respiratory pharma Flashcards
chromoglate and nedocromil ,actions , usage, eg , MOA, a/d/e and side effects
Sodium chromoglicate
Acts on the cholride channels on the plasma membrane of the mast cells stops the degranulation
Used in powder form for inhalation
PROPHYLAXIS and mainly is used for to reduce rhinitis in older children
To reduce the hyperreactivity
NOT EFFECT ON BRONCHOSPASMS
Irritation in the throat
beta blockers saba ,actions , usage, eg , MOA, a/d/e and side effects
Salbutamol/albuterol,
Terbutaline, metaproterenol, and pirbuterol
Bronchodilation , minimal effect on heart as a result inc rate and force of contraction
Beta2 receptor activation-> adenylate cyclase activation -> Inc cAMP -> inc protein kinase A-> dec MLCK -> dec contraction
Inhale in asthma
IV in severe asthma
3-5 h of effect
Prn (ie pts take it only when feeling uncomfortable )
used to prevent exercise induced asthma, acute asthmatic attack and also in copd
Tremors and tachycardia
Used for the immediate phase and NOT for the delayed phase
beta blockers laba,actions , usage, eg , MOA, a/d/e and side effects
Salmeterol and formoterol.
Ultra long eg indacaterol, olodaterol, vilanterol, and bambuterol
Same as saba
Metabolised by p450
And significant amount lost in feaces
Copd, exercise induced asthma and at night for those who need prolonged bronchodilation
Tremors ,tachycardia, arrhythmias, peripheral vasodilation
COMBINE WITH ICS , BUT CAN ALSO BE USED AS MONOTHERAPY FOR COPD
methyxanthine drugs,actions , usage, eg , MOA, a/d/e and side effects
theophylline (aminophylline i.v.form), theobromine, and caffeine.
Inhibits the phosphodiesterase 4 INHIBITION in INFLAMMATORY CELLS CAN DEC THE RELEASE of MEDIATORS
Orally (sustained release)
Plasma level inc in liver failure, cardiac problem and viral infection and dec during smoking and drinking
2nd line of drug for CHRONIC ASTHMA if b2 agonist don’t work
Aminophylline iv is used for severe asthma attack
STAG
Seizure
Tachycardia
Arrythmia
Gi disturbance
Check plasma levels
Don’t use it with b2 agonist as it may inc the side effects.
leukotrienes pathway inhibitor ,actions , usage, eg , MOA, a/d/e and side effects
Zileuton-> lipoxygenase enzyme inhibitor montelukast and zafirlukast Lt1 receptor inhibitors Two types 5’‐lipoxygenase enzyme inhibitor cys-LT1 receptor blocker Main use in ASPIRIN EXACERBATED RESPIRATOY DISEASE(aerd), 3rd line drug alongside with corticosteroids and b2 agonist for asthma Easy for children
muscuranic blockers ,actions , usage, eg , MOA, a/d/e and side effects
Sama: ipratropium bromide (inhaler)
Lama: tiotropium bromide, glycopyrronium bromide and umeclidinium bromide
Bronchonchodilation by binding to the m3 receptors on the bronchioles
NO EFFECT ON LATE PHASE
Competitive antagonism
Inhalation
For asthma : b agonist + muscuranic receptor antagonist +cortecosteroids
Lama is now the drug of choice for COPD
Given to pts with beta 2 agonist intolerance
due to the long tiem taken for its activation (sama) it has now been replaced by lama
Combining muscuranic antagonist and beta agonist is very useful as it can reduce the dosage of the drug
corticosteroids ,actions , usage, eg , MOA, a/d/e and side effects
triamcinolone, flunisolide, budesonide, fluticasone, mometasone and ciclesonide
No effect on immediate phase
Reduces the hypersensitivity and inflammation
Reduces the inflammatory mediators and chemotaxis
Full action takes weeks dose given by inhalation (most commonly)
Iv glucocorticoid in status asthmaticus and used in combination therapy (eg laba/corticosteroids)
Hoarse voice and thrush (to remove thrush the pts are told to wash their mouths after intaking corticosteroids as inhalers)
Prolonged dosage leads to adrenal suppression
MAB ,actions , usage, eg , MOA, a/d/e and side effects
Omalizumab
Reduces the plasma ige levels and thus preventing it from binding to the mast cell
Subq dosage with a gap of 2-4 weeks
Given If the asthma is not controlled by beta agonist or corticosteroids
Hypersensitivity
