Respiratory System (5)

A. NOSE:- Common cold and Flu ( part 3)

TREATMENT :- 

2. Antihistamines:- 

A. ACTION:- 

• block histamine receptors 
• block histamine release from mast cells 
• decrease inflammation and edema 

 B. CLASSIFICATION :-

1. FIRST GENERATION ( sedating ) :- 

        A. sedating :-

• Bromopheniramine 
• Chloropheniramine 

      B. high sedating :-

• Clemastine 
• Diphenhydramine 
• Doxylamine 
• Promethazine 

      C. Minimum  sedating :-

• Cetrizine 
• Chlorcyclizine 
• Meclizine 
• Levocetrizine 

2. SECOND GENERATION ( non-sedating ) :-

• Fexofenadine 
• Loratidine
• Phenindamine 

C. USE:-

• used to treat symptoms as 

                                           1. Sneezing 

                                           2. Itching 

                                           3. Rhinorrhea 

D. DOSE :- 

Antihistamines Doses
No.	Drug	Dose / day
		Above 12 year	6- 12 year	2 – 6 year
1	Bromopheniramine	24 mg	12 mg	No
2	Chloropheniramine	24 mg	12 mg	No
3	Cetirizine	10 mg	5 – 10 mg	2 – 5 mg
4	Diphenhydramine	300 mg	150 mg
5	Doxylamine	75 mg	37,5 mg
6	Loratidine	10 mg	10 mg	5 mg
7	Fexofenadine	180 mg	60 mg

E. OVERDOSE :-

 Over dose of sedating drugs can lead to :-

1.   Toxic psychosis 
2.   Hallucination 
3.   Insomnia 
4.   Tonic - clonic seizures 
5.   Tachycardia 
6.   Urine retention 

 Over dose of non - sedating drugs can lead to :-

1.  Headache 
2.  Tachycardia   

F. SIDE EFFECTS:-

1. Mainly sedation and drowsiness in case of sedating drugs 

2. Anexity 

3. Hallucination

4. Dryness of ( eye, mouth, vagina)

5. constipation  

G. DRUG INTERACTIONS:- 

1. Alcohol

2. Benzodiazepines 

3. Barbiturates 

H. CONTRAINDICATIONS:-

1. Newborns and infants 

2. Lactating mothers ( all antihistamines secreted in milk)

3. Glaucoma ( narrow angle)

4. Acute asthma

5. Peptic ulcer

6. Prostate hyperatrophy 

7. Bladder obustraction 

8. Epilepsy 

9. Liver disease 

10. Chronic bronchitis 

I. CAUTIONS :- 

 

DO NOT USE SEDATING DRUGS WITH 

1. Drivers 
2. Factory workers 
3. Machine workers    

J. NOTE :- 

Antihistamines ...... photosensetizing agents 

patients must avoid sun exposure  or wearing  protective cloths or use sun screen 

3. ANALGESICS AND ANTIPYRETICS :-           

Most common used in cold preparations 

1. Paracetamol
2. Aspirin 
3. Ibuprofen 

4. Other products :-

1. Cough preparation ( dextromethorphan and guaifenesin )
2. Vit. C
3. Herbal products ( eucalyptus, thymol, menthol, camphor, tilia , fennel)
4. Vaccines 
5. Antibiotics 

5. MARKET :- 

1. COMBINATION OF (chloropheniramine+pseudoephedrine+paracetamol)

1.  1   2   3® 
2.   Babyrhino®
3.   Cetal cold and flu®
4.  Cold free® 
5.  Congestal® 
6.  Fever n flu®
7.  Flumol ®
8.  Flupy x® 
9.  Flustat ®
10.  Neomichealon® 
11.  No flu® 
12. Panadol cold and flu® 
13. Rhinomol s ®

2. Same combination + Caffeine 

1. Flurest

®

 

2.  Coldact

®

 

3.  Coldex 2 

®

4. Flustop

®

 

5. Nova c n

®

6. Power cold and flu

®

 

3. Combination with Ibuprofen 

1. Sinlerg 
   ®  
2. Cetaphed® 
3. Brufen flu 
   ® 
4. Brufen cold 
   ®
5. Advil cold and sinus® 
6. Dolo d
   ®
7. Farex 
   ®
8. Powercaps 
   ®
9. Rhinofen® 

4. Combinations containing Vit. C :-

1. Euopack plus® 
2. Flu C®
3. Grippostad C® 
4. GC  mol® 
5. Ezmol c ®
6. Panadol cold and flu ®
7. Cidal c® 

5. Combinations containing ASPRIN :-

1. Vegaskine d®
2. Cidal c ®

6. Combinations containing Dextromethorphan :- 

1. Cold stop® 
2. Congestal syrup® 
3. Vegaskine d®
4. Triaminic cold and cough ®
5. Day nurse ®
6. Vicks day quil®
7. Tylenol cold ® 

7. Combinations containing non- sedating antihistamines :-

1. Decongess 1 ®
2. Decodine plus® 
3. Clarinase® 
4. Allercet® ( minimum sedation or negligable )
5. Loratin d ®
6. Trimed flu 
7. Xinase® ( minimum sedation ) 

8. Other combinations :-

1. Cometrex ®
2. Balkis ®
3. Otrivin ®
4. Cafamol ®
5. Conta flu ®
6. Night and day® 
7. Sine up® 

9. Herbal products :-

1. Immuno flu® 
2. Vapozol ®
3. Propolis Lemon ®
4. Sekem cold and flu®

6. DEALING WITH SPECIAL CASES:-

1. Infants and children :-

• Use low doses 
• Use syrup dosage forms 
• For nose ...... use Otrivin® children   or baby saline according to age 
• Avoid products containing ASPIRIN  ( Ray's syndrome )

2. Cardiovascular :-

• Avoid decongestant ( especially systemic )
• Use topical decongestant in low doses 
• Use combination of analgesic + antihistamines + topical decongestant 

3. Diabetes :-

• Avoid products containing systemic decongestant 
• Avoid syrups containing sugars 

4. Pregnancy :-

• Avoid combinations 
• most of systemic decongestant is contraindicated 
• Use 

1. Topical decongestant as Oxymetazoline ( Affrin® )
2. Use Herbal products as Vapozol®       and    Flonaz® 
3. Use analgesics  as Paracetamol ( paramol®, panadol®, adol® )
4. Use Antibiotics ( if needed) as Amoxicillin ( Amoxil®)
5. Use analgesics + Vit. C  combinations  as ( Cevamol® )
6. Use packets as ( Sekem Flu®)

5. Lactating Mothers :-

• Avoid decongestant as decrease milk production 
• Use nasal phenylephrine 
• Must avoid topical oxymetazoline (Affrin®) and naphazoline 
• Use analgesics as Paracetamol and avoid Aspirin 
• Use herbal products as above 
• Must drink large amounts of fluids 

6. Liver disease :-

• Avoid decongestant and antihistamines in severe cases 
• USE topical products  as Otrivin®         Vapozol® 
• Use analgesics as ........... Hepamol® 
• Must decrease doses in systemic drugs 

7. Workers and drivers :-

• avoid products containing sedating antihistamines 

OTHER PRODUCTS :-

1. ANTIVIRAL :-

• AS Amantadine 

2. VACCINES :-

• Used in patients who are at high risk to influenza 
• avoid in case of flu+ fever ( wait until recovery to get vaccinated )
• Used in October 
• EX:-

1. Hiberix® 
2. Agrippal®
3. Fluarix ®
4. Influvac® 
5. Vaxigrip® 

THANKS 

MILAD REDA