Medicatia Aparatului Respirator
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Transcript of Medicatia Aparatului Respirator
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Cuprinde:Cuprinde: - ANTITUSIVE- ANTITUSIVE
- EXPECTORANTE- EXPECTORANTE
- ANTIASTMATICE- ANTIASTMATICE
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ANTITUSIVEANTITUSIVE
Mecanism de actiuneMecanism de actiune::
- Deprima centrul tusei- Deprima centrul tusei
receptorii sensitivi din mucoasa receptorii sensitivi din mucoasa respiratorie respiratorie
Clasificare:Clasificare: - OPIOIDE- OPIOIDE
- NEOPIOIDE- NEOPIOIDE
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ANTITUSIVE OPIOIDE
1. Opiul si MorfinaActiune f-dinamica: - antitusiva
- analgezica
- tranchilizanta
Indicatii: - cancer bronhopulmonar
- anevrism de artera aorta
- infarct pulmonar
Efecte adverse: - dependenta
- deprimarea centrului respirator → stop respirator !
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ANTITUSIVE OPIOIDEANTITUSIVE OPIOIDE2. 2. Codeina Codeina (Metilmorfina)(Metilmorfina) – CODENAL, – CODENAL,
CODEINA FOSFATCODEINA FOSFAT
Actiune f-dinamicaActiune f-dinamica: - antitusiva: - antitusiva
- analgezica- analgezica
- sedativa slaba- sedativa slaba
3. 3. NoscapinaNoscapina – TUSAN – TUSAN
~ Codeina, dar ~ Codeina, dar NUNU deprima centrul deprima centrul respiratorrespirator
efect analgezicefect analgezic
4. 4. DextrometorfanDextrometorfan – – TUSIN, HUMEXTUSIN, HUMEX
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ANTITUSIVE NEOPIOIDEANTITUSIVE NEOPIOIDE
1. GLAUCINA1. GLAUCINA• • act. antitusiva slaba, de scurta durataact. antitusiva slaba, de scurta durata
2. CLOBUTINOL – TABCIN, TUSSAMED2. CLOBUTINOL – TABCIN, TUSSAMED • • antitusiv cu actiune centrala indicat in tusea antitusiv cu actiune centrala indicat in tusea
neproductiva, jenantaneproductiva, jenanta
3. BUTAMIRAT – SINECOD, TUSOSEDAL3. BUTAMIRAT – SINECOD, TUSOSEDAL•• indicat in - tusea iritativaindicat in - tusea iritativa
- bronhoscopie- bronhoscopie
4. OXELADINA – PAXELADINE4. OXELADINA – PAXELADINE• • preferat in pediatriepreferat in pediatrie
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EXPECTORANTE
• SECRETOLITICE (MUCOLITICE)
↓ vascozitatea mucusului
• SECRETOSTIMULANTE
↑ activitatea secretorie a gld. bronsice
↑ motilitatea cililor
↑ peristaltica mucoasei bronsice
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EXPECTORANTE SECRETOLITICEEXPECTORANTE SECRETOLITICE
Utilizari terapeutice:Utilizari terapeutice:
•bronsita ac./cr. acutizata;bronsita ac./cr. acutizata;
•pneumonii;pneumonii;
•bronhopneumonii;bronhopneumonii;
•bronsiectazie;bronsiectazie;
•mucoviscidoza;mucoviscidoza;
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EXPECTORANTE SECRETOLITICE
1. BROMHEXIN - BROFIMEN
- BISOLVON
• mucolitic cu actiune moderata
2. AMBROXOL- MUCOVENT, MUCOSOLVAN
• mucolitic cu actiune intensa
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EXPECTORANTE SECRETOLITICEEXPECTORANTE SECRETOLITICE
3. ACETILCISTEINA – MUCOSOLVIN, 3. ACETILCISTEINA – MUCOSOLVIN, FLUIMUCILFLUIMUCIL
• • mucolitic cu actiune intensamucolitic cu actiune intensa
• • utilizat si ca antidot in intoxicatia cu utilizat si ca antidot in intoxicatia cu Paracetamol Paracetamol !!
4. CARBOCISTEINA – KARBOCISTEIN, 4. CARBOCISTEINA – KARBOCISTEIN, FLUIDOLFLUIDOL
• • actiune mucoliticaactiune mucolitica
• • efect antiinflamator prin antagonizarea efect antiinflamator prin antagonizarea kininelor localekininelor locale
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EXPECTORANTE SECRETOLITICEEXPECTORANTE SECRETOLITICE
5. ERDOSTEINA - ERDOMED5. ERDOSTEINA - ERDOMED
• • mucolitic indicat in tulburari ale secretiei mucolitic indicat in tulburari ale secretiei bronsice;bronsice;
• • utilizat in bronsite acute, pusee acute ale utilizat in bronsite acute, pusee acute ale BPCO, bronsiectazie, astm bronsic BPCO, bronsiectazie, astm bronsic hipersecretor;hipersecretor;
• profilaxia si tratamentul complicatiilor respiratorii dupa interventii chirurgicale: bronhopneumonie, atelectazie pulmonara.
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EXPECTORANTE SECRETOLITICE
Preparate locale – aerosoli
• mucolitice cu actiune intensa, prelungita (12-24 ore)
• utilizate in: - mucoviscidoza
- bronsiectazie
- postoperator
- imunodeprimati
Prezentare: BISOLVON
MESNA - MISTABRON, MUCOFLUID
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EXPECTORANTE SECRETOSTIMULANTE
1. GUAIAFENESINA – TRECID
• act. expectoranta prin fluidificarea sputei
• act. sedativa
• act. miorelaxanta
2. SIROGAL
• amestec de SM cu efect expectorant modest
3. SIROP DE PATLAGINA ~ SIROGAL
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Componentele Componentele FIZIOPATOLOGICE majore ale FIZIOPATOLOGICE majore ale AB sunt:AB sunt:
• • bronhospasmulbronhospasmul
• • inflamatia inflamatia
• • hipersecretia bronsica hipersecretia bronsica
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Fenomenele PATOGENICE majore ale AB sunt:
1) Hiperreactivitatea musc. netede bronsice <= stimuli • mecanici
• chimici
Bronhospasm • alergeni
• efort
• frig
2) Autacoizi – formati si eliberati in CR
a) Histamina (mastocite) cu act.:
• bronhoconstrictoare;
• congestiva;
• secretie de mucus.
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COX
b) Prostanoizii acid arahidonic• Tromboxan agregant plachetar (plachete) bronhoconstrictor• Prostaciclina → vasodilatator (endot. vasc.)• Prostaglandina E → vasodilatator (celule)
c) Leucotrienele • LTB (L si epit. Traheal) → agreg.
plachetara• LTC• LTD L si mastocite → relax. br.
• LTE
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d) Factorul de agregare plachetara (PAF)d) Factorul de agregare plachetara (PAF)
→ → bronhospasmbronhospasm
vasodilatatievasodilatatie
inflamatieinflamatie
3. 3. SNV → dezechilibru la nivelul influentelor SNV → dezechilibru la nivelul influentelor adrenergice si colinergiceadrenergice si colinergice
a) ADR. → recept. a) ADR. → recept. ΒΒ22 → relax. br. mici → relax. br. mici
b) ACH. → recept. muscarinici → contr. br. marib) ACH. → recept. muscarinici → contr. br. mari
↑ ↑ secretiilesecretiile
In AB sunt implicate urmatoarele defecte:In AB sunt implicate urmatoarele defecte:
• • hiperexcitabilitate vagala;hiperexcitabilitate vagala;
• • defect de eliberare a ADR.defect de eliberare a ADR.
• • deficit al recept. deficit al recept. 22
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ANTIASTMATICEANTIASTMATICE
Medicamentele utilizate in Medicamentele utilizate in tratamentul AB sunt:tratamentul AB sunt:
• • BRONHODILATATOAREBRONHODILATATOARE
• • ANTIINFLAMATOAREANTIINFLAMATOARE
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BRONHODILATATOARE
• Agonistii β2 adrenergici;
• Antagonistii colinergici;
• Musculotrope
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AGONISTII AGONISTII ββ2 (SIMPATICOMIMETICE 2 (SIMPATICOMIMETICE ββ2)2)
= bronhodilatatoare de = bronhodilatatoare de I alegere I alegere in toate in toate treptele ABtreptele AB
Mecanism de actiune:Mecanism de actiune:Stimuleaza receptorii
β2
Activarea adenilatciclazei
↑ AMPc
Activarea proteinkinazei
Inhibitia fosforilarii miozinei ↓ Ca i-cel
relax. musc. bronsice
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AGONISTI β2 ADRENERGICI
De scurta durata:
• TERBUTALINA - BRICANYL
• SALBUTAMOL - VENTOLIN
• FENOTEROL - BEROTEC
• CLENBUTEROL – SPIROPENT
• METAPROTERENOL – ALUPENT
• BITOLTEROL – TOMALATE
• REPROTEROL
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AGONISTI β2 ADRENERGICI
Act. f-dinamica → bronhodilatatoare puternica
→ NU act. antiinflamatoare
Indicatii: - AB intermitent (I alegere)
- AB persistent (treapta II-III-IV) – in crize sau
profilactic
Administrare: - orala
- injectabila
- inhalatorie
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AGONISTI β2 ADRENERGICI
De lunga durata:
• SALMETEROL – SEREVENT
• FORMOTEROL - OXIS
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AGONISTI AGONISTI ΒΒ2 ADRENERGICI2 ADRENERGICIActiune f-dinamica → Actiune f-dinamica → bronhodilatatie lunga (~ bronhodilatatie lunga (~
12ore)12ore)
→ → NU act. antiinflamatoareNU act. antiinflamatoare
IndicatiiIndicatii: - AB persistent toate formele: - AB persistent toate formele
- NU in criza de AB- NU in criza de AB
Efecte adverseEfecte adverse: - toleranta ← ↓ sensibilitatii : - toleranta ← ↓ sensibilitatii recept.recept.ΒΒ22
← ↓ ← ↓ nr. recept. nr. recept. ΒΒ22
- interferenta eficacitatii - interferenta eficacitatii steroizilorsteroizilor
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ANTAGONISTII COLINERGICIANTAGONISTII COLINERGICI• • ATROPINAATROPINA
• • BROMURA DE IPRATROPIUBROMURA DE IPRATROPIU
• • OXITROPIUMOXITROPIUM
• • TIOTROPIUMTIOTROPIUM
CaracteristiciCaracteristici: :
• • mai slabe decat agonistii mai slabe decat agonistii ββ2 adrenergici2 adrenergici
• • efectul → instalat lent (~ 30 min)efectul → instalat lent (~ 30 min)
→ → dureaza 8 – 12 ore; 72 ore pentru dureaza 8 – 12 ore; 72 ore pentru Tiotropium Tiotropium
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ANTAGONISTII COLINERGICIANTAGONISTII COLINERGICIMec. de actiuneMec. de actiune: : → blocheaza recept. colinergici→ blocheaza recept. colinergici
→ → blocheaza contractia vagala a blocheaza contractia vagala a musculaturii si secretia bronsicamusculaturii si secretia bronsica
IndicatiiIndicatii: - alternativa terapeutica a : - alternativa terapeutica a ββ2 2 adrenergicelor adrenergicelor la la bolnavii coronarieni bolnavii coronarieni
- intoleranta la - intoleranta la ββ22 adrenergice sau Teofilina adrenergice sau TeofilinaPrezentarePrezentare: :
ATROVENT (bromura de ipratropiu)ATROVENT (bromura de ipratropiu)BERODUAL (fenoterol + bromura de ipratropiu)BERODUAL (fenoterol + bromura de ipratropiu)COMBIVENT (salbutamol + bromura de COMBIVENT (salbutamol + bromura de
ipratropiu)ipratropiu)SPIRIVA (tiotropium)
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MUSCULOTROPEMUSCULOTROPE
TEOFILINA – MIOFILIN, THEO SRTEOFILINA – MIOFILIN, THEO SR
Act. f-dinamicaAct. f-dinamica::
bronhodilatatoare – mai slaba decat bronhodilatatoare – mai slaba decat ββ2 2 adrenergiceleadrenergicele
antiinflamatoare si imunomodulatoareantiinflamatoare si imunomodulatoare
+ SNC → insomnie, nervozitate, tremor+ SNC → insomnie, nervozitate, tremor
cardiostimulanta → palpitatii, dureri precordialecardiostimulanta → palpitatii, dureri precordiale
diuretica - slabadiuretica - slaba
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MUSCULOTROPEMUSCULOTROPEMec. de actiuneMec. de actiune: inhiba fosfodiesteraza : inhiba fosfodiesteraza
→↑AMPc→↑AMPc
=> relaxeaza musc. bronsica=> relaxeaza musc. bronsica
IndicatiiIndicatii: - : - criza de ABcriza de AB – i.v. lent sau PEV – i.v. lent sau PEV
- de electie in AB nocturn- de electie in AB nocturn
- AB tratament de fond + - AB tratament de fond + corticoterapie corticoterapie inhalatorieinhalatorie
- bronsita cronica spastica- bronsita cronica spastica
!! Teofilina = M. cu IT mic → monitorizarea Teofilina = M. cu IT mic → monitorizarea tratamentuluitratamentului
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ANTIINFLAMATOARECORTICOTERAPIA INHALATORIE
• medicatie de electie in AB persistent, toate formele• permite ↓ semnificativa a dozelor=> ↓ efectelor adverse
BECLOMETAZONA – BECOTIDEFLUTICAZONA – FLIXOTIDEFLUNISOLIDE – BRONILIDEBUDESONIDE – PULMICORTTRIAMCINOLONE - AZMACORT
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Actiunea antiinflamatoare se manifesta:• la nivel celular →
• la nivel histologic: ↓ edemul mucoaseihipersecretia de mucusfibroza subepiteliala
receptori specifici citoplasmatici
complex
nucleu (ADN)
+ Lipocortina
Fosfolipaza A2
↓ leucotrienele↓ prostaglandinele
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CORTICOTERAPIA – INHALATORIECORTICOTERAPIA – INHALATORIEIndicatiiIndicatii: - AB persistent (toate formele): - AB persistent (toate formele)
- BPCO- BPCO
- sarcoidoza, mucoviscidoza- sarcoidoza, mucoviscidoza
Efecte adverseEfecte adverse::
→ → locale: - candidoza orofaringianalocale: - candidoza orofaringiana
- tuse iritativa- tuse iritativa
- disfonie- disfonie
- bronhospasm paradoxal- bronhospasm paradoxal
→ → sistemice: - ↓ rezistentei la infectiisistemice: - ↓ rezistentei la infectii
- osteoporoza- osteoporoza
Corticodependenta si corticorezistenta Corticodependenta si corticorezistenta !!
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CORTICOTERAPIA SISTEMICACORTICOTERAPIA SISTEMICA→→ doar in AB forma severa, pentru o perioada doar in AB forma severa, pentru o perioada
scurtascurta
AdministrareAdministrare:: oral - PREDNISON (cp. 5 mg) – dozele se oral - PREDNISON (cp. 5 mg) – dozele se
↓treptat ↓treptat !!!! i.v.i.v. - HEMISUCCINAT DE HIDROCORTIZON (f)- HEMISUCCINAT DE HIDROCORTIZON (f)
- METILPREDNISOLON (SOLU-MEDROL)- METILPREDNISOLON (SOLU-MEDROL)
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INHIBITOARE ALE DEGRANULARII MASTOCITAREINHIBITOARE ALE DEGRANULARII MASTOCITARE1.1. ACID CROMOGLICIC = CROMOGLICAT DISODICACID CROMOGLICIC = CROMOGLICAT DISODIC
(INTAL, LOMUDAL)(INTAL, LOMUDAL)antiastmatic cu proprietati antialergice si antiastmatic cu proprietati antialergice si antiinflamatoareantiinflamatoare
Mecanism de actiuneMecanism de actiune: inhiba elib. histaminei: inhiba elib. histaminei inhiba elib. de leucotrieneinhiba elib. de leucotriene inhiba PAFinhiba PAF
IndicatiiIndicatii: - profilactic in: - AB alergic: - profilactic in: - AB alergic - rinite, conjunctivite alergice- rinite, conjunctivite alergice - AB la frig, substante iritante, - AB la frig, substante iritante,
efort efort AdministrareAdministrare: - aerosoli: - aerosoli
- instilatii oculare, nazale- instilatii oculare, nazale
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INHIBITOARE ALE DEGRANULARII MASTOCITAREINHIBITOARE ALE DEGRANULARII MASTOCITARE
2) NEDOCROMIL – TILADE2) NEDOCROMIL – TILADE
• • derivat al acidului cromoglicic, cu potenta marederivat al acidului cromoglicic, cu potenta mare
3) KETOTIFEN – ZADITEN3) KETOTIFEN – ZADITEN
ProprietatiProprietati:: - antiastmatice; - antiastmatice;
- antihistaminice.- antihistaminice.
Mecanism de actiuneMecanism de actiune: : inh. elib. histaminei inh. elib. histaminei + leucotriene; + leucotriene;
inh. PAF inh. PAF blocarea recept. H blocarea recept. H11
IndicatiiIndicatii: profilaxia: - AB alergic: profilaxia: - AB alergic
- rinite, conjunctivite alergice- rinite, conjunctivite alergice
! ! NUNU in criza AB in criza AB
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ANTILEUCOTRIENE: ANTILEUCOTRIENE: • • MONTELUKAST SODIC – SINGULAIRMONTELUKAST SODIC – SINGULAIR• • ZAFIRLUKAST – ACCOLATEZAFIRLUKAST – ACCOLATE• • PRANLUKAST PRANLUKAST • • ZILEUTON ZILEUTON
MONTELUKAST SODIC – SINGULAIRMONTELUKAST SODIC – SINGULAIR• • antagonist selectiv al receptorului CYSLTantagonist selectiv al receptorului CYSLT11
IndicatiiIndicatii: - AB alergic: - AB alergic - AB la Aspirina- AB la Aspirina - profilaxia bronhoconstrictiei indusa de efort- profilaxia bronhoconstrictiei indusa de efort ! ! NUNU in criza ABin criza AB
Terapie asociata: Terapie asociata: - corticoterapiei- corticoterapiei → → permit ↓ dozelorpermit ↓ dozelor - - ββ22 adrenergicelor adrenergicelor
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Tipul de astm
bronsic
Tratament preventiv pe termen lung
Ameliorare rapida
Treapta I
intermitent
Nu este necesar
sau
Singulair
Β2 adrenergic inhalator la nevoie
NU mai mult de 1 data/saptamana
Β2 adrenergic sau cromoglicat disodic
inainte de efort expunere la alergen
Treapta II persistent usor
Corticosteroizi inhalatori
sau Singulair
sau Cromoglicat, Nedocromil
sau Teofilina cu eliberare lenta
sau Serevent inhalator
Idem treapta I
NU mai mult de 3 – 4 ori/zi
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Tipul de astm
bronsic
Tratament preventiv pe termen lung
Ameliorare rapida
Treapta III
Persistent moderat
Corticosteroizi inhalatori
+
Serevent inhalator
Teofilina cu eliberare lenta
sau Salbutamol comp.
Idem treapta II
Treapta IV persistent sever
Corticosteroizi inhalatori
+
Serevent inhalator
Teofilina cu eliberare lenta
sau Salbutamol comp.
+
Corticosteroizi oral
Idem treapta III
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Alte antiastmatice pentru uz sistemicAlte antiastmatice pentru uz sistemic
FENSPIRID – EURESPALFENSPIRID – EURESPAL, , antagonizeaza mediatorii antagonizeaza mediatorii chimici ai inflamatiei, responsabili de edem, chimici ai inflamatiei, responsabili de edem, hipersecretie, bronhoconstrictiehipersecretie, bronhoconstrictie
Indicatii: bronsite cronice, coriza, astmIndicatii: bronsite cronice, coriza, astm
SURFACTANTII PULMONARISURFACTANTII PULMONARI
CUROSURF,CUROSURF, SURVANTA, EXOSURFSURVANTA, EXOSURF NEONATALNEONATAL – – utilizati pentru substituirea surfactantului endogen utilizati pentru substituirea surfactantului endogen absent sau insuficient la n.n. cu VG < 34 sapt.absent sau insuficient la n.n. cu VG < 34 sapt.
Indicatii: Sindrom de detresa respiratorie (boala Indicatii: Sindrom de detresa respiratorie (boala membranelor hialine)membranelor hialine)
Administrare: endotrahealAdministrare: endotraheal
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