Atopic asthma exercise induced asthma some cases of

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Unformatted text preview: r – Blocks muscarinic receptors – Not drying • probably due to poor lipid solubility • Systemic side effects not seen so far. • Currently recommended for COPD but not asthma. – May have value in asthma as adjunct Asthma prophylactic Asthma cromolyn (Aaranene®, Intal®), nedocromil (Tilade®) (Aaranene® Intal ®), nedocromil (Tilade® AKA: Mast Cell Stabilizers/ Histamine Release Inhibitors • Therapeutic Uses Takes two weeks to become effective with 4-6 doses/day. – Atopic asthma – Exercise induced asthma – Some cases of intrinsic asthma – Not used for bronchitis/emphysema – Advantage: no cardiac stimulation • Mechanism of Action prevents release of histamine and other mediators • Is therefore “anti-inflammatory” • Interferes with bronchoconstriction that is histamine based. • Caution – inhalation occasionally causes bronchospasm, throat irritation, headache and unpleasant taste Leukotriene Receptor Antagonists Leukotriene montelukast (Singulair®), zafirlukast (Accolate®), zileuton (Zyflo®) montelukast (Singulair®), zafirluk zafirlukast (Accolate®), zileuton (Zyflo® zileuton Anti-inflammatory agents For prophyllaxis only - not a “rescue” drug – Efficacy similar to cromolyn but more side effects. • Mechanism of Action – prevents leukotrienes from causing inflammation. • Side Effects and Cautions – Headache – GI upset – Liver enzyme changes • Inhibits P450 enzymes so decreases metabolism of many other drugs. Corticosteroids Corticosteroids Beclomethasone dipropionate (Beclovent®, Vanceril®), dexamethasone Beclomethasone dipropionate (Beclovent®, Vanceril ), dexamethasone Vanceril®), dexamethasone (Decadron®) flunisolide (Aerobid®), triamcinolone (Azmacort®) ), triamcinolone (Decadron®) flunisolide Aerobid®), triamcinolone (Azmacort®) flunisolide • Used only if other therapy does not control symptoms. • Positive interaction of inhaled corticosteroids and long acting sympathomimetics • Corticosteroid available as aerosol, tablets, and injections. Note: when these medications are needed, side effects of inhalers are much more acceptable than consequences of non-treatment. Corticosteroids Corticosteroids • Therapeutic Uses – asthma and other severe COPD – status asthmaticus (associated with bronchospasms) • Mechanism of Action – suppression of antibody formation (including IgE responsible for allergy attacks) – increases cyclic AMP which is needed for bronchodilation – decreases cyclic GMP which causes bronchoconstriction Corticosteroids Corticosteroids • Side Effects – local (with inhaler use) • hoarseness, dry mouth, local infections in mouth and pharynx – systemic (minimized by inhaler) • irreversible – osteoporosis (Ca++, protein, vitamin D helps), cataracts, stunting of growth in children • reversible – proneness to infections. Poor wound healing (including proneness to ulcers) (vitamin C helps), salt and water retention, signs of CNS stimulation (restlessness, insomnia, even manic states including depressive episodes in some individuals) Corticosteroids Corticosteroids • Cautions – drugs must be withdrawn slowly - body has decreased capacity to produce its own glucocorticoids. Also must gradually switch to inhaler from oral forms of medication) – during times of stress, patient may need extra glucocorticoid – Full effect of steroid therapy may take two to four weeks to be seen. Warning: Corticosteroid inhaler is not for treatment of acute attacks (not to be confused with a catecholamine inhaler)...
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This document was uploaded on 02/07/2014.

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