MBBS Pharmcaology for BAMS students

1. 1
Anti Anginal- Anti platelet- Haemopoetic
& Anti Asthma drugs for BAMS students
Dr. Remya Krishnan MD PhD(Ay)

2. 2
ANGINA PECTORIS ?
– Inadequate coronary blood flow-
Inadequate oxygen supply to the heart
– Sudden severe pressing substernal pain
radiating to left arm .
– Imbalance between oxygen requirement and
supply to the heart via coronary vessels .
– Atheromatous obstruction of large coronary
vessels .

3. 3
Solution
Decrease oxygen demand by decreasing
cardiac work.
Increasing coronary blood flow (difficult ) .
http://www.drugfree.org/Portal/Drug_Guide/Prescription%20Sedatives%20Tranquilizers (2)

4. 4
Types of Angina
Transient spasm of localised portions of
blood vessels associated with atheromas .
Causes significant ischaemia and pain .
Spasm can be reversed by nitrates or
calcium channel blockers .

5. 5
Anti anginal Drugs
Organic nitrates -Nitroglycerine
Beta blockers- Propanolol
Calcium channel blockers- Diltiazem,
Verapamil
http://www.drugfree.org/Portal/DrugIssue/Features/Prescription_Medicine_Misuse Accessed May 2, 2006.

6. 6
Organic nitrates
Rapidly reduce myocardial oxygen
demand and rapidly relieve symptoms (Eg
– Nitroglycerine).
They are effective in stable as well as
unstable Angina .
In cases of attacks triggered by exercise
or stress, sublingual or spray of GTN
(Nitroglyscerine ) is the choice .

7. 7
Mechanism of action of Nitrates
Administration of nitrates  Conversion to
nitrites Conversion to Nitric oxide 
Activation of Cyclic GMP
Dephosphorylation of Myosin light chain
 Vascular smooth muscle relaxation

8. 8
Nitroglycerine effects 0n CVS
Dilatation of large veins - Pooling of
blood in the veins  Decreases preload (
Venous return to the heart ) and cardiac
work .
Dilatation of coronary vasculature
Increased blood supply to the heart
muscle and decreased myocardial oxygen
consumption due to decreased cardiac
work .
http://images.google.com/imgres?imgurl=http://www.long-island-hypnotherapy.com/images/anxiety Accessed May 2, 2006.

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Adverse effects
Flushing of face
Throbbing head ache owing to pressing of
sensory nerve due to vasodilatation.
Postural hypotension due to decreased
central venous pressure .
Syncopal attack
Methaemoglobinaemia
Nitrate tolerance

10. 10
Nitrate tolerance
Due to long term administration, the nitrate
effect is gradually lowered and finally
complete or partial loss of effects .
Providing nitrate free interval and increase
the sensitivity of drug is the only solution .

11. ANTIPLATELET DRUGS
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12. Arterial and venous thromboses
Arterial and venous thromboses are major
causes of mortality and morbidity rates.
Arterial thromboses causes MI, Ischemic
stroke, limb gangrene etc
Deep vein thrombosis leads to pulmonary
embolism
Plaque rupture exposes thrombogenic
material into blood
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13. Pathogenesis
This triggers platelet aggregation and fibrin
formation causing temporary or permanent
occlusion of blood flow.
Venous thrombi can develop after surgical
trauma to veins
Arterial thrombi are rich in platelets
because of high shear in injured artery
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14. Anti thrombotic drugs
Antiplatelet drugs
Anticoagulants
Fibrinolytic agents
In healthy blood vessels , circulating platelets
are maintained by Nitric oxide, and prostacyclin
released by endothelial cells lining the blood
vessels.
Endothelial cells also express ADPase that
degrades ADP released from activated platelets
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15. Role of COX 1
In platelets , COX-1 transforms
Arachidonic acid previously synthesized
from membrane phospholipids to
Thromboxane A2a potent platelet
aggregating agent
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16. Glycoprotein IIB and IIIA
Glyco protein IIB and IIIA play a major role
in the regulation of platelet adhesion and
aggragation during haemostasis.
Fibrinogen binding GP IIB and IIIA
undergoes further conformational changes
in the platelets resulting in their fast
aggregation
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17. Fibrinogen
Fibrinogen plays a critical role by inducing
platelet activation by GP VI ( Glycoprotein
receptor in platelets ).
Cyclic nucleotide phosphodiesterace
inhibitors attenuate platelet activity by
increasing cAMP and / or cGMP which
results in platelet secretion
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18. Antiplatelet drugs MOA
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19. BRONCHODILATORS, AEROSOLS, INHALANTS AND
EXPECTORANTS
DRUGS ON RESPIRATORY SYSTEM – FOR
BAMS STUDENTS
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20. Bronchodilator Drugs
Parasympathetic nerves mediate the
bronchial constriction and mucous
secretion through the action of M3
receptors
Circulating adrenaline actise on beta 2
adenoreceptors to relax airway smooth
muscles
NANC inhibitory transmitter and NO cause
relaxation of airway smooth muscles
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21. Pathophysiology
Inflammatory cells and viscous mucous
plugs .
Inflammatory mediators are histamine,
serotonin, prostaglandin, platelet activating
factor,neuropeptides etc
Goals of these drugs are to reduce
mortality, reduce exacerbations and
improve the quality of life
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22. Classification of Anti Asthma Drugs
Preventers, controllers and relievers .
Preventors- Inhaled and oral
corticosteroids
Controllers- Long acting beta 2 agonists,
methyl xanthines, leukotriene receptor
antagonists
Relievers- Short acting beta 2 agonists,
anticholinergic agents, theophylline
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23. Aerosol Drug Administration
Aerosol drug administration is the administration
of a drug via air particles delivered by an
appropriate device that is inhaled and absorbed
into the patient's body via the lungs .
Aerosol administration of drugs is indicated in
circumstances where rapid absorption and
localization effects of the drug are required to
produce the appropriate response.
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24. Aerosol Drug Administration
Aerosol drug administration, also known as inhalation therapy, or in
some cases, nebulized drug therapy, is the method by which drugs
are dispersed into the lungs or bronchial airways in the form of tiny
droplets—often bound to water, oxygen, or another gaseous
substance.
Drugs are generally delivered by two means. The first is via a device
called a nebulizer.
The nebulizer is a mechanical pump (of which there are many types)
that produces a fine mist in which the drug is dispersed via an
appropriate nebulizer-compatible face mask. This fine mist is
inhaled deep into the lungs for maximum effect.
The second method of delivery is via a hand-held, nebulized aerosol
device. These devices, also known as "puffers," use the effects of a
pressurized gas to create and disperse the drug into a fine mist or
spray, which is then inhaled.
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25. MOA – Hypothesis
Although their precise mechanism of action is not known,
these topical agents have beneficial antiinflammatory
and decongestive effects on the bronchial tree in both
the allergic and nonallergic forms of this disease.
Four of the newer aerosolized steroids--beclomethasone
dipropionate, triamcinolone acetonide, flunisolide and
budesonide--have been evaluated in clinical trials, the
last drug is still experimental.
Major side effects are candidiasis and dysphonia
To be used prophylactically and not in acute sthma
attacks
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26. Inhalants
The inhalant drugs are volatile substances that
produce chemical vapors that may be inhaled to
cause a particular psychoactive effect. They are
therefore substances whose main use is not
consumption.
Some examples of inhaled drugs are glues,
gasolines, paints or deodorants, among many
others. Each of the substances that make up this
type of psychoactive elements can cause
different effects.
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27. Classification
Solvents (liquids that become gas at room
temperature)
Aerosol sprays
Gases
Nitrites (prescription medicines for chest
pain)
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28. Applied inhalants
Inhalants are various products easily bought and found
in the home or workplace—such as spray paints,
markers, glues, and cleaning fluids.
They contain dangerous substances that have
psychoactive (mind-altering) properties when inhaled.
People don't typically think of these products as drugs
because they're not intended for getting high, but some
people use them for that purpose. When these
substances are used for getting high, they are called
inhalants.
Inhalants are mostly used by young kids and teens and
are the only class of substance used more by younger
than by older teens. 28

29. Products used as inhalants
Solvents of industrial/household products
like gasoline, paint thinners etc
Electronic contact cleaners, glues
Aerosols like spray paints, computer
cleaners and deodrants
Gases like butane lighters , anaesthesia
gases like chloroform
Nitrites like leather cleaner, home odorizer
etc
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30. Inhalants – Impact on brain
Slurred or distorted speech
Lack of coordination (control of body movement)
Euphoria (feeling high)
Dizziness
Long term uses –
Liver and kidney damage
Hearing loss
Bone marrow damage
Loss of coordination and limb spasms (from nerve damage)
Delayed behavioral development (from brain problems)
Brain damage (from cut-off oxygen flow to the brain)
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31. Expectorants – MOA
They liquefy lower respiratory tract
secretions, reducing the viscosity of these
secretions and making it easier to cough
them up.
Expectorants are available in many OTC
preparations, making them widely
available to the patient without advice from
a health care provider.
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32. Side effects
Nausea, head ache, vomiting, anorexia,
dizziness.
Underlying cough: The most important
consideration in the use of these drugs is
discovering the cause of the underlying
cough; prolonged use of the OTC
preparations could result in the masking of
important symptoms of a serious
underlying disorder.
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