respiratory system ppt
DESCRIPTION
Disease related to Rsepiratory SystemTRANSCRIPT
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The respiratory The respiratory systemsystem
Dhruvit KalathiyaVishal MangukiyaSuvik PatelRuchit ParmarSunil Prasad
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The respiratory systemThe respiratory system
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Learning objectivesLearning objectivesWhat we will learn in this presentation:
The structures of the respiratory system and their functions
The mechanisms of breathing
How gases are exchanged during breathing
The composition of inhaled and exhaled air
The different measurements of lung capacity and breathing
The effects of exercise on the respiratory system
What is meant by aerobic and anaerobic respiration
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The nasal passages and The nasal passages and lungslungs
Air is drawn into the body via the nose or mouth. There are advantages to breathing through your nose:
Air then travels through the larynx, trachea (windpipe), bronchi (one bronchus to each lung) and bronchioles to the alveoli, where oxygen passes into the bloodstream.
the air is warmed so that it is closer to body temperature
tiny hairs and mucus in the nose filter the air, preventing larger dust and pollen particles reaching the alveoli
mucus moistens the air, making it easier for the alveoli to absorb.
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PharynxPharynx Common space used by both the respiratory and digestive
systems. Commonly called the throat. Originates posterior to the nasal and oral cavities and extends
inferiorly near the level of the bifurcation of the larynx and esophagus.
Walls are lined by a mucosa and contain skeletal muscles that are primarily used for swallowing.
Partitioned into three adjoining regions: nasopharynx oropharynx
laryngopharynx
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LarynxLarynx
Voice box is a short, somewhat cylindrical airway ends in the trachea.
Prevents swallowed materials from entering the lower respiratory tract.
Conducts air into the lower respiratory tract. Produces sounds. Muscular walls aid in voice production and the swallowing
reflex Glottis – the superior opening of the larynx Epiglottis – prevents food and drink from entering airway
when swallowing pseudostratified ciliated columnar epithelium
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When you breathe in:
intercostal muscles between the ribs contract, pulling the chest walls up and out
the diaphragm muscle below the lungs contracts and flattens, increasing the size of the chest
the lungs increase in size, so the pressure inside them falls. This causes air to rush in through the nose or mouth.
Mechanisms of breathing – Mechanisms of breathing – inspirationinspiration
Diaphragm contracts
and moves down
Intercostal muscles pull
ribs up and out
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Mechanisms of breathing – Mechanisms of breathing – inspirationinspiration
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Mechanisms of breathing – Mechanisms of breathing – expirationexpiration When you breathe out:
Intercostal muscles between the ribs relax so that the chest walls move in and down.
The diaphragm muscle below the lungs relaxes and bulges up, reducing the size of the chest.
The lungs decrease in size, so the pressure inside increases and air is pushed up the trachea and out through the nose or mouth.
Diaphragm relaxes and bulges up
Ribs move in and down
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Mechanisms of breathing – Mechanisms of breathing – expirationexpiration
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Gas exchange at the Gas exchange at the alveolialveoli
The alveoli are bunches of tiny air sacks inside the lungs.
Each individual sack is called an alveolus.
When you breathe in, they fill with air.
The alveoli are covered in tiny capillaries (blood vessels).
Gases can pass through the thin walls of each alveolus and capillary, and into the blood stream.
Gases can also pass from the blood stream, into the alveolus.
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Gas exchange at the Gas exchange at the alveolialveoli
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Composition of inhaled and Composition of inhaled and exhaled airexhaled air
GasAmount in inhaled air
Amount in exhaled air
Oxygen 17%
Carbon dioxide 3%
Nitrogen 79%
Water vapour Small amount Large amount
17%
21%
Very small amount
79%
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Measuring breathingMeasuring breathingTidal volume is the amount you breathe in and
out in one normal breath.
Residual volume is the amount of air left in your lungs after you have breathed out as hard as you can.
Minute volume is the volume of air you breathe in one minute.
Respiratory rate is how many breaths you take per minute.
Vital capacity is the maximum volume of air you can breathe out after breathing in as much as you can.
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Breathing during exerciseBreathing during exercise
During exercise the muscle cells use up more oxygen and produce increased amounts of carbon dioxide.
Your lungs and heart have to work harder to supply the extra oxygen and remove the carbon dioxide.
Your breathing rate increases and you breathe more deeply.
Heart rate also increases in order to transport the oxygenated blood to the muscles.
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Breathing during exerciseBreathing during exerciseMuscle cell respiration increases – more oxygen is used up and levels of CO2 rise.
The brain detects increasing levels of CO2 – a signal is sent to the lungs to increase breathing.Breathing rate and the volume of air in
each breath increase. This means that more gaseous exchange takes place.
The brain also tells the heart to beat faster so that more blood is
pumped to the lungs for gaseous exchange.
More oxygenated blood gets to the muscles and more CO2 is removed.
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Breathing changes Breathing changes during exerciseduring exercise
During rest During exercise
Respiratory rate 14 breaths/ minute 32 breaths/ minute
Volume per breath
0.4 litres 2.4 litres
Look at these statistics for a 16 year-old athlete:
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RespirationRespiration
Glucose from food is used to fuel exercise.
Respiration is the process that takes place in living cells which releases energy from food molecules.
Waste products, including carbon dioxide, are produced as a result of the chemical reactions. These must be removed and excreted.
glucoseoxygen
energy
respirationOxygen is required to ‘break down’ the glucose to produce energy. This energy is used to make muscles contract.
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Aerobic respirationAerobic respiration
Aerobic exercise can be maintained for long periods without the performer getting breathless or suffering muscle cramps. Moderate activities like walking, jogging, cycling and swimming use aerobic respiration.
There are two different types of respiration.
When you exercise at a steady, comfortable rate, the cardiovascular system is able to supply the muscles with all the oxygen they need.
Under these conditions, aerobic respiration takes place.
glucose + oxygen energycarbon dioxide+ + water
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Anaerobic respirationAnaerobic respiration
When you exercise at a high intensity, the cardiovascular system cannot supply enough oxygen to the muscles.
Under these conditions, anaerobic respiration takes place.
With no oxygen available, glucose is burned to produce energy and lactic acid.
Lactic acid is a mild poison. As it builds up, it causes muscle pain and eventually cramp.
Short, intense activities like sprinting, weightlifting, jumping and throwing use anaerobic respiration.
glucose energy + lactic acid
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21
you might want to think twice about you might want to think twice about smoking….smoking….
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Respiratory Respiratory diseasesdiseases
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ObjectivesObjectives
1. Antihistamines2. Decongestants3. Antitussives4. Expectorants5. Bronchodilators
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DecongestantsDecongestants
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Nasal CongestionNasal Congestion
Excessive nasal secretions
Inflamed and swollen nasal
mucosa
Primary causes
◦Allergies
◦Upper respiratory infections
(common cold)
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Decongestants: Types Decongestants: Types (cont’d)(cont’d)
Two dosage forms
Oral
Inhaled/topically applied to the nasal
membranes
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Oral DecongestantsOral DecongestantsProlonged decongestant effects,
but delayed onsetEffect less potent than topical No rebound congestionExclusively adrenergicsExample: pseudoephedrine,
Sinutab, Dristan, Tylenol cold, Sudafed
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Topical Nasal Topical Nasal DecongestantsDecongestantsTopical adrenergics
◦ Prompt onset◦ Potent◦ Sustained use over several days causes
rebound congestion, making the condition worse
◦ Eg:
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Topical Nasal Topical Nasal Decongestants (cont’d)Decongestants (cont’d)Adrenergics
◦desoxyephedrine◦phenylephrine
Intranasal steroids◦beclomethasone dipropionate ◦flunisolide ◦fluticasone
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Nasal Decongestants:Nasal Decongestants:Mechanism of ActionMechanism of ActionSite of action: blood vessels surrounding nasal sinuses Adrenergics
◦ Constrict small blood vessels that supply URI structures
◦ As a result these tissues shrink, and nasal secretions in the swollen mucous membranes are better able to drain
◦ Nasal stuffiness is relieved
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Nasal Decongestants:Nasal Decongestants:Mechanism of Action (cont’d)Mechanism of Action (cont’d)Site of action: blood vessels surrounding nasal sinuses Nasal steroids
◦ Anti-inflammatory effect◦ Work to turn off the immune system cells
involved in the inflammatory response◦ Decreased inflammation results in
decreased congestion◦ Nasal stuffiness is relieved
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Nasal Decongestants: Nasal Decongestants: IndicationsIndicationsRelief of nasal congestion associated with: Acute or chronic rhinitis Common cold Sinusitis Hay fever Other allergies
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Nasal Decongestants: Nasal Decongestants: Indications (cont’d)Indications (cont’d)
May also be used to reduce swelling
of the nasal passage and facilitate
visualization of the nasal/pharyngeal
membranes before surgery or
diagnostic procedures
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Nasal Decongestants: Nasal Decongestants: Side EffectsSide Effects
Adrenergics SteroidsNervousness Local mucosal drynessInsomnia and irritationPalpitationsTremors(systemic effects due to adrenergic stimulation of theheart, blood vessels, and CNS)
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AntitussivesAntitussives
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Antitussives: DefinitionAntitussives: Definition
Drugs used to stop or reduce
coughing
Opioid and nonopioid
(narcotic and nonnarcotic)
Used only for nonproductive
coughs!
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Antitussives: Antitussives: Mechanism of ActionMechanism of ActionOpioidsSuppress the cough reflex by direct
action on the cough centre in the medullaExamples:◦ codeine ◦ hydrocodone
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Antitussives: Antitussives: Mechanism of Action (cont’d)Mechanism of Action (cont’d)NonopioidsSuppress the cough reflex by
numbing the stretch receptors in the respiratory tract and preventing the cough reflex from being stimulatedExamples:◦Dextromethorphan, Nyquil,
Robitussin
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Antitussives: IndicationsAntitussives: Indications
Used to stop the cough reflex when the cough is nonproductive and/or harmful
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Antitussives: Side EffectsAntitussives: Side Effects
DextromethorphanDizziness, drowsiness, nausea
OpioidsSedation, nausea, vomiting,
lightheadedness, constipation
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ExpectorantsExpectorants
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Expectorants: DefinitionExpectorants: Definition
Drugs that aid in the
expectoration
(removal) of mucus
Reduce the viscosity of
secretions
Disintegrate and thin secretions
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Expectorants: Expectorants: Mechanisms of ActionMechanisms of ActionDirect stimulationReflex stimulation
Final result: thinner mucus that is easier to remove
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Expectorants: Expectorants: Mechanism of Action (cont’d)Mechanism of Action (cont’d)Reflex stimulationAgent causes irritation of the GI tractLoosening and thinning of respiratory tract
secretions occur in response to this irritation◦ Example: guaifenesin
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Expectorants: Expectorants: Mechanism of Action (cont’d)Mechanism of Action (cont’d)Direct stimulationThe secretory glands are stimulated directly
to increase their production of respiratory tract fluids◦ Examples: iodine-containing products such
as iodinated glycerol and potassium iodide
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Expectorants: IndicationsExpectorants: Indications
Used for the relief of nonproductive coughs associated with:
Common coldBronchitisLaryngitisPharyngitisCoughs caused by chronic paranasal sinusitis
PertussisInfluenzaMeasles
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Bronchial AsthmaBronchial AsthmaRecurrent and reversible shortness of breath
that occurs when the bronchi and bronchioles become narrow as a result of bronchospasm, inflammation, and edema of the bronchial mucosa, and the production of viscid (sticky) mucous.
Symptoms• wheezing, • shortness of breath, • chest tightness, • coughing.Asthma is caused by inflammation in the
airways. When an asthma attack occurs, the muscles surrounding the airways become tight and the lining of the air passages swells. This reduces the amount of air that can pass by.
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AsthmaAsthmaMay be triggered by virusesIrritantsAllergensCan develop at any ageSeen more often in children who
are exposed to airway irritants during infancy
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AsthmaAsthmaBronchoconstrictionInflammationMucosal edemaExcessive mucous
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ClassificationClassification1.BronchodilatorsA . β2 Sympathomimetics : Salbutamol,Terbutaline,Bambuterol,Salmetrol,Formoterol,Ephedrine.
B . Methylxanthines : Theophylline, Aminophylline, Choline theophyllinate, Hydroxyethyl theophylline, Theophylline ethanolate of piperazine,Doxophylline
C . Anticholinergics :
Ipratropium bromide, Tiotropium bromide.
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ClassificationClassification2.Leukotriene antagonists : Montelukast, Zafirlukast.3.Mast cell stabilizersSodium cromoglycate, Ketotifen4.Corticosteroidsa.Systemic : Hydrocortisone,Prednisolone and
others.b.Inhalational : Beclomethasone dipropionate,
Budesonide, Fluticasone propionate, Flunisolide, Ciclesonide.
5.anti-IgE antibodyOmalizumab
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Salbutamol(Salbutamol(ββ2 2 sympathomimetics)sympathomimetics)Machanism of action :A highly selective β2 agonistCause bronchodilation through β2 receptor
stimulationIncreased cAMP formation in bronchial
muscle cellRalaxationIn addition,increased cAMP in the mast cells
and other inflammatory cells decreases mediator release
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SulbutamolSulbutamolSelectivity is further incresed by inhaling the
drugInhaled salbutamol produces bronchodilation
within 5 min and action lasts for 2-4 hours…therefor it is used to abort and terminate attacks of asthma,but not suitable for the round the clock prophylaxis.
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Side effectSide effect
Muscle tremorsPalpitationRestlessnessNervousnessThroat irritationAnkle edema
Dose2-4 mg oral,0.25-0.5 mg i.m./s.c., 100-200 µg by inhalation
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Theophylline(methylxanthTheophylline(methylxanthines)ines)Mechanism of action :Increase levels of energy-producing cAMP*This is done competitively inhibiting
phosphodiesterase (PDE), the enzyme that breaks down cAMP
Result: smooth muscle relaxation, bronchodilation, and increased airflow
*cAMP = cyclic adenosine monophosphate
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Side effectSide effect
Nausea, vomiting, anorexiaGastroesophageal reflux during sleepSinus tachycardia, extrasystole,
palpitations, ventricular dysrhythmiasTransient increased urination
Dose
100-300 mg TDS (15 mg/kg/day)
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Anticholinergics: Anticholinergics: Mechanism of ActionMechanism of ActionAcetylcholine (ACh) causes bronchial
constriction and narrowing of the airways.Anticholinergics bind to the ACh
receptors, preventing ACh from binding.Result: bronchoconstriction is prevented,
airways dilate.
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Side EffectsSide Effects
Dry mouth or throat
Gastrointestinal distress
Headache
Coughing
Anxiety
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AntileukotrienesAntileukotrienes
Currently available agents:montelukast (Singulair)zafirlukast (Accolate)zileuton (Zyflo)
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Antileukotrienes: Antileukotrienes: Mechanism of ActionMechanism of ActionLeukotrienes are substances released
when a trigger, such as cat hair or dust, starts a series of chemical reactions in the body.
Leukotrienes cause inflammation, bronchoconstriction, and mucus production.
Result: coughing, wheezing, shortnessof breath
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Antileukotriene agents Antileukotriene agents preventprevent leukotrienes leukotrienes from attaching to receptors on cells in the lungs from attaching to receptors on cells in the lungs and in circulation.and in circulation.
Inflammation in the lungs is Inflammation in the lungs is blockedblocked, and asthma , and asthma symptoms are relieved.symptoms are relieved.
Side Effects
HeadacheDyspepsiaNausea DiarrheaDizzinessInsomniaLiver dysfunction
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Corticosteroids: Corticosteroids: Mechanism of ActionMechanism of ActionStabilize membranes of cells that
release harmful bronchoconstricting substances.
These cells are leukocytes, or white blood cells.
Also increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation.
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Inhaled CorticosteroidsInhaled Corticosteroidsbeclomethasone dipropionate
(Beclovent, Vanceril)triamcinolone acetonide
(Azmacort)dexamethasone sodium
phosphate (Decadron Phosphate Respihaler)
flunisolide (AeroBid)
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Side EffectsSide EffectsPharyngeal irritationCoughingDry mouthOral fungal infections
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MucolyticsMucolytics
Agents which breakdown the mucus.
Examples:- Ambroxol, Bromhexine
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Ambroxol Bromhexine
Amcold (Brand Name)Cipla Ltd (Company
Name)
Ascoril (Brand Name)Glenmark Ltd
(Company Name)
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ExpectorantExpectorantDrugs Which helps in expelling out mucus.
Examples:- Guaifenesin, Potassium Iodide
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Guainfenesin Potassium Iodide
Barkeit (Brand Name)Unisankyo Ltd
(Company Name)
Betadine (Brand Name)
Win Medicare Ltd (Company Name)
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Cough Cough SuppressantSuppressant
Drugs used to suppress the cough specially used in dry cough.Examples:- Codeine phosphate, Dextromethorphan
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Codeine Dextromethorphan
Corex (Brand Name)Pfizer Ltd (Company
Name)
Alex Lozenge (Brand Name)
Glenmark Ltd (Company Name)
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Guided By:Mr. Prashant Pandey
Reference:Medical Pharmacology by K.D.TripathiEdition 6th.
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