Asthma

(reactive airway disease)

pathophysiology

chronic inflammatory disorder of the airway

-hypersensitivity or twitchy airways

-inflammation and bronchospasm caused by cytokine release

cause?: immune mediated airway inflammation

anti inflammatory

bronchodilatiors

Asthma Rx

anti inflammatory 

classes

glucocorticoids

cromolyn

nedocromil

Asthma Rx

bronchodilator

classes

beta 2 agonists

anticholinergics

leukotriene modifiers

methylxanthines

inhaliation drug

therapy

delivers drug juuust where it is needed

and minimizes systemic s/e

metered dose inhalers

-propellent and spacer

dry powder inhalers

nebulizer

what is the most effective 

anti asthma drug class??

Asthma Rx

inhaled glucocorticoids

overview

anti inflammary

Local ADRs: fungal growth

Systemic ADRs: with long term use

osteoprosis

retarded growth

cataracts

asthma Rx

glucocorticoid Rx

-beclomethasone

-budesonide

-ciclesonide

-flunisolide

-fluticasone

-mometasone

Asthma Rx

Beta 2 agonists

indications

and

ADRs

relief of ACUTE bronchospasm and prevention of excercise induced (used in routine therapy)

ADRS

-tremor in orals

-tachycardia (b1 effect) orals

-hypokalemia oral

Asthma Rx

Beta agonists

Quick and short acting

albuterol

levalbuterol

bitolterol

pirbuterol

Asthma Rx

Beta 2 agonists

long acting

salmetrol

formoterol 

and 

arformoterol??

Asthma Rx

cromolyn

(and nedocromil)

prophylaxis, suppresses inflammation but no bronchodilation

inhalation only

ADRS

SAFEST  anti-asthma Rx

Asthma Rx

Anticholinergics

Rx

ipratropuim

and 

tiotropium

Asthma Rx

ipratropium

blocks bronchoconstriction

-less effective than beta 2's so used as an additive

ADR's

dry mouth

Asthma Rx

methylxanthines

theophyline

-bronchodilator

-narrow theraputic index (10-20)

not used frequently

dont memorize just know

Asthma Rx

leukotriene modifiers

bronchodilation

-zileuton (short t)

-zafirlukast (short t and hepatotox)

-montelukast DOC