inflammatory disorder of the
airways in which many cells and cellular
elements play a role, in particular, mast cells,
eosinophils, T lymphocytes, and epithelial
cells.”

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Status asthmaticus

• Is a severe, prolonged form of asthma


unresponsive to drug treatment that may lead
to respiratory failure.

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Asthma
• Asthma is an airway disease that can be classified
physiologically as a variable and partially reversible
obstruction to air flow, and pathologically with
overdeveloped mucus glands, airway thickening due
to scarring and inflammation, and bronco
constriction, the narrowing of the airways in the
lungs due to the tightening of surrounding smooth
muscle. Bronchial inflammation also causes
narrowing due to edema and swelling caused by an
immune response to allergens.

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Asthma
• Asthma the airways are oversensitive and
react to certain triggers by tightening up
(‘bronchospasm’), swelling on the inside
(‘inflammation’) and producing more mucus.
As a result, the airways become narrower,
making it difficult for air to move in and even
more difficult for air to move out of the lungs.

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Types of asthma
• Extrinsic (Atopic) Asthma: Extrinsic or atopic
asthma is typically initiated by a type I
hypersensitivity reaction induced by exposure
to an extrinsic antigen or allergen. Persons
with atopic asthma often have other allergic
disorders, such as hay fever, urticaria, and
eczema. Attacks are related to exposure to
specific allergens.

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Phases
• acute-phase response, which usually develop
• within 10 to 20 minutes, are caused by the
release of chemical mediators from the
presensitized mast cells. In the case of
airborne antigens, the reaction occurs when
antigen binds to previously sensitized mast
cells on the mucosal surface of the airways

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Phases
• The late-phase response, which develops 4 to
8 hours after exposure to an asthmatic trigger,
involves inflammation and increased airway
responsiveness that prolong the asthma attack
and set into motion a vicious cycle of
exacerbations.

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Types of asthma
• Intrinsic (Nonatopic) Asthma:
• Intrinsic or non atopic asthma triggers include
respiratory tract infections, exercise,
hyperventilation, cold air, exercise, drugs and
chemicals, hormonal changes and emotional upsets,
airborne pollutants, and gastroesophageal reflux.
• Respiratory tract infections, especially those caused
by viruses, may produce their effects by causing
epithelial damage and stimulating the production of
IgE antibodies directed toward the viral antigens.

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Pathogenesis of bronchial asthma
• . (A) The immediate or early-phase response triggered by an
IgE-mediated release of mediators from sensitized mast cells.
The release of chemical mediators results in increased mucus
production, opening of mucosal intercellular junctions with
exposure of submucosal mast cells to antigen, and
bronchospasm.
• (B) The late-phase response involves epithelial cell injury with
decreased mucociliary function and accumulation of mucus;
release of inflammatory mediators with recruitment of
neutrophils, eosinophils, and basophils; increased vascular
permeability and edema; and increased airway responsiveness
and bronchospasm.

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Causes
Allergy triggers
• One of the most common allergens (substances which provoke
an allergic reaction) is house dust mite. Other triggers include:
• viruses (colds and flues)
• pollen
• pets
• cigarette smoke
• cold weather
• exercise
• stress
• perfume
• some medication.

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Asthma

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Symptoms
• feeling out of breath
• a 'tightness' in your chest
• wheezing
• coughing, especially at night.

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Pharmacotherapy
• Treatment of asthma
• BETA-ADRENERGIC AGONISTS
• Beta2-agonists are effective bronchodilators
for the management of asthma and other
pulmonary diseases. They are some of the
most frequently prescribed agents in
pulmonary medicine.
• Albuterol (Proventil, others), Bitolterol
mesylate (Tornalate)
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Beta-adrenergic Agonists
• Beta-adrenergic agonists are sympathomimetics
• Drugs of choice in the treatment of acute
broncho constriction
• Some beta-agonists activate both beta1- and
beta2-receptors, whereas others activate only
beta2
• Beta-agonists are commonly called
bronchodilators, because this is their primary
pharmacological action.

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Cont…
• Albuterol (Salbutamol)
• Albuterol (Salbutamol) is a short-acting β2-adrenergic receptor agonist.
• It is used to prevent and treat wheezing, shortness of breath, coughing, and
chest tightness caused by lung diseases such as asthma and chronic
obstructive pulmonary disease (COPD; a group of diseases that affect the
lungs and airway)
• Salmeterol acts by selectively binding to beta2-adrenergic receptors in
bronchial smooth muscle to cause bronchodilation. When taken 30 to 60
minutes prior to physical activity, it can prevent exercise-induced
bronchospasm.
• Its 12-hour duration of action is longer than that of many other
• bronchodilators, thus making it best suited for the management of chronic
asthma.
• Because salmeterol takes 15 to 25 minutes to act, it is not indicated for the
termination of acute bronchospasm.

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Anticholinergics
• Blocking the parasympathetic nervous system
produces effects similar to those caused by
activation of the sympathetic nervous system.
• Ipratropium (Atrovent) is the most common
anticholinergic prescribed for the
pharmacotherapy of chronic obstructive
pulmonary disease (COPD) and asthma.
• combining ipratropium with a beta-agonist
produces a greater and more prolonged
bronchodilation than using either drug separately
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Ipratropium
• is an anticholinergic (antagonist) that causes
bronchodilation by blocking cholinergic receptors in
bronchial smooth muscle. It is administered via
inhalation and can relieve acute bronchospasm within
minutes after administration, although peak effects may
take 1 to 2 hours.
• Effects may continue for up to 6 hours. Ipratropium is
less effective than the beta2-agonists but is sometimes
combined with beta-agonists or glucocorticoids for
their additive effects. It is also prescribed for chronic
bronchitis and for the symptomatic relief of nasal
congestion.
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IVIethylxanthiiies
• The methylxanthines comprise a group of bronchodilators
chemically related to caffeine. Theophylline (Theo-Dur,
others) and aminophylline (Somophyllin) were considered
drugs of choice for asthma 20 years ago.
• Theophylline, however, has a very narrow margin of safety
and interacts with numerous other drugs. In addition, side
effects such as nausea, vomiting, and CNS stimulation are
relatively common, and dysrhythmias may be observed at
high doses.
• Like caffeine, methylxanthines can cause nervousness and
insomnia.

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Glucocorticoids
• Glucocorticoids are the most potent natural anti-inflammatory
substances known. Because asthma has a major inflammatory
component, it should not be surprising that drugs in this class
play a major role in the management of this disorder.
• Glucocorticoids dampen the activation of inflammatory cells and
increase the production of antiinflammatory mediators. Mucus
production and edema is diminished, thus reducing airway
obstruction.
• Although glucocorticoids are not bronchodilators, they sensitize
the bronchial smooth muscle to be more responsive to beta
agonist stimulation. In addition, they reduce the bronchial hyper
responsiveness to allergens that is responsible for triggering
some asthma attacks

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Pharmacotherapy of COPD
• The goals of pharmacotherapy of COPD are to relieve symptoms and
avoid complications of the condition.
• Various classes of drugs are used to treat infections, control cough,
and relieve bronchospasm.
• Most clients receive bronchodilators such as ipratropium (Atrovent),
beta2- agonists, or inhaled glucocorticoids. Both short-acting and
long-acting bronchodilators are prescribed.
• Mucolytics and expectorants are sometimes used to reduce the
viscosity of the bronchial mucus and to aid in its removal. Long-term
oxygen therapy assists breathing and has been shown to decrease
mortality in.
• clients with advanced COPD. Antibiotics may be prescribed for
clients who experience multiple bouts of pulmonary infections.

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Drugs used in TB
• Isoniazid.
• Rifampicin.
• Pyrazinamide.
• Ethambutol.
• and Streptomycin.

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References:
• Pneumonia - Pathophysiology Of Pneumonia - Alveoli, Blood,
Pneumonias, and Carbon - JRank Articles. (2015). Retrieved from
http://science.jrank.org/pages/5358/Pneumonia-Pathophysiology-
pneumonia.html
• Pneumonia - Health Navigator NZ. (2014, August 18). Retrieved from
http://www.healthnavigator.org.nz/health-topics/pneumonia/
• Adams, M., Dempsey, C., & Holland, L. N. (2008). Instructor's
resource manual for Pharmacology for nurses: A pathophysiologic
approach (2nd ed.). Upper Saddle River, NJ: Pearson / Prentice Hall.

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