Chronic inflammatory disorder of the airway, due to immune response to allergens in 50% of patients

bronchospasm and inflammation

bronchospasm needs rescue treatment

inflammation needs prevention

bronchodialators (Beta2 agonists)

anti-inflammatories (Glucosteroids)

therapeutic effects delivered directly to site of action

systemic effects minimized

relief of attack is rapid

Beta2-adrenergic agonists

mechanism of action

sympathomimetic drug

promote bronchodilation

suppress histamine release

oral beta2-agonists

inhaled beta2-agonists

oral- long acting

inhaled-mostly short acting (albuterol)...there are 2 long acting inhaled available

mostly inhaled used for "rescue" PRN

can also be for long-term control inhaled on daily schedule in ADDITION to inhaled steroids

adverse effects of beta2 agonists

inhaled short acting (albuterol)

well tolerated

systemic effects: tachycardia, angina, tremor

Beta2 agonists adverse effects

inhaled long acting (salmeterol)

may increase risk of severe attacks and ashtma related deaths if used alone

safe if used correctly

used as an additive to inhaled steroids

beta2 agonists adverse effects

oral (terbutaline)

may activate beta1 receptors in heart

causing angina, tachyarrythmias. 

salmeterol (serevent Diskus)

Formoterol (Foradil Aerolizer)

both inhaled, dosed q 12 hours

if additional bronchodilation is needed

short-acting beta2 agonists can be used in addition

albuterol

terbutaline

3-4x per day

steroids

glucocorticoids

suppress inflammation

(decrease leukotrienes, histamine, and prostaglandins)

decease activity of inflammatory cells

(esinophils, leukocytes)

decreases edema of airway mucosa

steroids in asthma

slow or fast acting?

slow acting- cannot be used for acute attack

give on fixed schedule

minimal

commonly: orophayngeal candidiasis and hoarseness

bone loss- use lowest dose, ensure adequate calcium and vitamin D

prolonged use of steroids

side effects

adrenal suppression with high doses

osteoporosis

hyperglycemia

peptic ulcer disease

slows growth in children

Advair Diskus

fluticonisone + salmeterol

2x daily

>4 yrs old

inflammatory disorder of sneezing, rhinnorhea, pruritis, and nasal congestion

can also cause conjunctivitis, sinusitis, and asthma

histamine

leukotrienes

prostaglandin

seasonal (hayfever, springfever)

perennial (dust mites, dander)

first line drug for allergic rhinitis

can relieve sneezing, runny nose, and itching

oral antihistamines

prophylaxis- prevention

given on regular basis throughout allergy season

sedation with first generation

dry-mouth, constipation, urinary retention

loratidine (claritin)

fexofenadine (allegra)

Azelastine >12 yrs old

most effective drug for prevention and treatment of allergic rhinitis

can prevent or suppress all major symptoms

first line therapy

drying of nasal mucosa and itching sensation most commom

sore throat, bloody nose, H/A

systemic effects possible but rare

reduce nasal congestion

cause vasoconstriction in nasal passage

which is faster- topical? oral?

sympathomimetics (decongestants)

topical use-rapid intense response

oral use- response more moderate and delayed

rebound congestion- becomes more congested after each application 3-5 days

CNS stimulation from oral agents

Cardiac- cannot use with hypertension or coronary artery disease d/t vasoconstriction of systemic blood vessels

hemorrhagic stroke

abuse

antitussives (opiod/nonopioid)

expectorant/ mucolytic increases productiveness

elevate CNS cough threshold

codein most effective suppressant available

hydrocodone

antitussives

opioids

antitussive

nonopioid