6 Asthma and COPD

non-selective B agonist

rarely used for tx of asthma - studies showed an increase death

many side effects - stimulates B1 receptors of heart
-tachy, nervousness, tremor etc

PROTOTYPE selective B2 agonist

Short Acting**

causes bronchodilation via inhalation - activates adenylate cyclase
-increases cAMP which relaxes sm mm and stabilizes mast cells

LESS LIKELY TO HAVE TOLERANCE since taken as needed for attack
-don't need a corticosteroid

Immediate effect used to treat mild or intermittent asthma-
can STOP and asthma attack in progress
effects last 4-6 hrs

Short acting B2 agonist - similar to albuterol

L-isomer of albuterol
more bronchodilation and less SE than albuterol

Short acting B2 agonist - similar to albuterol

Some pts tolerate this better than albuterol

Not available with spacer

LONG ACTING B2 agonist - 12 hrs

TOLERANCE likely to develop
-administer with corticosteroids
(Advair - combines with corticosteroids)
-corticosteroid also aids inflammation

Takes 20 minutes for effect - not used for acute attack
-given PROPHYLACTICALLY
-Pt should ALSO carry rescue inhaler

Muscarinic antagonist - bronchodilation

Used for COPD

anticholinergic SE

Muscarinic antagonist - bronchodilation

Similar to Ipratropium, but LONGER duration of action
-only need once a day

Used for COPD

Bronchodilator - CNS stimulant

-Blocks adenosine receptors, inhibits phosphodiesterase and increases cAMP
-multiple mechanisms to RELAX bronchioles

Used to treat COPD

Central SE: Nervousness, insomnia, Tachy, arrhythmias
OD - fatal arrhythmia

don't switch to generics once dose is established - issues

NARROW THERAPEUTIC RANGE - rarely used

ANTACIDS block absorption - cANT breathe
Cimetidine blocks breakdown - ARRHYTHMIA

INHALED coritcosteroid to decrease inflammation in airway of asthmatic

Improve sx and decrease requirement for B-agonists

Oralpharyngeal candiasis (thrush) and horseness are complications
- greatly reduced by using a SPACER

Decreases in bone density in women have been reported

Many docs feel this should be DOC for asthma - under perscribed

INHALED coritcosteroid to decrease inflammation in airway of asthmatic

Improve sx and decrease requirement for B-agonists

Oralpharyngeal candiasis (thrush) and horseness are complications
- greatly reduced by using a spacer

Decreases in bone density in women have been reported

Many docs feel this should be DOC for asthma - under perscribed

INHALED coritcosteroid to decrease inflammation in airway of asthmatic

Improve sx and decrease requirement for B-agonists

Oralpharyngeal candiasis (thrush) and horseness are complications
- greatly reduced by using a spacer

Decreases in bone density in women have been reported

Many docs feel this should be DOC for asthma - under perscribed

LT receptor blocker
-decreases inflammation of airways in asthmatics

Inhibits response to allergens, cold air, and exercise

decreases need for steroids

effective ORALLY, must be taken CHRONICALLY,
-WILL NOT STOP AN ATTACK IN PROGRESS

LT receptor blocker
-decreases inflammation of airways in asthmatics

Inhibits response to allergens, cold air, and exercise

decreases need for steroids

effective ORALLY, must be taken CHRONICALLY,
-WILL NOT STOP AN ATTACK IN PROGRESS

LT receptor blocker
-decreases inflammation of airways in asthmatics

Inhibits response to allergens, cold air, and exercise

decreases need for steroids

effective ORALLY, must be taken CHRONICALLY,
-WILL NOT STOP AN ATTACK IN PROGRESS

Blocks 5-lipooxygenase --> Decreased LT synthesis

NOT USED MUCH ANYMORE - but similar effects to LT receptor inhibitors -lukasts

May decrease aspirin-sensitive asthma

Inhibits release of histamine from mast cell

NOT A BRONCHODILATOR

Tx of asthma, especially in CHILDREN
ANTI-INFLAMMATORY OF CHOICE FOR KIDS

PROPHYLAXIS - must be taken several times a day and chronically to be effective - BAD TASTE

Monoclonal antibody targeted at IgE
-prevents binding to mast cells and basophils

Prevents allergic rxn in pts with moderate to severe asthma

May decrease need for steroids and reduce exacerbations

Methylprednisolone (Medrol)
Prednisone

SIgnificant SE when given long term:

Osteoporosis, Thinning of skin
Hyperglycemia
truncal obesity

RESOLVE WHEN DRUG IS STOPPED