Bronchial asthma

Albuterol, Biotolterol, Ephedrine,Ephinephrine, Ethylnorepinephrine,  Isoetharine, Isoproterrenol,
Metaproterenol, Pirbuterol, Sametrol, Terbutaline

Refer- Ephedrine- Inhalation
 

Cardiovascular- palpitations, tachycardia, precordial apin, cardiac arrhythmias

CNS- Headache,insomnia, sweating, nervousness, vertigo, confusion, delirium, restlessness, anxiety,
 tension, tremor, weakness, dizziness, hallucinations

GI- nausea, vomiting, anorexai

GU- vesical spinter spasm resulting in difficulty and painful urination, urinary retension may develop  in males with prostatism

Miscellaneous- respiratory difficulty,pallor

Nasal Drops: Local irritation rebound nasal congestion and drug induced rhinitis on prolonged use

 

IHD, hypertension, Thyrotoxicoses, BHP.

Special precautions:
Lactation, preganacy, elderly.

Administer with caution -to patients with heart disease, coronary insufficiency, cardiac arrhythmias, angina pectoris, diabetes, hyperthyroidism, prostatic hypertrophy, hypertension, unstable vasomotor
 system or in patients on digitalis.

Prolonged use- may produce a syndrome resembling an anxiety state.

Tolerance- although tolerance to ephidrine develops, addiction does not occur. Temporary cessation  of mediaction restores the patients original response to the drug.

Hypovalemia- use is not a substitute for the replacement of blood plasma, fliuds and electrolytes, which should be restored promptly when loss has occured.

Warnings-
Hypertension- ephidrine may cause hypertension resulting in intracranial hemorrhage, anginal pain in  patients with coronary insufficiency or ischemic heart disease or potentially fatal arrhythmias in  patients with organic heart disease or who are receiving drugs to sensitize the myocardium

Labor and delivery- it is not known what effect ephedrine  may have on the newborn or on the childs  later growth and development when administered to the mother just before or during labor.

Pregnancy- give to pregnant women only if clearly needed

Lataction- use by nursing mothers is  not recommended  


 

Indications:
Bronchial asthma
Dosage:
Adults - 25 to 50mg 2 or  3 times a day.
Children-  3mg/kg/day divided in  4 to 6 divided doses.

Overdosage-

                                Symptoms                                                   
The principal manifestation of ephedrine poisoning is  convulsions. The following have occured in  acute poisioning- nausea, vomiting, chills,cyanosis, irritability, nervousness, fever, suicidal behaviour, tachycardia,   dilated pupils,blurred vision, opisthotonos, spasms, convulsions,pulmunary edema, gasping respirations,   coma later by hypotension accompanied by anuria.  
              
Large doses may lead to personality changes with  psychological craving for the drug. Chronic use of              
ephedrine can also cause symptoms of tension and anxiety progressing to psychosis.                                             

                               Treatment

 1. Discontinue the drug                                                                             
2. Remove the drug from the stomach by ipecacemesis,  followed by activated charcoal or airway
   protected gastric lavage in depressed hyperactive patients
 3. If respirations are shallow or cyanosis is present administer artificial respiration.
4. Vasopressors are contraindicated.
5.In cardiovascular collapse maintain blood pressure  
6. For hypertension 5mg phenotolamine mesylate diluted in saline may be administered slowly.
    or 100mg may be administered slowly.
7. Convulsions may be controlled by diazepam or  paraldehyde.
 8. Cool applications and dexamethasone 1mg/kg administerd slowly IV , will control pyrexia.


Missed dose-
1. If you are using this medicine regularly and you miss a dose, use it as soonas possible.
2. Then use the remaining dose fotbthat day at regularly spaced intervals.
3. Do not double doses.

 

. RESPIRATORY SYSTEM/ DISORDERS/ AND OR ADVERSE REACTIONS - NOTES
  
1. Anaphylaxis -  ( 342 )
2. Allergic Rhinitis ( 345 )
3. Urticaria and Angioedema  ( 344 )
4. Vasculitis ( 351 )
5. Systemic Lupus Erythematous ( SLE ) ( 355 )


1.Anaphylaxis -  ( 342 )

Definition- Life trhreatening anaphylactic response of a sensitized human apears withi minutes after  administration of specific antigen and is manifested by respiratory distress, often followed by vascular collapse or shock without antecedent respiratory difficulty. Cutanious manifestation exemplified by pruritus and urtcicaria with or without angioedema are cgaracterstic of such sysyemic  anaphylactic reactions.

Treatment-

Early recognition of an anaphylactic reaction is mandatory since death occurs within minutes to hours after the first
symptoms. Mild symptoms such as pruritus and urticaria can be controlled by administration of 0.2 to 0.5ml of 1:1000
epinephrine subcutaneously  with repeated doses as required at 3 min interval for a severe reaction.

2. Allergic Rhinitis ( 345 )

Allergic rhinitis is characterised by sneezing, rhinorrhoea, obstruction of of the nasal passges,conjuntival and phaaryngeal itching, and lacrimation. Although comonly seasonal owing to its relation owing to its relation to airborne pollens, other patterns and etioloies occur. The use ofterm - Hay fever - to describe seasonal allergic rhinitis is a common convention but is  literally inappropiate because the systom complex  is neither produced by hay nor associated with fever

3. Urticaria and Angioedema  ( 344 )

Urticaria and angioedema may appear separately or together as cutaneous manifestations of nonpitting edema, a similar process may occur at mucosal surfaceof of upper respiratory or gastrointestinal tract.

Urticaria involves only the superficial portion of the dermis presenting as well- circumscribed wheals with erythematous raised serpiginous borders with bblanched centers which may colalese to become giant wheals

Angioedema is a well- demarcated localized edmea involving the deeper layers of the skin involving the deeper layers of the skin including the subcutaneous acute, while attacks persisting beyond this period are diagnosed chronic

4. Vasculitis ( 351 )

Vasculitis is a known manifestation of human serum sickness and occurs frequently in several known immune -complex diseases. For example, in systemic lupus erythematous DNA  antibodies  to DNA and complement components have been identifed in vascular lesions

5. Systemic Lupus Erythematous ( SLE ) ( 355 )

Systemic lupus erythematous ( SLE ) is a disease of unknown cause. However, abundant evidence  shows that immunlogical mechanisms of tissue injury are important in pathogenesis. The clinical presentation of this disease is the presence of a number antibodes to neuclear components, but other immunlogical abnormalites exist as well. Some patients with SLE have spontaneous  remissions, otheres  respond favourably to treatment with corticosteroids, and in some patients the course is
unresponsive to available medications

 

Refer- Ephedrine- Inhalation

     
1. Allergies- Tell your doctor if you have ever had any unusual or allergic reaction to albuteroil, bitlterol, epinephrine,
   fenotereol, isoetharine, isoproterenol, metaproterenol, pirbuterol, procaterol, racepinephrine, terbutaline, or other
   inhalation medicines
   Tell your doctor yunare allergic to any oi any other substances such as fods, presrvatives or dyes.

2. Pregnancy-
    For albuterol, biolterol, and metaproterenol- have not been studied in pregnant woman. However, studies in animal
    have shown that  albeterol, bitolterol and metaproterenol cause birth defects when given in doses manytimes the usual
    inhalatiojn doses.
    
    For epinephrine - not studied in pregnant woman. use of epinephrine during pregnancy may cause birth defects in humans.  
   
    For feneoterol- has not shown to cause birth defects or other problems in humans
    
    For terbutaline- has not been studied in pregnant woman. Does not cause any birth defects, but may delay labor.

3. Breast feeding-
    For albuterol, bitolterol, fenoterol, isoetharine, isoproterenol, metaproterenol- mothers who are this medicine,    and who wish to breast-feed should discuss with their doctor.
    
    For epinephrine - may cause unwanted side effects in babies of mothers using epinephrine or   racepinephrine
    
     For terbutaline- mothers who are taking this medicine and whowish to breast-feed should discuss this with their   doctor.

4. Children- no specific information comapring use of these medicines inchildren comparing with different age     group available. These medicines are expected to cause different side effects than they do in adults.
 
5. Elderly- No specific information on use in elderly is available.      

6. Other medicines- Tell your doctor if you are taking any of the following medicines-

    Beta-blockes- thesecmedicines may prevent the adrenergic bronchodilators from working properly    Cocaine or
    Ergoloid mesylates or
    Ergometrine or
    Maprotiline or
    Tricyclic antidepressants - the effect of these medicines on the heart and blood vessels may be increased
    Digitalis glycosides-   chance of irregular heartbeats may be increased

    Monoamine ixidase inhibitors- MAOI- using adrenergic bronchodilators while you are taking orvwithin 2 weeks   of taking MAOI may increase the efects of MAO inhibitors.

7. Other medical problems- Tell your doctor if you are having other medical problems especially-
 
    Brain damage or
    Convulsions or
    Diabetes mellitus or - adrenergic bronchodilators may make the conditions worse. Your doctor may need to
    change the dose of your diabetes medicine

    Heart or blood vessel disease or
    High blood pressure - adrenergic bronchodilators may make the conditons worse
    Mental disease- ephinephrine may make the condition worse
    Overactive thyroid- sideefects may be increased
    Parkinsons disease- ephinephrine may temporariy increae certainsymptoms of Parkinsons disease, such
    as rigidity and tremor.

8. Missed dose- If youare using this medicine regulrly and  you miss a dosectakre it as soon as possible.    Then use any remaining doses for that day at regulrly spaced intervals.
    Do not double doses.

9. Storage-
    
    Keep out of reach of children
    Store away fromheat and children
    Do not store  the medicine in te bathroom near the kitchen skin,or in other damp places.
    Heat and moisture  may cause the medicine to break down
    Do not keep outdated medicines  or medicines no longer in use . Be sure that any discarded medicine
    is kept out of reach of children.

Refer sympathomimetics - bronchodilators

Pregnancy-

Give to pregnant women only if clearly needed

Lataction-

Use by nursing mothers is not recommended