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18 Cards in this Set

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assignmnent 6

chapter 11 page 181 to 194 Rau


Rau workbook chapter 9 finish


Chapter 11 109 to 112

Non steroidal anti inflammatory

Chromylin sodium (Intal)


:Prevents degranulation of the mast cell


:therefore muting allergic stimuli


Nedocromil sodium (tilade)


:inhibits mast cells, eosinophils, airway epithelial cells from releasing inflammatory cytokines


:increases eosinophil production (present in allergic reactions)


Anti leukotrine

Slide of life


When the antigen antibody reaction takes place, it decreases cyclic 35 amp.


Cromolyn sodium and nedyl cromosodium prevent degranulation from occuring


Non steroidal anti inflammatory

Montelukast (singulair)


:leukotriene receptor antagonist


:Thus preventing bronchoconstriction, mucus secretions, vascular permeability... inflammation

Non steroidal anti inflammatory

Cromolyn like drugs (mast cell stabilizers)


Antileukotrienes (anti LTs)


Monoclonal antibodies (prevent release of leukotrienes for asthma)


Non steroidal anti infmallamtory indications

Prophylactic management (control) of mild persistent asthma


:Cromolyn and anti Luekotriene as alternatives to ICS (inhaled cortico steroid) in asthma requiring step 2 care



Generel indications for Cromolyn


:cromolyn is often used with infants and young children as alternatives to ICS in asthma requiring step 2 care because of safety profiles of ICS


:Anti leukotrienes can be useful in combination with ICS to reduce the steroid dose

Immunological (allergic) response

Allergic response of asthma involves mast cells and IgE


Mast cells release


:Leukotrienes


:prostaglandins


:Proteases


:Histamines


:Platelet activating factor (PAF)


:cytokines

Cascade of mediators

Inflammatory response manifests as


:vascular leakage(occurs in the interstitium and tissue leading to edema)


:bronchoconstriction


:mucus secretions


:mucosal swelling


All of these lead to obstruction of airflow in the bronchioles


Accumulation and activation of eosinophils lead to damage of the airway


Cromolyn Mast cell stabilizing agent

Prophylactic agent in the treatment of asthma


Cromylyn sodium (disodium cromoglycate)


:Dosage and administration


::SVN 20 mg/ampule or 20 mg/2ml (1%)


:Mechanism of action


::Prevents mast cell degranulation



Cromolyn sodium (disodium cromoglycate)


:side effects


::Cough


::Nasal congestion


::Wheezing


::Epixtaxis


::nose burning


Anti Leukotrine (they are anti inflammatories, but not steroids)

Cromolyn prevents a release of IgE and protaglandins via mast cell stabalization.



Leukotriene receptors are blocked so the

Antileukotriene agents

Leukotrienes and inflammation


Leukotrienes are potent bronchoconstrictors and stimulate other cells to cause


:Airway edema


:Mucous secretion


:Ciliary beat inhibition


::Recruitment of other inflammatory cells


Antileukotriene agents

5-LO inhibitor


:Zileuton (Zyflo, Zyflo CR)


Leukotriene receptor antagonists


:Zafirlukast (Accolate)


:Montelukast (Singulair)


Monoclonal antibodies


:Omalizumab (Xolair)


ANtileukotriene agents

Omazlizymab (Xolair)


Dosage and administration


:Oral administration


:600 mg tables qid



Mechanism of action


:inhibits 5:LO enzyme


Hazards and side effect


:Headache, abdominal pain, oss of stregth, dyspepsia


:Monitor liver functions


:Interacts with theophylyine and warfarin



Zafirlukast (accolate)


:Dosage


::Oral administration


::10 mg bid children 5 to 11 years old


::20 mg bid 12 years old and older


:mechanism of action


::Leukotrine receptor antagonists


:Hazardsa and side effects


::Headache, infection, nausea, diarrhea, generalized and abdominal pain

Antileukotriene agents

Montelukast (Singulair)


:Dosage and administration


::Oral administration


::4mg and 10 mg


::5 mg chewable


:Mechanism of action


::Leukotriene receptor antagonists


::Binds with high affinity and selectivity to CysLT, receptor subtype

Antileukotriene agents

Montelukast (singulair)


:Hazards and side effects


::Diarrhea, nausea


::Laryngitis, pharyngitis


::Otitis, sinusitis, viral infection


Antileukotriene agents advantages

Oral administration, possible once daily dosing


Safe, with few side effects to date


Effective in aspirin sensitivity and often in exercise induced asthma


Systemic distribution reaches entire lung through the circulation



Additive effect with inhaled steroids


May reduce steroid dose or prevent an increase in steroid dose


Formulation approved for pediatric dosing (montelukast)


Antileukotriene agents disadvantages

Antiinflammatory action limited to one mediator pathway


Unknown long term toxicity


Variable response


:Effective in about 50% to 70% of patients


Systemic drug exposure


Generally not useful as monotherapy

Antiinflammatory overview

Inhaled steroids, cromolyn like and antileukotreines all have a brochoprotective effect


All are given prophyllactically (preventative, before the horse gets out)


All are the maintenance drugs of choice for asthma