Term
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Definition
Class: asthma, beta2 receptor agonist
Mechanism: short-acting beta2 selective receptor agonist, bronchodilates, activates cAMP in SMC
Indication: rescue inhaler
Contraindication: cardiac disease, MAO-inhibitors
Adverse Effects: tachycardia, mild hypotension, tremor |
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Term
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Definition
Class: asthma, beta2 agonist
Mechanism: long-acting beta2 selective agonist, bronchodilates via cAMP activation; long action due to absorption into epithelial lung cells
Indication: prophylactic tx
Contraindication: cardiac disease, MAO-inhibitors
Adverse Effects: tachycardia, mild hypotension, tremor |
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Term
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Definition
Class: asthma, methylxanthine
Mechanism: bronchodilates via increase cAMP and blocks adenosine A2 receptors
Indication: maintenance therapy for asthma/COPD (less use now b/c of beta2)
Adverse Effects: insomnia, agitation, tachycardia, tremor [think caffeine side effects] |
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Term
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Definition
Class: asthma, muscarinic antagonist
Mechanism: muscarinic antagoonists --> bronchodilation; antagonizes PSNS induced constriction
Indication: COPD, combo bronchodilators for asthma (esp. pt who can't take Beta2 agonists)
Adverse Effects: minimal CNS effects (poor absorption) |
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Term
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Definition
Class: asthma, mast cell stabilizer
Mechanism: inhibit mast cell degranulation, prevents release of autocoids (histamine and leukotriences, etc)
Indication: inhalation prophylaxis of mild-moderate asthma; with glucocorticoids in moderate-severe
Adverse Effects: bad taste, cough, wheeze, bronchospasm, HA |
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Term
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Definition
Class: asthma, LT receptor antagonism
Mechanism: prevents action of leukotrienes; bronchodilates and reduces inflammation
Indication: prophylactic tx in mild asthma
Adverse Effects: rare inflammatory condition (pulm infiltrates, neuropathy, skin rashes, vasculitis) |
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Term
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Definition
Class: asthma, lipoxygenase inhibitor
Mechanism: inhibits 5-lipoxygenase, prevent formation of leukotrienes; bronchodilates and reduces inflammation
Indication: prophylactic tx for mild asthma
Adverse Effects: rare elevated liver enzymes |
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Term
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Definition
Class: asthma, anti-IgE antibody
Mechanism: binds Fc domain of IgE and prevents interaction w/ receptor on mast cells; IV or subq every 2-4wks; reduce airway responsiveness and decrease need for other drugs
Indication: asthma severe and refractive to other therapy
Adverse Effects: infection/pain on injection, very expensive |
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Term
| cortisol (hydrocortisone) |
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Definition
Class: asthma, glucocorticoid; endogenous
Mechanism: decrease inflammatory reponse, reduce cytokine release, reduce eicosanoid production
Indication: asthma reduce inflammation |
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Term
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Definition
Class: asthma, glucocorticoid
Mechanism: decrease inflammatory reponse, reduce cytokine release, reduce eicosanoid production; 4-6X MORE POTENT THAN CORTISOL FOR ANTI-INFLAMMATORY (little mineralocorticoid activity)
Indication: asthma reduce inflammation |
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Term
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Definition
Class: asthma, glucocorticoid
Mechanism: suppress ACTH production; 18X MORE POTENT THAN CORTISOL, no mineralocorticoid activity
Indication: diagnosis of cortisol disorders |
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Term
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Definition
Class: asthma, glucocorticoid inhaler
Mechanism: suppress inflammation,
Indication: daily inhaler for suppression of inflammation in asthma
Adverse Effects: hoarse voice, oral candidiasis |
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Term
| asthma drugs that bronchodilate |
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Definition
beta2 receptor agonists
methylxanthines
muscarinic antagonists
leukotriene antagonism |
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Term
| asthma drugs that reduce inflammation |
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Definition
glucocorticoids
inhibit mast cell degranulation
leukotriene antagonism
anti-IgE antibody |
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Term
| glucocorticoid general actions |
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Definition
antagonize insulin, promotes gluconeogenesis
increases muscle catabolism
augment GH action on lipolysis, increase TGs
decrease inflammatory response
reduce cytokine release
reduce production of eicosanoids |
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Term
| glucocorticoid pharmacokinetics |
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Definition
well absorbed in GI tract
cortisol highly ppb (cortisol-binding globulin and albumin, synthetics are less so)
lipophilic
metabolized by liver (11B-hydroxysteroid dehydrogenase I activates prednisone) |
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Term
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Definition
replacement therapy (Addison's)
anti-inflammatory (immune suppression)
inhaled for asthma
topical for psoriasis and dermatitis
depot injections for arthritis/gout
immunosuppression for transplant and adjunct in blood cancer tx |
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Term
| glucocorticoid side effects |
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Definition
inc. susceptibility to infection
increased glucose levels and DM
2* hyperparathyroidism
osteoporosis
edema
suppression of linear bone growth in kids
steroid psychosis (rare)
Cushing's syndrome
withdrawal rebound phenomenon (adrenal insufficiency)
myopathy |
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Term
| glucocorticoids + beta blocer combos for asthma |
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Definition
fluticasone + salmeterol
budesonide + formoterol
mometasone + formoterol |
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Term
| severity of asthma + managment |
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Definition
mild/intermittent: beta2 agon as needed
mild/persistent: inhaled glucocorticoid/cromolyn/LT receptor antag + beta2 agon as needed
moderate/persistent: inhaled glucocorticoid/LABA/theophylline + beta2 agon as needed
severe/persistent: inhaled glucocorticoid/LABA/theophylline/systemic glucocorticoid/anti-IgE Ab |
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