NEET MDS Lessons
Pharmacology
Cough is a protective reflex which helps in expulsion of respiratory secretion or foreign particles which are irritant to respiratory
tract. Irritation to any part of respiratory tract starting from pharynx to lungs carried impulses by afferent fibres in vagus and
sympathetic nerve to the cough centre in the medulla oblongata. \
Cough may be dry (without sputum or unproductive) or productive (with sputum production).
Classification for drugs used in cough.
I. Pharyngeal demulcents
Certain lozenges, linctus and cough drops containing glycerine, liquorice and syrups.
II. Expectorants
Sodium and potassium citrate
Sodium and potassium acetate
Potassium iodide
Ammonium chloride & carbonate
Acetylcysteine
Bromhexine
Guaiphenesin
III. Antitussive
i. Opioids
Codeine (as linctus) Pholcodeine
ii. Non-opioids
Noscapine
Dextromethorphan
Pipazethate
iii. Antihistaminics
Chlorpheniramine
Diphenhydramine
Promethazine
Erdosteine is recently introduced mucolytic with unique protective functions for the respiratory tract. It is indicated in the treatment of acute and chronic airway diseases such as bronchitis, rhinitis, sinusitis, laryngopharyngitis and exacerbations of chronic bronchitis.
EPHEDRINE
It act indirectly and directly on α and β receptors. It increases blood pressure both by peripheral vasoconstriction and by increasing the cardiac output. Ephedrine also relaxes the bronchial smooth muscles.
Ephedrine stimulates CNS and produces restlessness, insomnia, anxiety and tremors.
Ephedrine produces mydriasis on local as well as systemic administration.
Ephedrine is useful for the treatment of chronic and moderate type of bronchial asthma, used as nasal decongestant and as a mydriatic without cycloplegia. It is also useful in preventing ventricular asystole in Stokes Adams syndrome.
Organic Nitrates
Relax smooth muscle in blood vessel
Produces vasodilatation
– Decreases venous pressure and venous return to the heart Which decreases the cardiac work load and oxygen demand.
– May have little effect on the coronary arteries CAD causes stiffening and lack of
– responsiveness in the coronary arteries
– Dilate arterioles, lowering peripheral vascular resistance Reducing the cardiac workload
Main effect related to drop in blood pressure by
– Vasodilation- pools blood in veins and capillaries, decreasing the volume of blood that the heart has to pump around (the preload)
– relaxation of the vessels which decreases the resistance the heart has to pump against (the afterload)
Indications
- Myocardial ischemia
– Prevention
– Treatment
Nitroglycerin (Nitro-Bid)
• Used
– To relive acute angina pectoris
– Prevent exercise induced angina
– Decrease frequency and severity of acute anginal episodes
Type
• Oral - rapidly metabolized in the liver only small amount reaches circulation
• Sublingual – Transmucosal tablets and sprays
• Transdermal – Ointment s
– Adhesive discs applied to the skin
• IV preparations
Sublingual Nitroglycerine
• Absorbed directly into the systemic circulation, Acts within 1-3 minutes , Lasts 30-60 min
Topical Nitroglycerine
• Absorbed directly into systemic circulation, Absorption at a slower rate. , Longer duration of action
Ointment - effective for 4-8 hours
Transdermal disc - effective for 18-24 hours
Isosorbide dinitrate
• Reduces frequency and severity of acute anginal episodes
• Sublingual or chewable acts in 2 min. effects last 2-3 hours
• Orally, systemic effects in about 30 minutes and last about 4 hours after oral administration
Tolerance to Long-Acting Nitrates
• Long-acting dosage forms of nitrates may develop tolerance
– Result in episodes of chest pain
– Short acting nitrates less effective
Prevention of Tolerance
• Use long-acting forms for approximately 12-16 hours daily during active periods and omit them during inactive periods or sleep
• Oral or topical should be given every 6 hours X 3 doses allowing a rest period of 6 hours
Isosorbide dinitrate (Isordil, Sorbitrate) is used to reduce the frequency and severity of acute anginal episodes.
When given sublingually or in chewable tablets, it acts in about 2 minutes, and its effects last 2 to 3 hours. When higher doses are given orally, more drug escapes metabolism in the liver and produces systemic effects in approximately 30 minutes. Therapeutic effects last about 4 hours after oral administration
Isosorbide mononitrate (Ismo, Imdur) is the metabolite and active component of isosorbide dinitrate. It is well absorbed after oral administration and almost 100% bioavailable. Unlike other oral nitrates, this drug is not subject to first-pass hepatic metabolism. Onset of action occurs within 1 hour, peak effects occur between 1 and 4 hours, and the elimination half-life is approximately 5 hours. It is used only for prophylaxis of angina; it does not act rapidly enough to relieve acute attacks.
Phenobarbital (Luminal): for generalized tonic-clonic and partial seizures (not used for absence seizures)
Mechanism: enhances GABA inhibition (↑ open time of Cl channels in presence of GABA)
Side effects: sedation, ataxia, cognitive impairment, induction of hepatic microsomal enzymes
Fourth Generation:
These are extended spectrum antibiotics. They are resistant to beta lactamases.
Cefipime
On the basis of Receptors, drugs can be divided into four groups,
a. agonists
b. antagonists
c. agonist-antagonists
d. partial agonists
a. Agonist
morphine fentanyl pethidine
Action : activation of all receptor subclasses, though, with different affinities
b. Antagonist
Naloxone , Naltrexone
Action : Devoid of activity at all receptor classes
c. Partial Agonist: (Mixed Narcotic Agonists/Antagonists)
Pentazocine, Nalbuphine, Butorphanol , Buprenorphine
Action: activity at one or more, but not all receptor types
With regard to partial agonists, receptor theory states that drugs have two independent properties at receptor sites,
a. affinity
The ability, or avidity to bind to the receptor
Proportional to the association rate constant, Ka
b. efficacy
or, intrinsic activity, and is the ability of the D-R complex to initiate a pharmacological effect
Drugs that produce a less than maximal response and, therefore, have a low intrinsic activity are called partial agonists.
These drugs display certain pharmacological features,
a. the slope of the dose-response curve is less than that of a full agonist
b. the dose response curve exhibits a ceiling with the maximal response below that obtainable by a full agonist
c. partial agonists are able to antagonise the effects of large doses of full agonists
Methyl salicylate
also known as oil of wintergreen, betula oil, methyl ester) is a natural product of many species of plants Structurally, it is methylated salicylic acid It is used as an ingredient in deep heating rubs