Drug Therapy: Allergies and Asthma Flashcards
- List the pharmacologic strategies used to modulate allergic inflammatory reactions and describe the rationales for their use.
antihistamines anticholinergic agents Beta 2 agonists corticosteroids luekotriene modifiers mast cell stabilizers methylxanthnes, biologic agents
- List the drugs used to treat acute asthmatic episodes and describe the mechanistic basis for their actions.
rescue medication, typically B2 agonists are used for acute relief of symptoms
- List the drugs used for long-term therapy of chronic asthma and explain the rationale for their use.
corticosteroids used on daily basis to control baseline symptoms by reducing inflammation
- Compile a list of drugs or drug groups that are relatively or absolutely contraindicated for patients with asthma and state their main problems.
B blockers and NSAIDs
Give examples of corticosteriods.
beclomethasone budesonide flunicosone fluticasone triamcinolone mometasone prednisone methylprednisolone
Discuss antihistamine drugs and their role in treating chronic or acute asthma.
1st gen: chlorpheniramine, diphenhydramine
2nd gen: cetirizine, fexofenadine, loratdine
nasal and ocular antihistamines
most effective for allergic rhinitis and as part of anaphylaxis management (no significant benefit in asthma)
cholinergic effects cause drowsiness
Discuss short acting B2 adrenergic agonist drugs and their role in treating chronic or acute asthma.
albuterol, levalbuterol and salbutamol
binds to B2 adrenergic receptors and causes airway smooth muscle relaxation, generally tolerated at recommended doses
tx. of asthma exacerbations (rescue inhaler)
Discuss inhaled/intranasal croticosteroids and their role in treating chronic or acute asthma.
class is the most effective for maintenance treatment strategy for allergic rhinitis and asthma
perform global suppression of inflammatory pathways by modulating cytokines, chemokines, eos. apoptosis, decrease elukotriene production, decrease vascular permeability
Discuss leukotriene and their role in treating chronic or acute asthma.
monteluekast, zafirlukast (inhibitors of leukotriene receptor), zilueton (inhib production of leukotrienes)
tx. as an alternative to inhaled corticosteroids for mild asthma in children (25% patients due better on monteleukast than inhaled corticosteroids)
may be particularly useful for aspirin-sensitive asthma and exercise induced asthma
Discuss long acting B2 adrenergic agonists and their role in treating chronic or acute asthma.
salmeterol, fomoterol
lipophilicity of LABA keeps the drug in the membrane environment longer and allows for longer duration of action (long term exposure down regulates B2 receptor expression on most cells)
Discuss biologics and their role in treating chronic or acute asthma.
omalizumab (anti Ig-E)
humanized monoclonal antibody that recognizes the Fc portion of IgE and preventing binding of IgE
some concern about anaphylactic events associated with omalizumab
Discuss oral corticosteriods and their role in treating chronic or acute asthma.
prednisone, methylprednisone, dexamethasone
these are important by managing acute exacerbations but due to their side effects, maintenance therapy is reserved for patients with severe asthma
toxicity includes mood disturbances, increased appetite, impaired glucose tolerance in diabetics, candidiasis, osteoporosis
Discuss mast cell stabilizers and methylxanthines and their role in treating chronic or acute asthma.
cromolyn (not really used any more as inhaler, not very effective)
methylxanthines- theophylline (related to caffeine) acts as a phosphodiseaterase inhibitor and as antagonist for the adenosine receptor causing relaxation of bronchial smooth muscle (has a really narrow therapeutic index and requires monitoring of serum levels)
