Drugs on asthma and COPD Flashcards
Asthma- bronchodilator
- beta2 agonist
- PDE(phosphodiesterase) inhibitors/ methylxanthines
- muscarinic receptor antagonist/ anti-cholinergics
Asthma- beta 2 agonist
MOA: Gs protein coupled, increase cAMP and smooth muscle relaxation -> bronchodilation
- increase mucociliary clearance by increase ciliary beating
- reduce vascular permeability and oedema
SABA: salbutamol and terbutaline; LABA: salmeterol and formoterol
side effects: tremor, tachycardia, hypokalemia
Tachyphylaxis/ desensitization, downregulation
IV or inhalation
Asthma- PDE inhibitors (second line)
MOA: prevent the breakdown of cAMP
block the adenosine receptor -> bronchodilation and reduce release of histamine
theophylline, aminophylline
Side effects: CNS, CVS (chronotropic and inotropic), diuresis, GI irritations (oral tablets)
Asthma- anticholinergics
MOA: inhibit Ach induced bronnchoconstriction by blocking all muscarinic receptors
reduce the vagal cholinergic tone
reduce mucus secretion
SAMA: ipratropium, LAMA: tiotropium
side effects (inhalation related): dry mouth and irritating cough
Asthma- bronchodilators (second line)
leukotriene pathway modifiers
- cysteinyl leukotriene receptor antagonist: block LTC4, LTD4 to prevent bronchoconstriction e.g. montelukast
- 5-lipoxygenase inhibitors: Zileuton
side effects (oral): diarrhea, vomitting and headache
Asthma- antiflammatory drugs
glucocorticoid
anti-allergic drugs
Asthma- glucocorticoids
MOA: reduce synthesis and release of inflammatory mediators
reduce infiltration and activity of inflammatory cells
reduce vascular permeability and mucosal edema
reduce mucus secretion
increase beta 2 receptor number and responsiveness
Inhalation: fluticasone/budesonide; oral: prednisone; IV: hydrocortisone
side effects: osteoporosis, cataract, glucose intolerance, immunodeficient, cushingoid syndrome
Asthma- anti allergic drug
- mast cell stabiliser: cromolyn sodium (inhalation with inhaltaion side effects)
reduce mast cell degranulation
suppressed the exaggerated neuronal reflex caused by irritant receptors - prophylaxis
Asthma- monoclonal antibodies (biologics, prophylaxis)
anti-IgE monoclonal antibodies: omalizumab (SC injection every 2-4 wk), side effect: anaphylaxis
anti-IL5: mepolizumab (SC or IV)
anti-IL4: dupilumab (SC or IV)
side effect: local reaction, headahce, diarrhea
Combination therapy for asthma
- inhaled ICS + inhaled LABA
controllers: ICS+LABA, LAMA, ICS
relievers: ICS+formoterol, salbutamol
COPD- treatment
beta 2 agonist
muscarinic receptor antagonist
anti-inflammatary drugs
COPD- beta 2 agonist
- ultra long acting: indacaterol
COPD- annticholinergics
ultra long acting: glycopyrrhonium, aclidinium
COPD- anti-inflammtion
glucocorticoid
selective PDE4 inhibitors: roflumilast
theophylline
Combination therapy for COPD
dual therapy: beta + anticholinergic (more useful)/ ICS + LABA (less useful)
triple therapy: ICS + LABA + LAMA
