Lesson 2: Mucolytics, Corticosteroids, & Nonsteroidal Antiasthma Drugs Flashcards
What diseases use mucolytics?
CF, chonic bronchitis, PNA, asthma, and bronchectasis
3 FDA approved mucoactive agents
N-acetylcyseine: Mucomyst
Dornase Alfa: Pulmozyme
Hypersmoler saline: Hypertonic saline
What are the two doses for mucomyst
10% or 20%
SVN: 3-5 mL
What is the dose for Dornase Alfa
2.5 mg QD
What are the side affects associated with Dornase Alfa
Voice alteration, pharyngitis, rash, chest pain
What is the dose for hypertonic saline
7% for sputum induction
Note: 0.9% is normal saline
What are the contraindications of mucolytics
Profound airway compromise: FEV1 <25% predicted
Severely compromised: Vital capacity, expiratory flow
Inability to protect airway
What steroids are naturally secreted by the adrenal glands, and what do they do?
Cortisol: Circadian rhythm, stress hormone
Aldosterone: regulates body water by increasing sodium reabsorption in renal tubules
Androgens and estrogens: sex hormones
What does administering steroidal drugs supress?
naturally occurring steroids (adrenal supression)
Indications for corticosteroids
Maintenance therapy of asthma and severe COPD
Control of allergic and nonallergic rhinitis
What step is corticosteroids indicated in the asthma guidelines?
Step 2
What is the HPAA control?
Hypothalamic - pituitary - adrenal axis: body’s feedback mechanism for controlling the production of corticosteroids
Plays large role in times of stress
What is the main purpose of cortisol
Helps mobilize glucose for energy
What must you do before discontinuing steroid tx
Must taper dosage of steroids to allow for body to being producing steroids naturally
Why does steroid diabetes happen?
Corticosteroids make the liver less sensitive to insulin, so it continues to make glucose with high levels of insulin.
It also reduces the ability of muscle and fats to absorb glucose for use.
Why does corticosteroids cause muscle wasting
Causes a breakdown of protein stores
Low doses and low systemic distribution, inhaled corticosteroids do not usually see muscle wasting and diabetes as side effects
Why does corticosteroids cause overall increase in white cell count
Demargination: causes a depletion of neutrophil stores reduces their accumulation at inflammatory sites and in exudates.
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What are the 3 groups of non steroidal anti asthma meds
Cromolyn like drugs (mast cell stabilizers)
Antileukotrienes
Monoclonal antibodies
What step is NSAAD used in regards to asthma managment
Step 2
What are the mediators of inflammation that allergic stimuli trigger IgE-mediated cells to release
Leukotrienes
Histamines
Cytokines
What does cromolyn sodium inhibit?
Degranulation of mast cells in response to allergic and non allergic stimuli
Prevents release of histamine, etc
Leukotrienes cause problems with what?
Bronchoconstriction, mucus secretion, vascular permeability, and plasma exudation into airway
What are the three types of antileukotrienes
5-LO inhibitor: Zileuton (Zyflo)
Leukotriene receptor antagonist:
Zafirlukast (Accolate)
Montelukast (Singulair)
What antileukotrienes were approved for pediatric dosing
Montelukast
What are disadvantages of antileukotrienes
Unknown long term toxicity
Effective in 50-70% of patients
No predictor of who will respond
What are the 4 types of monoclonal antibodies
Omalizumab (Xolair)
Benralizumab (Faserna)
Mepolizumab (Nucala)
Relizumab (Cinqair)
How does Omalizumab (Xolair) work
Inhibits attachment of IgE to mast cells and basophils, reducing release of chemical mediators of allergic response
How does Benralizumab (Faserna), Mepolizumab (Nucala), Relizumab (Cinqair) work?
Blocks interleukin-5 (IL-5) changing the signaling of IL-5 reducing eosinophils
What is the route of admin for monoclonal antibodies
Parenteral
What is the side effects of monoclonal antibodies
Most severe is anaphylaxis
