Mmc Pharmacology- Therapeutics Of Asthma

Front 1

Goals of Asthma Therapy

Back 1

1) Symptomatic relief

(to relieve bronchocontriction)

2) Disease modification

(to reduce inflammation and lung damage)

Front 2

Asthma treatment schema

Back 2

1) Environmental control

2) Medical therapy

Front 3

Environmental control of asthma: Allergic factors to avoid

Back 3

1) Pollen

2) Mold spores

3) Dust mites

4) Animal allergies

Front 4

Environmental control of asthma:

Non-allergic factors to avoid

Back 4

1) Smoke

2) Cold air and weather

3) Chemicals

4) Drugs (beta blockers, aspirin)

5) Exercise

6) Hormonal changes

Front 5

Drugs used for quick relief of asthma

Back 5

1) Short-acting beta2 adrenergic agonists

2) Anticholinergics

3) Systemic corticosteroids

Front 6

Names of short-acting beta2 adrenergic agonists

Back 6

1) Albuterol

2 Salbutamol

3) Terbutaline

4) Fenoterol

5) Bitolterol

6) Levalbuterol

7) Pirbuterol

Front 7

Short-acting beta2 adrenergic agonists:

Mechanism of action

Back 7

1) Activation of beta2 receptors activates adenylate cyclase, resulting in increased cAMP and bronchodilation

2) Enhance mucociliary clearance

3) May decrease vascular permeability

Front 8

Short-acting beta2 adrenergic agonists:

Clinical uses

Back 8

1) Relief of acute symptoms and exacerbations

2) Prevent exercise-induced bronchospasm

Front 9

Short-acting beta2 adrenergic agonists: Adverse Effects

Back 9

1) Tremor

2) Hypokalemia

3) Tachycardia

Front 10

Drugs used for long- term/maintenance control of asthma

Back 10

1) Inhaled corticosteroids

2) Long-acting beta2 adrenergic agonists

3) Leukotriene modifiers

4) Methylxanthines

5) Inhaled cromones

Front 11

Names of long-acting beta2 adrenergic agonists

Back 11

1) Salmeterol

2) Formoterol

Note: Both of these drugs are inhaled!

Front 12

Long-acting beta2 adrenergic agonists: Mechanism of action

Back 12

1) Activation of beta2 receptors activates adenylate cyclase, resulting in increased cAMP, smooth muscle relaxation and bronchodilation

2) In vitro inhibition mast cell mediator release, resulting in decreased vascular permeability and increased mucociliary clearance

Front 13

Long-acting beta2 adrenergic agonists: Clinical uses

Back 13

1) Long-term prevention of asthma symptoms (especially nocturnal); used in addition to anti-inflammatory therapy

2) Prevention of exercise-induced bronchospasm

3) Steroid sparing

NOTE: DO NOT USE for acute symptoms or exacerbations!

Front 14

Ipratropium bromide

Back 14

1) A long-acting anticholinergic used to treat acute cholinergically mediated bronchospams

2) Given via aerosol or nebulizer

Front 15

Ipratropium bromide and long-acting anticholinergics: Mechanism of action

Back 15

1) Competitive inhibitor of muscarininc cholinergic receptors

2) Decreases intrinsic vagal tone to the airways

3) May also block reflex bronchoconstriction secondary to irritants or reflux esophagitis

4) May decrease mucous secretions

Front 16

Ipratropium bromide and long-acting cholinergics: Clinical uses

Back 16

Relief of acute cholinergically mediated bronchospasm

Note: May provide additive effects to beta2 adrenergic agonists

Front 17

Ipratropium bromide and long-acting cholinergics: Side effects

Back 17

1) Dry mouth

2) Sedation

3) Mydriasis

4) Urinary retention

Front 18

Names of long-acting inhaled corticosteroids

Back 18

1) Methylprednisolone

2) Prednisone

3) Prednisolone

4) Beclomethasone

5) Budesonide

6) Flunisolide

7) Fluticasone

8) Triamcinolone

Front 19

Long-acting inhaled corticosteroids: Mechanism of Action

Back 19

1) Anti-inflammatory agents; block late reaction to allergen and decrease airway hyperresponsiveness

2) Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration

3) Reverse beta2 adrenergic receptor down-regulation, which results in inhibition of microvascular leakage

Front 20

Long-acting inhaled corticosteriods:

Clinical Uses

Back 20

To address moderate to severe exacerbations:

1) to prevent progression to exacerbation

2) to reverse inflammation

3) to speed recovery

4) to reduce rate of relapse

Front 21

Long-acting inhaled corticosteriods:

Adverse Effects

Back 21

1) Thrush (yeast infection)

2) Hoarseness

3) Dwarfism (in children)

4) Osteoporosis

5) Cataracts and glaucoma

Front 22

Names of Leukotriene Modifiers

Back 22

1) Zafirlukast (LTD4 receptor antagonist)

2) Montelukast (LTD4 receptor antagonist)

3) Zileuton (5-lipoxygenase inhibitor)

Front 23

Leukotriene Modifiers: Clinical Uses

Back 23

1) Long-term control of asthma and prevention of symptoms

2) Prevention of exercise-induced bronchospasm

3) Treatment of aspirin-induced asthma

4) STEROID SPARING

Front 24

Leukotriene Modifiers:

Side Effects

Back 24

1) Hepatitis/Liver toxicity

(especially with zileuton)

2) Drug allergies

Note: Overall toxicity is minimal with these drugs

Front 25

Cromolyn Sodium and Nedocromil:

Mechanism of Action

Back 25

Anti-inflammatory drug:

1) Blocks early and late reaction to allergen

2) Interferes with chloride channel function

3) Stabilizes mast cell membrane

4) Inhibits activation and release of mediators from eosinophils and epithelial cells

Front 26

Cromolyn Sodium and Nedocromil:

Clinical Uses

Back 26

1) Long-term prevention of symptoms (may modify inflammation)

2) Preventative treatment prior to exercise or exposure to known allergen

Front 27

Cromolyn Sodium and Nedocromil:

Side Effects

Back 27

1) Infrequent laryngeal edema

2) Cough

3) Wheezing

Front 28

Methylxanthines: Mechanism of Action

Back 28

1) Smooth muscle relaxation and bronchodilation due to phosphodiesterase inhibition and possibly adenosine antagonism

2) May affect eosinophillic infiltration into bronchial mucosa

3) May decrease T cell numbers in epithelium

4) Increase diaphragm contractility

5) Increase mucociliary clearance

Front 29

Methylxanthines:

Clinical Uses

Back 29

1) Long-term control and prevention of asthma symptoms (especially noctural symptoms)

2) NOT generally recommended for exacerbations

Front 30

Methylxanthines:

Side Effects

Back 30

1) Seizure/Tremor (most dangerous)

2) Insomnia (most dangerous)

3) GI upset

Front 31

Theophylline

Back 31

1) A weak bronchodilator given orally for treatment of asthma (4th line therapy)

2) Produces prominent immunomodulatory/anti-inflammatory effects

3) Has narrow therapeutic range and is poorly tolerated in up to 1/3 of patients

Front 32

Treatments for Aspirin-induced Asthma

Back 32

1) Aspirin desensitization

2) Nasal/Inhaled steroids

3) Leukotriene antagonists