drugs effective on the respiratory system
TRANSCRIPT
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DRUGS EFFECTIVE ON THE RESPIRATORY SYSTEM
Prof. Dr. Esin AKI-YALÇIN
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1. Antitussive (cough breaker) Drugs2. Expectorants3. Mucolytics4. Bronchodilators5. Drugs used for the treatment of asthma6. Bulbar Respiratory Center Stimulators
Prof. Dr. Esin AKI
CLASIFICATION OF RESPIRATORY SYSTEM DRUGS
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A protective physiological reflex.
A weak syndrome
It can also be observed in health status as in the case
of disease.
Cough reflexes are stimulated in some disease states
or mechanical irritation of the respiratory tract (larynx,
trachea, bronchial mucosa,..) or outside the
respiratory tract (pleura, external ear canal, middle ear
epithelium ..).
Cough
Prof. Dr. Esin AKI
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Cough is accompanied by 2 reflexes.
1. Bronchoconstriction
2. Mucus secretion
Symptomatic (Palliative) Treatment
Antitussives; they reduce the intensity and
frequency by suppressing the cough reflex.
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It is initiated by chemoreceptors
or mechanoreceptors in the
lungs.
Stimulus is transmitted to the
COUGH CENTER where the
afferent nerve fibers in the vagus
nerve are located in the brain
stem in the Medulla.
Prof. Dr. Esin AKI
COUGH STIMULATION
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ANTITUSSIVE DRUGS
Prof. Dr. Esin AKI
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• Central effect: Inhibition of cough center
• Peripheral effect: Depression of nerve endings in the
lung and other peripheral areas
• Spasmolytic effect: Reducing the sensitivity of cough
receptors in the lungs due to spasmolytic effect
Mechanisms of Action of Antitussives
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ANTITUSSIVE DRUGS
1. Opioid derivatives
2. Synthetic Antitussives
I. Methadone Type Antitussives
II. Antitussives with Basic Ester Group
III. Local Anesthetic Effective Antitussives
IV. Other Antitussives Not Classified by
Chemical Structures
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OPIOID DERIVATIVES
Affected Receptors:
1. Opioit receptors
2. Cough inhibitory receptors
Morphine and similar drugs
Inhibitory effect on cough center
Although these compounds are effective, their
use is limited due to their intolerance and
dependence and toxic effects.
Prof. Dr. Esin AKI
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O
N
HO
HO
CH3
O
N
HO
CH3
H3CO
O
N CH3
H3CO
H3CO
Morphine Codeine Thebaine(Narcotic analgesic) (Prototype antitussive) (very toxic)
3,6-dihydroxy-7,8-
didehydro-4,5-epoxy-17-
methylmorphinan
7,8-didehydro-4,5-epoxy-3-
methoxy-17-methylmorphinan
-6-ol
(Synthesis of starting
compound)
OPIOID DERIVATIVES
Prof. Dr. Esin AKI
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R1 R2 Position of
ethylenic
bond
Other Name Salt
CH3O - - OH 7 Codeine HCI, phosphate
C2H5O - - OH 7 Ethylmorphine (Dionine) HCI
- OH 7 Pholcodine
__
CH3O - - OH Saturated Dihydrocodeine (Paracodin) Hydrogen Tartrate
CH3O - O Saturated Hydrocodone (Dicodid) Hydrogen Tartrate
CH3O - O Saturated 14-OH Oxycodone (Eucodal) HCI
CH3O - -OCOCH3 6 Tebacon (Acedicon) HCI
O N CH2CH2O
O
N CH3
R1
R2
12
3
4
5
67
8
9
101112
1314
15 16
Opium Alkaloids and Derivatives:
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CODEINE It is still used today.
Phenolic OH —> Ether : analgesic effect decreases,
antitussive effect increases, side effect decreases
• The compound inhibits gastrointestinal
motility and fluid secretion of the intestinal
mucosa.
•Side Effects: Sedation, Drowsiness,
Constipation (antidiarrheal)
Rarely; Euphoric and addiction
Levo and dextro isomer effective
levo = 6 x dekstro
Used as base or sulfate salt
Polystyrene salt is long effective.
Prof. Dr. Esin AKI
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OH
O
NCH3
O
CH3
N-demetilasyonO-demetilasyon
OH
O
NCH3
OH
O
O
NCH3
OH
Glu
OH
O
NH
O
CH3
Morfin (%5-15)
Glukuronat konjugatlari
6-Glukorinat
Idrarla atilim
Norkodein (10-20)
glukuronat
konjugatlari
Kodein
Codeine Metabolism
O-demethylation
Glucuronate conjugates
Morphine (%5-15)
Codein
N-demethylation
Glucuronate
conjugates
6-Glucuronate
Norcodein (%10-20)
excretion
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Dihydrocodeine
O
N CH3
CH3O
HO
12
3
4
5
67
8
9
101112
1314
15 16
Its antitussive effect is more than codeine.
It is addictive like morphine.
Therefore it is used only in severe cases.
Prof. Dr. Esin AKI
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Dihydrocodeinone
O
N CH3
CH3O
O
12
3
4
5
67
8
9
101112
1314
15 16
Potent
analgesic
Antitussive
Addictive effect
is more than
codeine
Prof. Dr. Esin AKI
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Effect and Usage of General Opioid Derivatives:Reduction of mucosal secretion in the respiratory tract
—> sense of dryness
They expose histamine —> It should not be used in
bronchial asthma.
Pholcodine —> less addictive than codeine, equally effective
Dionine —> less addictive than codeine, equally effective
Paracodin —> more addictive than codeine
Dicodid —> more addictive than codeine, stronger effect
Oxycodone —> more addictive than codeine, stronger effect
7-8 Saturated bond is more addictive
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O
N
HO
HO
CH3
MORFIN
ClCH2CH2N O
O
N
O
HO
CH3
O N CH2CH2 O
PHOLCODIN
Etilasyon M etilasyon
+ CH3Cl
O
N
O
HO
CH3
H5C2
DIONIN (Etilmorfin)
O
N
O
HO
CH3
H3C
KODEIN
Red.
O
N
OH3C
HO
CH3
PARACODIN (Dihidrokodein)
Oks.Red.
O
N
O
CH3
H3C
OH H
DICODID
Dihidrokodeinon(HYDROCODON)
Asetilasyon
O
N
O
O
CH3
H3C
CH3CO
Tebakon (ACEDICON)
2H
Demetilasyon2)
1)O
N
O
O
CH3
H3C
H3C
TEBAIN
Red.
(HBr)
H2O2 / HBr
(Hidroliz)
O
N
O
CH3
H3C
OH
O
Hidroksikodeinon
+ O
N
H3C
OH
O
O
CH3
OKSIKODON
2H
Demetilasyon2)
1)O
N
O
O
CH3
H3C
H3C
TEBAIN
Red.
(HBr)
H2O2 / HBr
(Hidroliz)
O
N
O
CH3
H3C
OH
O
Hidroksikodeinon
+ O
N
H3C
OH
O
O
CH3
OKSIKODON
Syn
the
sis
methylation
Codein
Morphine (%5-15)
ethylation
PARACODINE
THEBAIN
demethylation
acetylation
Hydroxycodeinone Oxycodone TEBACON
PHOLCODİNE
DIONINE
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Dekstrometorphan
N CH3N CH3
** *
CH3O
It is a synthetic morphinan derivative.
The methane derivative of the d-enantiomer of levorphanol, a narcotic
analgesic drug, has low affinity for conventional opioid receptors.
Does not have any analgesic effect..
Although it effects by inhibiting the cough center in the brain there are no
constipation, central depression, and addictive effects. It does not dry mucosa.
It should not be used using bronchial asthma.
Caution should be exercised in liver patients since demethylation is inactivated
in the liver.
3-methoxy-N-methylmorphinan
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SYNTHETIC ANTITUSSIVES
They don’t have side effects of
opioids, such as addiction,
constipation, drowsiness and
sedation .
They inhibit the cough reflex with a
peripheral effect.
Prof. Dr. Esin AKI
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Methadone (analgesic) Normethadone (antitussive)
I. METHADONE LIKE ANTITUSSIVES
Spasmolytic, bronchodilator,
selective effect on the respiratory system
Prof. Dr. Esin AKI
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ChlophedianolDETIGON
1-o-chlorophenyl-1-phenyl-3-dimethylamino propanol
Selective effects to the respiratory system. It blocks the cough
center with partially central and peripheral, spasmolytic and local
anesthetic effects.
It has local anesthetic, spasmolytic and antihistaminic properties.
May perform anticholinergic effects and hallucinations in high
doses.
Does not cause respiratory depression and drowsiness.
Side Effect: Nausea, vomiting
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Synthesis of Chlophedianol
Klofedianol
Red
+C
Cl
O ClMgCH2CH2N
CH3
CH3
C
Cl
CH2CH2N
O-Mg+Cl
CH3CN/NaNH2
C
Cl
CH2CN
OH
C
Cl
CH2CH2
OH
NH2
CH3
CH3
CH2O/HCOOH
HOH
Prof. Dr. Esin AKI
Chlophedianol
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SILOMAT
1-(p-chlorophenyl)-2,3-dimethyl-4-dimethylamino-2-butanol
Spasmolytics
Local anesthetic
Inhibits the cough center
Does not cause respiratory depression and drowsiness.
Prof. Dr. Esin AKI
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Silomat Synthesis
Prof. Dr. Esin AKI
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,Sitrik Ac. ISOAMINIL=PEROCAN
C
H
C N
CCH3
CH3
CH2 CH
CH3
N
CH3
CH3
-isopropyl--(2-dimethylaminopropyl) phenylacetonitril
Supress the center of cough with its bronchodilator
effect.
There is no suppressive effect on analgesic, sedative
or respiratory center.
Prof. Dr. Esin AKI
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Synthesis of Isoaminyl
+
CH2CN
ClCH
CH3
CH3
NaNH2C
CNCH
CH3
H3C
H
ClCH2CHNCH3
CH3CH3
(NaNH2)
C
CH
CH3
H3C
CN
CH2CHN
CH3
CH3CH3
Prof. Dr. Esin AKI
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Levopropoxyphene- NOVRAD
.
The (-) isomer of the compound exhibits much more antitussive activity
than both the (+) isomer and the racemic mixture. The analgesic effect is
dominant in the (+) isomer of the dextropropoxyphen compound.
It acts by inhibiting the cough center.
It is used in the upper respiratory tract infections (cold, flu).
Used in cases of laryngitis due to smoking.
There is also a spasmolytic effect.
(-)4-dimethylamino-1,2-diphenyl-3-methyl-2-butilpropiyonat
Prof. Dr. Esin AKI
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Synthesis of Levopropoxifene
Napsilate :
.
3-dimethylamino-isobutirophenon
2-Naphtalene sulfonic acid
D-camphorsulfonic acid
hydrolysis
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II. BASIC ANTITUSSIVES Carrying
ESTER GROUP
Prof. Dr. Esin AKI
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1-phenyl-cyclopentanecarboxylic acid 2-(2-
diethylaminoethoxy)ethyl ester
Sitrik Ac.C
COOCH2CH2 CH2CH2NC2H5C2H5
,O
Carbetapentane Citrate- Pentoxiverine
SEDOTUSSIN--GAYABEN
A little more effective than codeine.
Suppresses cough caused by upper respiratory tract infection.
Spasmolitic.
Local anesthetic.
Parasympatholytic side effects are seen.
It can depress the heart if used in high doses.
Prof. Dr. Esin AKI
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1-phenyl cyclopentanecarboxylic acid (2-diethylamino)ethyl ester
Etan disülfonat
C
COOCH2CH2 N
C2H5
C2H5,
Caramiphen-ALCOPON
Bronchodilator.
It affects the cough center.
Less powerful than codeine.
Prof. Dr. Esin AKI
Ethane sulphonic acid
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,- Diethylphenylacetic acid-2-(2-diethylaminoethoxy)ethyl ester
, Sitrik Asit
CCOO
Et Et
CH2CH2 O CH2CH2 NEt
Et
Okseladin-PECTAMOL
Less powerful than codeine, less side effect.
Prof. Dr. Esin AKI
Citric Acid
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General Reaction Scheme
+R COCl HO CH2 CH2 N R COOCH2CH2N
Et
Et
Et
Et
2-Dietilamino etoksi etil klorür
+
DietilaminoetanolHO CH2CH2 N
C2H5
C2H5
N CH2CH2OH
Et
Et
ClCH2CH2OH N CH2CH2O
Et
Et
CH2CH2Cl
Amino Alcohol Division
Prof. Dr. Esin AKI
Diethylamino ethanol
2-Diethylamino ethoxy ethyl chloride
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+
1-siyano-1-fenilsiklopentan
1-fenil-1-siklopentan
karboksilik Asit
Caramiphan
Carbetapentanverecek asit klorürü.
2-etil-2-fenil-butironitril2-etil-2-fenil butirik asit
(okseladin verecek asit)
Benzil siyanür
CH2 C NBr (CH2)4 Br
NaNH2
-HBr
CC N
HOH/H+
CCOOHSOCl2
C
COCl
}
2C2H5Br/NaNH2
-HBr C
C
C2H5H5C2
HOH/OH-
C
COOH
C2H5H5C2
N
Synthesis
Benzyl cyanide 1- cyano-1-phenylopentane
e
2-ethyl-2-phenyl-butyronitrile2-ethyl-2-phenyl-butyronitrile2-ethyl-2-phenyl butyric acid
1- phenyl-1-cylopentane
carboxylic acid
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Example Synthesis: Oxeladine citrate
Oxeladine citrate Oxeladine
Prof. Dr. Esin AKI
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-Diethylaminoethoxy ethylphenothiazine-10-
carboxylate
, HClCOO CH2CH2 O CH2CH2
S
N
NEt
Et
Dimetoxanate - TUSSIDIN
Prof. Dr. Esin AKI
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1-Azaphenothiazine-10-carboxylic acid2-(2-piperidino ethoxy) ethyl ester
S
N N
COO CH2CH2 O CH2CH2N
Pipazetat - SELVIGON
Less potent than codeine, less side effects.
Prof. Dr. Esin AKI
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Synthesis of Pipazethate
Pipazetat
2(2-piperidino etoksi)etanol
+
1-Azafenotiyazin
S
N N
CH2CH2 O CH2CH2N
H
COCI2S
N N
COCI
HO
S
N N
COO CH2CH2 O CH2CH2N
1-Azaphenotiazin
Pipazethate
2-(2-piperidino ethoxy)ethanol
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2-2-(diethylamino) ethoxyethyl-2-phenyl butyrate
, SitratCH
C2H5
COOCH2CH2OCH2CH2NC2H5
C2H5
Butamyrate Citrate = SINECOD
Used in cases of bronchitis.
Prof. Dr. Esin AKI
Citrate
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3. LOCAL ANESTHETIC EFFECTIVE
ANTITUSSIVES
Prof. Dr. Esin AKI
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HNBun COO (CH2CH2O)9
CH3
Benzonatate - TESSALON
A viscous liquid.
Both central and peripheral effective.
It provides local anesthesia in the lungs, afferent nerve
endings and receptors when systemically taken.
It blocks the receptors responsible for the cough reflex.
Side effects: Nasal obstruction, urticaria, constipation,
drowsiness.
4-butylamino-benzoic acid-(o-methyl)- nona ethylene glycol
ester
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5-(2-diethylaminoethyl)-3-phenyl-1,2,4-oxadiazole
N
N
O CH2CH2NC2H5
C2H5
Oxolamine Phosphate - PEREBRON - FENKO
Bronchodilator.
Local anesthetic.
Spasmolitic.
Antipyretic, anti-inflammatory.
It is used in inflammatory diseases of the respiratory
tract.
Prof. Dr. Esin AKI
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Synthesis of Oxolamine
(3-kloro-propiyonil klorür)
CONH2+ NH2OH
C NH2N OH
(Benzamidoksim)
CI CH2CH2COCI
CNH2
N O CO CH2CH2CI
HNEt
Et
ISIOksolamin
N
N
O CH2CH2NC2H5
C2H5
Prof. Dr. Esin AKI
Benzamidoxime
Oxolamine
3-chloro-propionyl chloride
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4- OTHER ANTITUSSIVES
Prof. Dr. Esin AKI
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Isoquinoline derivative alkaloid in opium.
Does not create dependency.
It is used in cough caused by bronchial asthma and pulmonary
emphysema.
Slight bronchodilator effect
It has no analgesic effect.
It is the candidate to be an effective compound as anticancer.
Noscapine (1-Narkotin)
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Dibunate BEBEKO - ,BEKANTIL
3,7-Bis(1,1-dimetil etil)-1-naf talen sülfonic ac.Na tuzu
3,6-Di-Ter-butil-1-naftalen sülfonik ac.etil esteri
Dibunat Na
Etildibunat+
SO3Na
C(CH3)3(CH3)3C
SO3Na
C(CH3)3
C(CH3)3(CH3)3C
(CH3)3C
SO3C2H5
This mixture is found in Turkey.
Sedative effect
Prof. Dr. Esin AKI
e
3,6-Di-ter-buthyl-1-napthalen sulphonic acid ethyl ester
Ethyldibunate
3,7-Bis(1,1-dimethyl ethyl)-1-napthalen sulphonic acid sodium salt
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The classical histamine is the H1-receptor blocker.
It has antitussive effect by inhibiting cough center.
As with classical antihistaminic drugs, side effects: sedation
and anticholinergic.
Diphenhydramine HCl
2-(diphenylmethoxy)-N,N-dimethylethylamine
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(R,S)-2-(2-methoxyphenoxy)-methyl-3-ethoxy-carbonyl-acetyl-
1,3-thiazolidine
It shows effect with peripheral pathway.
There is no bronchodilator feature.
The antitussive activity of both enantiomers is identical.
OCH3
ON
S
C C
OO O CH3
Moguisteine
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1-[3-(4-(diphenylmethyl)-1-piperazinyl) propyl]-1,3-
dihydro-2H-benzimidazole-2-one
Oxatomide
ATOXAN,FLAVORASE
TINSET,TANZOL
It's antiallergic.
It can be used in patients with asthma.
N
N
O
H
CH2CH2CH2 N N CH
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3-(4-phenyl piperazinyl)-propane-1,2-diol
Dropropizine
The –OCH3 coming into the 4nd position of the phenyl ring decreases the
effect.
-Cl, F increases effect
The –OCH3 at the 2nd position of the phenyl ring increases the side effect.
There is not effect difference between the R and S isomers of the
substituted and nonsubstituted derivatives.
N N CH2 CH CH2
OH OH
LevodropropizineN N OHHHO Dropropizin's S derivative
Prof. Dr. Esin AKI