1. what are the general cause of rhinitis & rhinorrhea?

Rhinitis is linked to cold & flu, it is inflammation of the nasal cavity. Mucosal rhinitis is linked to sinusitis. Allergic rhinits is linekd to allergen exposure & IgE. Non-allergic is the physiological reaction.

 

2. Which drugs can be used for the treatment of rhinorrhea?

• Mast cell stabilizer -> ketotifen
• Alpha1 agonist -> naphozoline
• Moculytic -> Mesna
• Antihistamine -> Loratadine
• Diversdrugs -> Saline
• Antibiotics -> Neomycin
• Corticosteriods -> beclomethasone

 

3.  How do decongestants differ with respect to the MOA & duration of action ? How are they administered typically?

Vasoconstriction of mucosal blood vessels, which decreases oedema of the nasal mucosa. topical de congestants have fewer side effects than drops, drops can also end up the GIT. the short acting drugs have a 4-6 hour duration, the intermediary acting 8-10 hours & the long- acting have a duration of 12 hours. They are mainly direct acting drugs, mixed action drugs.

4. what is rhinitis medicamentosa ? How is it treated?

May present following chronic treatment with decongestants. Permanent vasoconstriction with poor local blood supply that leads to damage of mucosa membranes of the nose with permanent inflammation & swelling & deregulation of the A-adrenergic receptorson the blood vessels, making them unresponsive to alpha-agonists.

5. How does the first & second gen of antihitamines differ with respectto the mech. according to which rhinits & rhinorrheoa are relived? What are the advantages of the second gen ? Why should they not be used to relieve cold rhinitis?

There is contraversy, however, about the use of antihistamine for the treatment of rhinorrhoea during colds. Bradykinin is the medator of inflmaation here. There is, therefore no rationale for the application of the antihistamine characteristics of the ANTIHISTAMINE. It is however true that the old gen histamines are used for cold rhinorrhoea in view of their antimuscarinic characteristics to dry all watery secretions.

 

6. When are corticosteroids, anti-allergic drugs, mesna & normal salt solutions valid & how are they administered?

Topical mesna is especiall meaningful to use when the nasal secretion is sticky.

Sodium chromoglycate as a nasal spray for prophylactic treatment of allergic rhinitis.

Normal salt is very safe as nose drops

• Give your own definition of COPD:  it is a combination of lung diseases that prevent airflow resulting in difficulty breathing. Most common conditions that make up COPD are: bronchial asthma, emphysema & chronic bronchitis. These conditions limit pulmonary airflow & gas exchange & can therefore lower life quality by causing sleeping disorders, reducing the ability to perform physical activity. Damage to the lungs from COPD can't be revered.
• Briefly describe the proposed aetiology & pathophysiology of chronic bronchitis & emphysema:

Chronic bronchitis : Is a non-specific obstructive airway disease which the exact aetiology is unclear, characterized by reduced mucus secertion & mucosal clealance, but which is associated with long-term exposure to irritants e.g. cigarette smoke, dust & irritating gases. Chronic bronchitis is due to hypersecretion of mucus, causing chronic cough due to sticky phlegm, an overactive parasympathetic nervous system plays an important role in chronic bronchitis.

Emphysema: Comprises a non-reversible dilation of the respiratory bronchiole & alveoli as a result of structural damage to the walls. The air is, therefore, caught in the respiratory space of the lungs & is exhaled with difficulty, disrupting ventilation of the lungs. It is generally continuous exposure to irritant that damage your lungs & airway.Due to this reason the lungs are being deprived of continuous flow of oxygen therefore causing deeper breathing, leading to SOB.

• Which type of therapy are included in the treatment of a COPD patient? :  Stop smoking, hypoxia (oxygen inhalation), poor lung capacity(regular exercise), airway obstruction ( bronchodilation), surgery( lung transplant) & bacterial infection ( antibiotic against influenza).

 

• Why is ipratropium more effective in the treatment of chronic bronchitis than in the treatment of bronchial asthma? : Ipratropium is a muscarinic Ach receptor antagonist which prevents the function of the PNS. The function includes: the production of bronchial secretion as well as constriction. With COPD the bronchodilatory effect is usually better than what is achieved with beta2-sympathomimetics. This can be understood, especially in the light of the role  of the PNS in chronic bronchitis, as discussed above.

 

• In which way do the skeletal muscle effects of theophylline have advantage in the treatment of COPD: Theophylline has the special advantage that it improves diaphragm contractility & reduces diaphragm exhaustion, improves cardiac contractility, lowers pulmonal resistance, improve muscociliary clearance & improves the ventilatory response.

 

•  What is the role of oxygen therapy in COPD? : Increases the amount of oxygen that flows into your lungs & bloodstream & as a result this improves breathing,

The rationale for using fluvoxamine in the treatment of Covid patients.

Fluvoxamine is a selcetive serotonin reuptake inhibitor (SSRI)  & a potent σ-1 (S1R) receptor agonist The lung tissue damage caused by Covid results in an excessive immune response (also inflammatory) by the patient which further exacerbates a patient's condition.(Lenze et al.,2020:2292).

It has a anti-inflammatory effect & is therefore used to help Covid patients.Fluvoxamine binds to sigma-1 receptor in the immune cells of the body, reducing the production of inflammatory cytokines.

Stimulation of the stigma-1 receptor reduces the synthesis of pro-inflammatory cytokines, thereby reducing systemic inflammation.

References:

Lenze E.J,Mattar C.,Zorumski C.F.,Stevens,A.,Schweiger,J.,Nicol.G.E.,...Reiersen,A.M. 2020. Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized Clinical Trail.

https://www.covid10treatmentguidlines.nih.gov/therapies/immunomodulators/fluvoxamine/#:~:text+Anti%2Dlnflammatory%2oEffect%2of%20fluvoxamine,reduced%20production%20of%20inflammatory%20cytokines