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PHARMA-Anti inflammatory drugs


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  • 1. Anti-Inflammatory DrugsSteroids and NSAIDs RC 195
  • 2. Corticosteroids, “Steroids”Naturally-occurring hormones produced by the adrenal glands Glucocorticoids: Hydrocortisone Mineralcorticoids: Aldosterone Sex Hormones: Testosterone
  • 3. Actions of GlucocorticoidsAnti-inflammatory– Supresses actions of kinins, cytokines, and other mediators of inflammation • Maintains microcirculation and minimizes edema • Maintains cell membrane integrity • Inhibits macrophage movementInhibition of immune response– Stabilizes mast cells– Reduces histamine levelsBronchodilation– Potentiates catecholamine activity by inhibiting COMT and increasing adenyl cyclase production– Decreased cholinergic and alpha stimulation– Decreased phosphodiesterase production
  • 4. Steroid UsesAcute InflammationOrgan TransplantAllergic Inflammation
  • 5. Steroid Side Effects: “Cushing’s Syndrome”GluconeogenesisOsteoporosis Increased gastric acidityPhysical changes Decreased resistance to– Increased fat production and infection redistribution – MDI may cause candida– Acne albicans, “thrush”– Hirsutism – Patients need to rinse mouth– Fragile skin after MDISodium retention Dependency– Fluid retention – Both physical and– Potassium loss and metabolic psychological alkalosis • Patients may need to be weaned from steroid therapy
  • 6. Interaction with other drugsIncreased breakdown in the presence of:– Dilantin, barbiturates, certain tranquilizers, anti- histamines, ephedrineDecreased breakdown (and greater chance ofsevere side effects) in the presence of someantibiotics, eg erythromycin
  • 7. Steroids in Respiratory CareFor prevention of inflammation – aerosol For relief of inflammation: systemic
  • 8. HydrocortisoneBrand name(s): Solu-Cortef, CortefGiven orally or IVNot usually aerosolized because of side effects
  • 9. Prednisone (Prednisolone)Brand: Deltasone, Delta-Cortef4X as potent as hydrocortisoneGiven orally– Side effects minimized if given every other day– Patient’s usually need to be weaned from it
  • 10. MethylprednisoloneBrand: Solu-MedrolOral or IV– Often used to help relieve airway inflammation
  • 11. TriamcinoloneBrands: Azmacort, KenalogMDI- to prevent airway inflammation
  • 12. DexamethasoneBrand: DecadronOften nebulized for acute upper airwayinflammation– What else is used with it?
  • 13. BeclomethasoneBrands: Vanceril, Beclovent, BecotideMDI– to prevent airway inflammation
  • 14. Mometasone FuroateBrand: AsmanexDPI “Twisthaler” 220mcg per pffStarted as one puff per day in then evening andmay go as high two puffs BID
  • 15. FlunisolideBrand: AeroBidMDI – to prevent airway inflammationUsually effective when given only BID
  • 16. FluticasoneBrand: FloventMDI (similar to Flunisolide)Fluticasone is also sold as a combo drug,Advair, which contains fluticasone andsalmeterol– Taken as a dry powder inhaler (DPI)
  • 17. BudesonideBrand: PulmicortMDI – to prevent airway inflammationSeems to get best effects with minimal sideeffects
  • 18. NSAIDsDrugs that prevent airway inflammationbut usually have less side effects thansteroids
  • 19. Cromolyn SodiumBrands: Intal, AaraneIs a mast cell stabilizer so used to prevent airwayinflammation– Does not relieve airway inflammation!Often used as an alternative to aerosol steroids inchildrenAdministered via Spinhaler (DPI), MDI, nebulizer– Usually needs to be administered Q.I.D.– May take at least two weeks before any effects are seen
  • 20. Nedocromil SodiumBrand: TiladeSimilar to cromolyn sodium (used to preventairway inflammation)MDI – usually only needed B.I.D.
  • 21. NSAIDs: Leukotriene Inhibitors (used to prevent airway inflammation)Zafirlukast (Accolate)– Taken as a pill B.I.D.Zileuton (Zyflo)– Taken as a pill Q.I.D.Montelukast (Singulair)– Taken as a pill just once a day
  • 22. NSAIDs: Omalizumab (Xolair)Genetically engineered recombinant humanizedmonoclonal antibodyBinds to IgE and prevents it from attaching tomast cellsGiven sub-Q 1-2 times per month
  • 23. Case Study Time!