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    Drugs used in asthma note

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    Drugs used in asthma note

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    28 views17 pages

    Drugs Used in Asthma

    Uploaded by

    Yoon Yoon
    Drugs used in asthma note

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 17
    Athenee + common chronic Ys ACID + prevalence {3 increasing esp omong chikbren reversible olrway cbstraction Frsenothvily symp Bya — paeymp Se + dy, Inherited or acquired imbolarce of edrenergic 2 cholinergic control of alrway 1 resporsveness to chelinangiessesntale Conassarini- constriction) L responsiveness to adrenerge control ¢ A, - dilatation) ppt by rent infection, tritants , exercise, allergens emotional upset breathless) ecuvrent eplndes + 660 chest tightness Oe cove ioe aap ot night cory morning = apt: GHGS — wheering ly “po Pathology. porting of alseys —— mucosal cadena dip inflena + chemical mediators x ows i A® 272% tenacious mucous production A PR Oo: Ge re PS Bev d spiration tohercostakor, Zs IY ‘asp — Ez Ruri Codiive? — L accerwry mh FSP enaclenl, seproctical sire obd mh? elodic. recoil Cpomive? ||> Il expivotion —> ing ¢ gatube? Inhaleal. - beclomethasone , fluticason. corticosteroids <— 0"! ~, Prednisclone, dexamethasone porenteral . hydrocortisone , dexometh Drugs used to asthma ollergen —_~, @~ ve IgE onbbody - Omalizumab telper Teel ne ISE | eet boord Igk Bronchodiletation ATP eet Pr, agent et eam [tere geotet toe t -= EESY comonphylive Alegen cvostiek Bronchocenstriction theephgline? stobileer Ceremolyn socio +— most cell nectocyomi!) release mecuiators —. 1. lakemphawe Ark ILS Anhbodty (mepolzama,, Reslizumab, Benraleumed U7 Rg cntagenist (Montelubast, Zaftlabasd Lt sypthests inhibitor (Zileuton) + Adenosine vrais Caeser = aye (A 8% saak TAgA parcaynp (M2 > Bie (salbutamol, terbutaline> CSalmetere! th ores (CTpratropiam, Tiotropiam) ‘Tmmedinte phase CHistomine, Leukotriene) Las8 + uF ONCHIAL AStyy ment OF BR 2. Sodium crot ; imulated jseases, with an estimay,, St of the most ommon especially aMOngchildren., ce is increasiNs stimulation Asthena Is one ler i thi mi revi juli those ar individuals affected worldwide I P sponse to irritant stimu! © tOo%, Goal of asth jon in Detter: ana to achieve non asthmatic subjects in quality ology unknown cholinergic control of airway diam. jc and nherited or acquired imbalance of adrener (muscarinic ...constriction) Caseiticetic ad A. Bronchor cxcresretresponsivenesstoadrnergicsonisabesciataliofh 1. By Adren inritants (gasoline, fumes, cigarette smo may be precipitated by stress: infection, {a} Selective allergens, emotional upset shor Asthma causes EEUFFINg episodes of wheezingrsbreathlessness , chestitizin, Long geuhing, particularly atinightor intheearlymorning. (b) Bothae Pathology: consists of two elements: These changes are brought about by chemical mediat; (c) Both Bi 1. narrowing of airways: - muscle spasm, mucosal'eedema (inflammation) 2. Xanthin 2 tenacious mucous production = Aminop ‘Tworphases in allergic asthma: 3. Muscar | Ammediste Phase initial response to allergen provocation) - Ipratro occurs abruptly, is mainly caused by spasm of bronchi B. Drugs! lal smooth muscle due to release of chemical mediato ——, 1. Cortice ALEPH S (inhale ~ 2 progressing inflar it ie: inflammatory reaction, initiated during the first phase, may be nocturnal | more sustained bronchocoy >, May be nocturt (oral: striction, mt 7 - due torelas of sSonoam “Mucosal edema, mucous secretion ; (parer Release of chemical Mediators Nd toxic proteins 2 Crom A. Inhibited by: 3. Leuk . Leuko 1. Cyclic AMP - : formed by adenylate cyclase actio Bes mdse by Baserete sinus 0 Which j > Leuke ~ Inhibited by a-adrenergic stimulation pe ~ also formed by action of Prostaglandin ¢ is : in 28€ action wh; i oe ich i his inhibited hue — S saw — eT ate, by action independent of CAMP. 2. Sodium cromos'¥e s_simutated by Cyelc GMP, formed by action of guanylate cyclase which is stimulated by cholinergic stimulation Goal of asthma care “4 to achieve asthma control, enabling @ patient to live without functional limitations, impairment of life, oF risk of adverse events in quality © ee * )aoneeataon —— . used as eetiewens) ») Setectivesiaszction: (inhalation, oral, parenteral) g: SaibuRaRO| (ANwUtero!) “TEREST, Orciprenaline (Metaproteranc!) (3-4 hr) u 1: Saimetero!, Formoteroh(12 hr or more) (b) Bo! dB actions: Adrenaline (SC), Ephedrine (oral) (c) ea isoprenaline (inhalation) > xgnthinexderivative® (oral, parenteral) g DENS minophyline, enprofyline *Asophy line. 3. smuscorinigjreceptorvantagonists (inhalation) pretropium, oxitropium, tiotropiumy Gre that reduce the bronchial hyperactivity (anti=inflammatoryagents) corticosteroids (inhaled steroid used as controllersbeclometasone, budesonide sluticasone, momekasone.and ciclesonide } (ora! prednisolone, dexamethasone) (parenteral "hydrocortisone sodium succinate, desamethasone for permissive action), east cell stobrher @) Cromolyn sodium and nedocromil (no longer used in USA) - Leukotriene pathway inhibitors Leukotriene receptor antagonist: Zafriukast;Montelukast=> Leukotriene synthesis inhibitor -2ileutom {least prescribed because of occasional liver t @ Targeted (Monoclonal Antibody) Therapy Anti ig antibody - Omalizumab— Anticks5:therapy —'Wf@polizumab, ReslizumabyBenralizumab> © Mucolytics- acetyleystinesbromnexine ‘oxicity) ——————— SCS ‘agonists Mon Z P, —> ek enby inte sk omy PL egpnists a SABA short acting Pe agonist octir ist Ceolbutomel, terbutaline? fe te Oe clos!) as needed basis not used. os neadact bosls gven regularly bd howe fn wadequated controlled. by glucocorticoids - Ioholation , oral, parenteral maint in asthena exercise induced ashma nocturnal asthma Dose - 24mg 3-4 times a doy CSalbudtomol > Untoward effects — 9°! oP MD Z palpion,tachyeorda te . headache 2. SABA + ee 3. + WBA = fine tremor of bond Maz - metered dove inher ~ et 38 | SRBA ~ 08 neecled imhelec corficosteroite MID oebalize¥ Methylxonthines Le 4 er? Tminophyline - theophyline + ethylenediamine Car solubility) + Theophylline eer ——s fry —vePt ae P 1 —_fhaenyle eure fh cAMP ethy) zanthines CAminophline, Tecpel Bronchial tone AMP Aamnesioe > smooth m/s constriction mediotor release “Methyleonthines Pharmacobgical actions ns BIB relieve asthma 2. Wy except cerebral wolignont-wasodiator) —> tochysorcis errhytheta 2. crs - stimutotion ‘restlessness , nervous nas, insomnia yareiety, tremors agnarty = verdose 4. Kidney - id. ciereais 5. GE - 7 secretion PK » absorplen, 3D. plasera * Use — , ow - 7¥ oathre fay tere - ovet a. presto iofenb Ba 1 > 2. yp Lo techy sere 3. CNS 4 —> fren goshre 4. gid. old dire , I by anfacil Creurabire Zz ful ge rote ~ vIpred Se perenymp —9 ch —> 1 —9B/c ain E 7 ao crm = BO iy My SBOP he Ach binding to muscorinie — chelinergie Ric MOA . competitive ontogonist of J 1 eGMP 5 By5 3} inbabtion —» quaternary MN, compd —phighly poker X: given by aerors bh _ Uses © asthma —o nck tne dreg edjenct 4 Pemaganinte ond steroid, int valuable 4 patient intolerant + wnholeck Pe ageoists Q@. core - mportent rele (Tistropiom - loagmesting drug fr morteronce) @ Bronchospasm cz P blocker A. vision , cycloplegi slike atropine we yh ByF rreer _ blurred. vision , cycloplegia. ByS SHS 8S + diy mouth «light heodestoess rinary retension ,consbpation » glucona. Corticosteroids Inhaled. —» beclomethasone , fluticasone , monn Lon > prednisolone, dexernethassne ydrocortisons., cexamethnvons Injection > MOA Allergee ——9 @— o> . @ phospholpase Ay —> v PS 5 UT ageless rL3 ~ Lg veleote of maditors fom mon cell | © sensitivity of P Rye 1 cotechabnS > < es, « @ aythens of TL tat repile mart cel pot ——..zt——_? Immediate phase Late pave Histamine LT, PG Phospholipids _ prertctpor es Arachidonic. acl of Se ur samvere ofg osthena (ersts asthma/statie alhmabrus TV hydrocortisone of asthma ( ora oF inhalotional > sing ‘after each oe 1. oropharyngeal condiis!?) J whe 2. hoarseness of WEIS ( Aysphooia) ernploging spacer or mere devices 2. 900 mouth & throat by water fess = fluticasone | gaaternie ontomsard. offects B agstems © smometasone aiclescnidle (poor obsorption? Cromelyn sodium C Sodium cromoglycate) B Nedocromi! MOA —p mast cell stobsheer Route — inhalation Use sr cathme, ,ollergre reactions —oloeg ten prophylous of Induced. asthma bs extrinsie. ollerge asthma ,cxercve s not effective ot terminating 07 casting atlock —snomrsleminm QjqxsbronevSSposr 8. Allerg: rhinitis C nasal spray? fy. Allergic conjunctubs Ceye op? Untoward effects — wel foleratted except ennor treat trntation montelukast , Zofrlakast Montelukast , Zafrfukast Mon LT @, LT Cg LT Dy» ETEH severe orthena. asthena Bye asthma exacerbation \Phavmawelogicel action +9 early fate respons to Whaled allergeo «action 9 odditve © P, agonist Uses: 1. allege asthina Cospivin senstive astheno> 2. exercise induced ‘asthvna. > monetherapy Pr prophybas 3. chronic asthma —> 0s adjenct inhaled CS rapid onset © era) odministration 5 approved for chiktven € mon -5 yr not recommended ip chiklren < !2yr Cent inhibitor) Adverse effects ‘Anti Ig theropy XOmolzumab) -ecombirant humanized monccloncel Ab —o target ogoinst To MOA IgE bound to ‘omalizamab « ‘0 i Seek connect bind to Ig Re oF mast ceils, basophils the reaction ot 0 very cory step io the procs 2 + prevent Pharmacokinetics by ver + Ig€-emalreamb comples exertoo Lee agsten to bile Uses «moderate to severe persistent asthma. 4 inadequately controlled by high dove CS + LABA on oral 8 Hhaled CS — TL.5 —» mepolizumab,, reslizumab jorgeting / TLS Rg. —> benvalieumnad Acute ottock emia. 40 moderate asthma severe asthma PEF 36-1007: predicted Cent? PEF s9-s0v life ning “PER 51-75% predicted. Cemoderate> RR > 25/0 @ary . HR > HO Jeni inability 40 complete. sentence in 1 breathy peck Flow expiratory pode Drug therapy for bronchial asthe goC amnophyline TV (caution cardne a adrenaline SC (ML FI F2? Severe astheno: 1-0, Wholotion SAoA a. nebuized Pr ogerist Ceabutamel 26-5 79% devbutalve © 79> a. ale ipratrepior® OF 79 4. bydrocortisens 200 mg or more TV repeat, 2-4 beg asthma oF status asthmaticu> Cotercid is compolory ° consis 2 those already CS theropy> lternatnes'. fz. ogerst I? amine phyloe, iv Antihistamines (anticholinergic - secretion 32> 6?) obneneabatormotenstiesl? L sare C hfe Yrresterng otro (F Cough suppressanis ( extied -Jeq6? Non nye, osthma—s prevent recur Miscellansous te Oe 2. Retibicticn CF inf) 2. ossisted. ventlation , in YP Poilure symp — ¥/9 poorer — Qodrerersic ontogpnists €9- proproncle) bastornines Ceg-opites, crore 2. those eshich release © perasympatremmetic: 4. PG Fx Cbrenchoconstriction) ogents eg - methacholine > STARTING TREATMENT {Im adults and adolescents with a Glagnosis of asthma ‘Tach 1 preter te posers aly be por acre mth day concer, (Elgar neracy a menos nel foyer we aaa se ‘suze eek of sovre nator on eed See, re oa CONTROLLER snd ALTERNATIVE RELIEVER copa «irreversible [permonet way 30king SABA, LAGA ; COPD

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