Term
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Definition
Class - beta 2 adrenoceptor agonists (relievers)
MOA - Stimulate beta 2 receptors, AC converts ATP to cAMP, cAMP causes bronchodilation of smooth muscle and inhibition of mast cell activation
Dosage - Inhaler for relief of symptoms, neubuliser/IV for status asthmaticus
Side effects - skeletal muscle tremor, restlessness, hypojalemia, cardiac arrhymias (rare) receptor
down regulation with over use |
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Term
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Definition
Class - long acting beta 2 agonist (relievers)
MOA - binds to exo-site via flexible tail and repeatedly stimulates the receptor. AC converts ATP to cAMP, cAMP causes bronchodilation of smooth muscle and inhibition of mast cell activation
Dosage - once or twice a day (useful in nocturnal asthma)
Note - if patient is using beta 2 agonist inhaler regularly then need to add in a steroid |
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Term
| Theophylline/Aminophylline |
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Definition
Class - Methylxanthines (relievers)
MOA - Inhibit PDE (so inhibits the breakdown of cAMP to AMP) leading to bronchodilation of sm and inhibition of mast cell activation
Dosage - Oral administration only, variable gut administration and hepatic metabolism. Plasma conc is increased by heart fialure/liver disease/some drugs and decreased by smoking/alcohol/other drugs
Side effects - nausea, insomnia, dysrythmia. Not a front line drug. |
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Term
| Ipratropium/oxitropium/tiotropium |
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Definition
Class - anti muscarinics (aka preventers)
MOA - M1/M3 antagonists block parasympathetic bronchoconstriction and mucus secretion
Side effects - poorly absorbed from the lung so classic side effects of anti-muscarinics are rare |
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Term
| Beclomethasone/budesonide/fluticasone/prednisolone/hydrocortisone |
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Definition
Class - Corticosteroid
MOA - combine with steroid receptors in the cytoplasm, enter nucleus, controls synthesis of proteins. Inhibits inflammatory genes, cytokines, COX-2, adhesion molecules, immunoglobulins. Induces anti-inflammatory genes, IL-10, annexin 1, beta 2 adrenoceptor, ribonucleases.
Dosage - give the lowest possible dose, limiting systemic side effects with effective inhaler technique and using drugs such as fluticasone that are inactivated by first pass metabolism.
Side effects - chronic oral steroids lead to abnormalities in fat, protein and carbohydrate metabolism (rare with inhaled steroids if used properly), long term use leads to Cushingoid features |
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Term
| Sodium cromoglycate/nedocromil sodium |
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Definition
Class - cromones (preventers)
MOA - Prevent mast cell degranulation and initial release of histamine
Dosage - inhaler, must be taken 4x daily (so compliance is bad |
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Term
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Definition
Class - anti-leukotriene (preventer)
MOA - 5-LO inhibitor, thereby inhibiting the leukotriene pathway, preventing bronchoconstriction, eosinophil recruitment, music secretion, microvascular leak |
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Term
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Definition
Class - anti-leukotriene (preventer)
MOA - Antagonists of the Cys-LT receptors on smooth muscle and eosinophils in the leukotriene pathway, thereby preventing bronchoconstriction, eosinophil recruitment, music secretion, microvascular leak
Note - people with allergic asthma often have other conditions like allergic rhinitis so anti-leukotrienes help with this too |
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Term
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Definition
Class - Anti-IgE (preventer)
MOA - Binds IgE plasma and doesn’t cause mast cell degranulation
Side effects - risk of anaphylaxis |
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