July 2017

Respiratory Stimulants and Pulmonary Surfactants

Pulmonary surfactants are used in the management of respiratory distress syndrome (hyaline membrane disease) in neonates and preterm neonates. They may also be given prophylactically to those considered at risk of developing the syndrome. Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement in arterial oxygen concentration. Pulmonary haemorrhage has been rarely associated with therapy especially in more preterm neonates; obstruction of the endotracheal tube by mucous secretions has also been reported.

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Mucolytics

Mucolytics are prescribed to facilitate expectoration by reducing sputum viscosity. In some patients with chronic obstructive pulmonary disease and a chronic productive cough, mucolytics can reduce exacerbations; mucolytic therapy should be stopped if there is no benefit after a 4-week trial. Steam inhalation with postural drainage is effective in bronchiectasis and in some cases of chronic bronchitis.

Mucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.

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Bronchodilators

The selective beta2 agonists (selective beta2-adrenoceptor agonists, selective beta2 stimulants) such as salbutamol or terbutaline are the safest and most effective short-acting beta2 agonists for asthma. Less selective beta2 agonists such as orciprenaline should be avoided whenever possible. Adrenaline (epinephrine) (which has both alpha- and beta-adrenoceptor agonist properties) is used in the emergency management of allergic and anaphylactic reactions and in the management of croup

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Corticosteroids

Corticosteroids are used for the management of reversible and irreversible airways disease. An inhaled corticosteroid used for 3–4 weeks may help to distinguish asthma from chronic obstructive pulmonary disease; clear improvement over 3–4 weeks suggests asthma. Corticosteroids are effective in asthma; they reduce airway inflammation (and hence reduce oedema and secretion of mucus into the airway). An inhaled corticosteroid is used regularly for prophylaxis of asthma when patients require a beta2 agonist more than twice a week, or if symptoms disturb sleep more than once a week, or if the patient has suffered exacerbations in the last 2 years requiring a systemic corticosteroidor a nebulised bronchodilator. Regular use of inhaled corticosteroids reduces the risk of exacerbation of asthma.

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Leukotriene Receptor Antagonists

Dose and Administration:Prophylaxis of asthma, adult and child over 15 years, 10 mg once daily in the evening; child 6 months–6 years 4 mg once daily in the evening, 6–15 years 5 mg once daily in the evening.

Seasonal allergic rhinitis, adult and child over 15 years, 10 mg once daily in the evening.

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Lipid Regulating Drugs

Statins: Simvastatin: Indications: primary hypercholesterolaemia, homozygous familial hypercholesterolaemia or combined (mixed) hyperlipidaemia in patients who have not responded adequately to diet and other appropriate measures; prevention of cardiovascular events in patients with atherosclerotic cardiovascular disease or diabetes mellitus. Contraindications: Active liver disease, which may include unexplained persistent elevations in hepatic…

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Antihistamines

All antihistamines are of potential value in the treatment of nasal allergies, particularly seasonal allergic rhinitis (hay fever), and they may be of some value in vasomotor rhinitis. They reduce rhinorrhoea and sneezing but are usually less effective for nasal congestion. Antihistamines are used topically in the eye, in the nose and on the skin. Oral antihistamines are also of some value in preventing urticaria and are used to treat urticarial rashes, pruritus, and insect bites and stings; they are also used in drug allergies. Injections of chlorphenamine (chlorpheniramine) or promethazine are used as an adjunct to adrenaline (epinephrine) in the emergency treatment of anaphylaxis and angioedema.

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Local Sclerosants

Local Sclerosants
Ethanolamine Oleate:

Indications: indicated for the treatment of patients with esophageal varices that have recently bled, to prevent rebleeding. sclerotherapy of varicose veins.

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Fibrinolytic Drugs

Fibrinolytic drugs act as thrombolytics by activating plasminogen to form plasmin, which degrades fibrin and so breaks up thrombi.

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Anticoagulants

Parenteral Anticoagulants: The main use of anticoagulants is to prevent thrombus formation or extension of an existing thrombus in the slower-moving venous side of the circulation, where the thrombus consists of a fibrin web enmeshed with platelets and red cells. They are therefore widely used in the prevention and treatment…

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