This document provides an overview of drugs used to treat various respiratory disorders. It focuses on preferred and alternative drugs for treating asthma. The preferred drugs discussed are inhaled beta-2 agonists like albuterol for quick relief of symptoms and long-acting beta-2 agonists like salmeterol as long-term controllers. Inhaled corticosteroids are identified as the long-term controllers of choice. Alternative drugs mentioned include leukotriene modifiers, cromolyn, anticholinergics, theophylline, and monoclonal antibodies. The document reviews the mechanisms of action, indications, and side effects of these drug classes.
This document discusses respiratory pharmacology and drugs used to treat disorders of the respiratory system. It begins with an overview of the respiratory system and process of respiration. The main focus is on pharmacotherapy for bronchial asthma, including bronchodilators like beta-2 agonists, methylxanthines, muscarinic receptor antagonists, and corticosteroids. Other topics covered include mast cell stabilizers, treatment of status asthmaticus, anti-tussives, decongestants, bronchitis, and treatment of the common cold.
Bronchial asthma is a chronic inflammatory airway disease characterized by wheezing, breathlessness, and coughing. Allergens like dust or pollen can trigger an immune response releasing inflammatory mediators from mast cells that cause bronchospasm and obstruction. Asthma treatments include short-acting beta-2 agonists for acute symptoms, inhaled corticosteroids as primary treatment to reduce inflammation, and other drugs that dilate airways or block inflammatory pathways like leukotriene receptors. Managing asthma requires identifying and avoiding triggers while maintaining treatment to prevent symptoms and exacerbations.
Pharmacological agents in bronchial asthma and copdDr. Marya Ahsan
This document provides an overview of pharmacological agents used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It discusses the classification, mechanisms of action, and side effects of various drugs including bronchodilators, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, monoclonal antibodies, and other agents. Treatment guidelines are also presented, outlining a stepwise approach for asthma management and algorithms for acute asthma exacerbations.
This document discusses pulmonary pharmacology, focusing on asthma treatment. It begins by outlining the pathophysiology of asthma, involving mast cell activation and inflammation. It then classifies different types of asthma drugs, including bronchodilators like beta-2 agonists, methylxanthines, and muscarinic antagonists. It also discusses corticosteroids' mechanism of reducing inflammation. The document provides details on drug classes, specific medications, dosages, and side effects for treating both acute and chronic asthma, as well as other respiratory conditions like cough.
DRUGS USED IN THE TREATMENT OF BRONCHIAL ASTHMA AND COPD
Characterized by hyper responsiveness of bronchial smooth muscle to a variety of stimuli”
Resulting in:
Narrowing of air ways
Increased secretion
Mucosal edema
Mucus plugging
This document discusses respiratory pharmacology and drugs used to treat disorders of the respiratory system. It begins with an overview of the respiratory system and process of respiration. The main focus is on pharmacotherapy for bronchial asthma, including bronchodilators like beta-2 agonists, methylxanthines, muscarinic receptor antagonists, and corticosteroids. Other topics covered include mast cell stabilizers, treatment of status asthmaticus, anti-tussives, decongestants, bronchitis, and treatment of the common cold.
Bronchial asthma is a chronic inflammatory airway disease characterized by wheezing, breathlessness, and coughing. Allergens like dust or pollen can trigger an immune response releasing inflammatory mediators from mast cells that cause bronchospasm and obstruction. Asthma treatments include short-acting beta-2 agonists for acute symptoms, inhaled corticosteroids as primary treatment to reduce inflammation, and other drugs that dilate airways or block inflammatory pathways like leukotriene receptors. Managing asthma requires identifying and avoiding triggers while maintaining treatment to prevent symptoms and exacerbations.
Pharmacological agents in bronchial asthma and copdDr. Marya Ahsan
This document provides an overview of pharmacological agents used to treat bronchial asthma and chronic obstructive pulmonary disease (COPD). It discusses the classification, mechanisms of action, and side effects of various drugs including bronchodilators, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, monoclonal antibodies, and other agents. Treatment guidelines are also presented, outlining a stepwise approach for asthma management and algorithms for acute asthma exacerbations.
This document discusses pulmonary pharmacology, focusing on asthma treatment. It begins by outlining the pathophysiology of asthma, involving mast cell activation and inflammation. It then classifies different types of asthma drugs, including bronchodilators like beta-2 agonists, methylxanthines, and muscarinic antagonists. It also discusses corticosteroids' mechanism of reducing inflammation. The document provides details on drug classes, specific medications, dosages, and side effects for treating both acute and chronic asthma, as well as other respiratory conditions like cough.
DRUGS USED IN THE TREATMENT OF BRONCHIAL ASTHMA AND COPD
Characterized by hyper responsiveness of bronchial smooth muscle to a variety of stimuli”
Resulting in:
Narrowing of air ways
Increased secretion
Mucosal edema
Mucus plugging
This document provides an overview of asthma and COPD, including definitions, pathophysiology, classification of drugs, and treatment approaches. Asthma is defined as reversible airway obstruction due to inflammation, while COPD involves irreversible airway obstruction. For acute asthma attacks, short-acting beta-2 agonists are used, while maintenance therapy includes inhaled corticosteroids and long-acting beta-2 agonists. Severe acute asthma requires hospitalization. COPD is treated with bronchodilators and may involve long-term oxygen therapy. The key difference between the two is reversibility of airway obstruction.
The document discusses pharmacology of the respiratory system. It covers drug therapy for pulmonary disorders like asthma, COPD, cough, and allergic rhinitis. For asthma, beta-2 agonists, methylxanthines, corticosteroids, and mast cell stabilizers are discussed. COPD drug therapy focuses on inhaled bronchodilators. Antihistamines and corticosteroids are used for allergic rhinitis. Cough can be productive or dry, and each is treated differently.
This document summarizes recent advances in the pharmacotherapy of bronchial asthma. It discusses improvements to inhaled corticosteroids like ciclesonide that have fewer systemic side effects. New drug classes like phosphodiesterase inhibitors (roflumilast), monoclonal antibodies targeting cytokines like omalizumab (anti-IgE), mepolizumab (anti-IL5), and dupilumab (anti-IL4) are described. Long acting beta agonists (LABAs) and their combination with inhaled corticosteroids in single inhalers are covered. Novel bronchodilators involving ion channels and peptides are mentioned. Overall the document provides an overview of guideline-based management and new targeted bi
Asthma is characterized by acute episodes of bronchospasm caused by underlying airway inflammation and bronchial hyperreactivity. Treatment involves controllers like inhaled corticosteroids and relievers for exacerbations like short-acting beta-2 agonists. Other agents used include methylxanthines, muscarinic antagonists, leukotriene inhibitors, and glucocorticoids. Rhinitis involves nasal congestion from inflammation while cough is produced by irritation of the cough center. Both are treated with antihistamines, decongestants, inhaled corticosteroids, antitussives, expectorants and mucolytics.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to mediators released from mast cells. The main classes of drugs used to treat asthma are then summarized: bronchodilators like beta-2 agonists relieve bronchospasm, while anti-inflammatories like corticosteroids control the underlying inflammation. The mechanisms and uses of representative bronchodilators like epinephrine and beta-2 agonists are then outlined, along with their adverse effects and how tolerance can develop.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to release of mediators from mast cells. Drugs used to treat asthma are classified as bronchodilators or anti-inflammatories. Bronchodilators work by relaxing airway smooth muscle through stimulation of beta-2 receptors or inhibition of muscarinic receptors. Corticosteroids are the most important anti-inflammatory drugs for long-term asthma control by suppressing the inflammatory process in the airways. The document then focuses on specific bronchodilator drugs like epinephrine, isoproterenol, and beta
8.drugs affecting on respiratory systemLama K Banna
1. The document discusses drugs used to treat respiratory conditions like asthma. It describes different classes of drugs including bronchodilators, anti-inflammatory steroids, mast cell stabilizers, leukotriene pathway inhibitors, and monoclonal antibodies.
2. Bronchodilators like beta-2 agonists and anticholinergics work to relax airway smooth muscle and provide quick relief from bronchoconstriction. Anti-inflammatory steroids have multiple mechanisms but work to reduce inflammation in the airways.
3. Mast cell stabilizers like cromolyn sodium inhibit the release of inflammatory mediators from mast cells to prevent allergic responses while leukotriene inhibitors block the leukotriene
Asthma medications aim to reduce airway inflammation, prevent bronchoconstriction, and minimize symptoms. Common classes include bronchodilators like albuterol, anti-inflammatory corticosteroids, and leukotriene inhibitors like montelukast. Severe asthma may be treated with biologics targeting immunoglobulin E, interleukin-5, or the interleukin-4 receptor. Proper inhaler technique allows targeted delivery of medications to the airways.
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is caused by constriction and inflammation of the bronchial airways. The document discusses various drugs used to treat asthma, categorized as bronchodilators and anti-inflammatory drugs. Bronchodilators such as beta-2 agonists, methylxanthines, and muscarinic antagonists work to relax smooth muscle in the airways. Anti-inflammatory drugs such as corticosteroids, leukotriene receptor antagonists, and 5-lipoxygenase inhibitors work to reduce inflammation in the airways. The long-term goals of treatment
This document provides an overview of pharmacology related to the respiratory system. It begins by outlining the contents to be covered, including drugs for asthma, COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then delves into detailed descriptions of asthma pathogenesis and treatment, characteristics of COPD, and principles and specific treatments for COPD management, with a focus on the roles and mechanisms of bronchodilators, corticosteroids, methylxanthines, leukotriene antagonists, and other emerging targeted therapies.
This document provides information about drugs used to treat respiratory conditions like asthma and COPD. It begins by outlining the contents to be covered, which include anti-asthmatic drugs, drugs for COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then discusses the pathogenesis and treatment of asthma in detail. It describes the classes of drugs used for asthma including bronchodilators, corticosteroids, leukotriene antagonists, and monoclonal antibody treatment. The principles and specific drugs for managing COPD are also outlined.
pharmacothrapy of asthma.pptxBronchial asthma is a chronic respiratory diseas...AbhishekKumarGupta86
pharmacotherpy of asthma M pharm 2nd sem.
Bronchial asthma is a chronic respiratory disease characterized by inflammation and narrowing of airways in the lungs, which cause difficulty in breathing.
Symptoms can include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment.
Asthma affected an estimated 262 million people in 2019 (1) and caused 455 000 deaths.
This document provides an overview of asthma management. It defines asthma as a disease characterized by episodic airway obstruction, airway hyperresponsiveness, and usually eosinophilic airway inflammation. Common manifestations include shortness of breath, wheezing, cough, chest tightness and mucus production in relation to triggers. The diagnosis is based on patient history, physical exam, pulmonary function tests showing reversibility and airway responsiveness testing. Treatment involves reducing triggers, medications to provide rapid relief of symptoms like SABAs, and controllers to reduce inflammation like ICSs alone or in combination with LABAs. The goals of treatment are to control symptoms and exacerbations.
This chapter discusses pharmacologic management of stable COPD. It identifies the main drug classes used: bronchodilators including beta-2 agonists and anticholinergics, corticosteroids, and antibiotics. The chapter reviews the benefits and side effects of these drugs and notes guidelines have differing recommendations due to a lack of scientific evidence. Noncompliance with drug therapy is also addressed.
Hakeem khan presented on asthma. Key points include:
1. Asthma is a chronic inflammatory disorder of the airways characterized by wheezing, coughing, and shortness of breath.
2. It is caused by factors like allergies, environment, emotions, and drugs.
3. Clinical features include coughing, wheezing, tightness in the chest, and labored breathing.
4. Treatment involves short-acting bronchodilators for relief of symptoms and long-acting controllers like inhaled corticosteroids to reduce inflammation.
1. The document discusses various medications used to treat respiratory conditions like asthma and COPD. It describes different classes of bronchodilators including beta-2 agonists, anticholinergics, and methylxanthines.
2. Within each class, it outlines specific short-acting and long-acting medications. For beta-2 agonists, it discusses SABAs, LABAs, and ultra-LABAs. For anticholinergics it covers SAMAs and LAMAs.
3. The document also discusses the use of inhaled corticosteroids and other biologic therapies to treat asthma. It provides an overview of GINA treatment guidelines which use a stepwise approach to
Asthma and classification and its mechanism and dosage ganeshpayyavula8
This document provides an overview of asthma, including its pathophysiology, signs and symptoms, causes, and treatment options. Asthma is a chronic inflammatory disease of the airways characterized by bronchial smooth muscle constriction and obstruction of airflow. The main symptoms include wheezing, coughing, chest tightness, and shortness of breath. It can be caused by both genetic and environmental factors such as allergens and irritants. Treatment involves bronchodilators to relieve symptoms, anti-inflammatory drugs to reduce inflammation, and other drugs targeting specific inflammatory pathways.
Asthma is a chronic inflammatory disease of the airways that causes periodic obstruction of airflow. The document outlines the pharmacological basis for treating asthma, including the pathophysiology and various drug classes used. The main drug classes used are bronchodilators like beta-2 agonists, corticosteroids, leukotriene modifiers, and monoclonal antibodies. Treatment is aimed at preventing symptoms, exacerbations, and maintaining normal lung function and activity levels.
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This document provides an overview of asthma and COPD, including definitions, pathophysiology, classification of drugs, and treatment approaches. Asthma is defined as reversible airway obstruction due to inflammation, while COPD involves irreversible airway obstruction. For acute asthma attacks, short-acting beta-2 agonists are used, while maintenance therapy includes inhaled corticosteroids and long-acting beta-2 agonists. Severe acute asthma requires hospitalization. COPD is treated with bronchodilators and may involve long-term oxygen therapy. The key difference between the two is reversibility of airway obstruction.
The document discusses pharmacology of the respiratory system. It covers drug therapy for pulmonary disorders like asthma, COPD, cough, and allergic rhinitis. For asthma, beta-2 agonists, methylxanthines, corticosteroids, and mast cell stabilizers are discussed. COPD drug therapy focuses on inhaled bronchodilators. Antihistamines and corticosteroids are used for allergic rhinitis. Cough can be productive or dry, and each is treated differently.
This document summarizes recent advances in the pharmacotherapy of bronchial asthma. It discusses improvements to inhaled corticosteroids like ciclesonide that have fewer systemic side effects. New drug classes like phosphodiesterase inhibitors (roflumilast), monoclonal antibodies targeting cytokines like omalizumab (anti-IgE), mepolizumab (anti-IL5), and dupilumab (anti-IL4) are described. Long acting beta agonists (LABAs) and their combination with inhaled corticosteroids in single inhalers are covered. Novel bronchodilators involving ion channels and peptides are mentioned. Overall the document provides an overview of guideline-based management and new targeted bi
Asthma is characterized by acute episodes of bronchospasm caused by underlying airway inflammation and bronchial hyperreactivity. Treatment involves controllers like inhaled corticosteroids and relievers for exacerbations like short-acting beta-2 agonists. Other agents used include methylxanthines, muscarinic antagonists, leukotriene inhibitors, and glucocorticoids. Rhinitis involves nasal congestion from inflammation while cough is produced by irritation of the cough center. Both are treated with antihistamines, decongestants, inhaled corticosteroids, antitussives, expectorants and mucolytics.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to mediators released from mast cells. The main classes of drugs used to treat asthma are then summarized: bronchodilators like beta-2 agonists relieve bronchospasm, while anti-inflammatories like corticosteroids control the underlying inflammation. The mechanisms and uses of representative bronchodilators like epinephrine and beta-2 agonists are then outlined, along with their adverse effects and how tolerance can develop.
This document discusses drugs used to treat respiratory diseases like asthma. It begins by describing the clinical features and pathophysiology of asthma, which involves chronic airway inflammation and bronchospasm due to release of mediators from mast cells. Drugs used to treat asthma are classified as bronchodilators or anti-inflammatories. Bronchodilators work by relaxing airway smooth muscle through stimulation of beta-2 receptors or inhibition of muscarinic receptors. Corticosteroids are the most important anti-inflammatory drugs for long-term asthma control by suppressing the inflammatory process in the airways. The document then focuses on specific bronchodilator drugs like epinephrine, isoproterenol, and beta
8.drugs affecting on respiratory systemLama K Banna
1. The document discusses drugs used to treat respiratory conditions like asthma. It describes different classes of drugs including bronchodilators, anti-inflammatory steroids, mast cell stabilizers, leukotriene pathway inhibitors, and monoclonal antibodies.
2. Bronchodilators like beta-2 agonists and anticholinergics work to relax airway smooth muscle and provide quick relief from bronchoconstriction. Anti-inflammatory steroids have multiple mechanisms but work to reduce inflammation in the airways.
3. Mast cell stabilizers like cromolyn sodium inhibit the release of inflammatory mediators from mast cells to prevent allergic responses while leukotriene inhibitors block the leukotriene
Asthma medications aim to reduce airway inflammation, prevent bronchoconstriction, and minimize symptoms. Common classes include bronchodilators like albuterol, anti-inflammatory corticosteroids, and leukotriene inhibitors like montelukast. Severe asthma may be treated with biologics targeting immunoglobulin E, interleukin-5, or the interleukin-4 receptor. Proper inhaler technique allows targeted delivery of medications to the airways.
Asthma is a chronic inflammatory disease of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. It is caused by constriction and inflammation of the bronchial airways. The document discusses various drugs used to treat asthma, categorized as bronchodilators and anti-inflammatory drugs. Bronchodilators such as beta-2 agonists, methylxanthines, and muscarinic antagonists work to relax smooth muscle in the airways. Anti-inflammatory drugs such as corticosteroids, leukotriene receptor antagonists, and 5-lipoxygenase inhibitors work to reduce inflammation in the airways. The long-term goals of treatment
This document provides an overview of pharmacology related to the respiratory system. It begins by outlining the contents to be covered, including drugs for asthma, COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then delves into detailed descriptions of asthma pathogenesis and treatment, characteristics of COPD, and principles and specific treatments for COPD management, with a focus on the roles and mechanisms of bronchodilators, corticosteroids, methylxanthines, leukotriene antagonists, and other emerging targeted therapies.
This document provides information about drugs used to treat respiratory conditions like asthma and COPD. It begins by outlining the contents to be covered, which include anti-asthmatic drugs, drugs for COPD, expectorants, nasal decongestants, and respiratory stimulants. The document then discusses the pathogenesis and treatment of asthma in detail. It describes the classes of drugs used for asthma including bronchodilators, corticosteroids, leukotriene antagonists, and monoclonal antibody treatment. The principles and specific drugs for managing COPD are also outlined.
pharmacothrapy of asthma.pptxBronchial asthma is a chronic respiratory diseas...AbhishekKumarGupta86
pharmacotherpy of asthma M pharm 2nd sem.
Bronchial asthma is a chronic respiratory disease characterized by inflammation and narrowing of airways in the lungs, which cause difficulty in breathing.
Symptoms can include coughing, wheezing, shortness of breath and chest tightness. These symptoms can be mild or severe and can come and go over time.
Although asthma can be a serious condition, it can be managed with the right treatment.
Asthma affected an estimated 262 million people in 2019 (1) and caused 455 000 deaths.
This document provides an overview of asthma management. It defines asthma as a disease characterized by episodic airway obstruction, airway hyperresponsiveness, and usually eosinophilic airway inflammation. Common manifestations include shortness of breath, wheezing, cough, chest tightness and mucus production in relation to triggers. The diagnosis is based on patient history, physical exam, pulmonary function tests showing reversibility and airway responsiveness testing. Treatment involves reducing triggers, medications to provide rapid relief of symptoms like SABAs, and controllers to reduce inflammation like ICSs alone or in combination with LABAs. The goals of treatment are to control symptoms and exacerbations.
This chapter discusses pharmacologic management of stable COPD. It identifies the main drug classes used: bronchodilators including beta-2 agonists and anticholinergics, corticosteroids, and antibiotics. The chapter reviews the benefits and side effects of these drugs and notes guidelines have differing recommendations due to a lack of scientific evidence. Noncompliance with drug therapy is also addressed.
Hakeem khan presented on asthma. Key points include:
1. Asthma is a chronic inflammatory disorder of the airways characterized by wheezing, coughing, and shortness of breath.
2. It is caused by factors like allergies, environment, emotions, and drugs.
3. Clinical features include coughing, wheezing, tightness in the chest, and labored breathing.
4. Treatment involves short-acting bronchodilators for relief of symptoms and long-acting controllers like inhaled corticosteroids to reduce inflammation.
1. The document discusses various medications used to treat respiratory conditions like asthma and COPD. It describes different classes of bronchodilators including beta-2 agonists, anticholinergics, and methylxanthines.
2. Within each class, it outlines specific short-acting and long-acting medications. For beta-2 agonists, it discusses SABAs, LABAs, and ultra-LABAs. For anticholinergics it covers SAMAs and LAMAs.
3. The document also discusses the use of inhaled corticosteroids and other biologic therapies to treat asthma. It provides an overview of GINA treatment guidelines which use a stepwise approach to
Asthma and classification and its mechanism and dosage ganeshpayyavula8
This document provides an overview of asthma, including its pathophysiology, signs and symptoms, causes, and treatment options. Asthma is a chronic inflammatory disease of the airways characterized by bronchial smooth muscle constriction and obstruction of airflow. The main symptoms include wheezing, coughing, chest tightness, and shortness of breath. It can be caused by both genetic and environmental factors such as allergens and irritants. Treatment involves bronchodilators to relieve symptoms, anti-inflammatory drugs to reduce inflammation, and other drugs targeting specific inflammatory pathways.
Asthma is a chronic inflammatory disease of the airways that causes periodic obstruction of airflow. The document outlines the pharmacological basis for treating asthma, including the pathophysiology and various drug classes used. The main drug classes used are bronchodilators like beta-2 agonists, corticosteroids, leukotriene modifiers, and monoclonal antibodies. Treatment is aimed at preventing symptoms, exacerbations, and maintaining normal lung function and activity levels.
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Respiratory Disorders Physiology Presentation by group 1 .pptx
1. WELCOME TO
Course Title: Pharmacology
Lecture Topic: Respiratory Disorders
Submitted to: Ma'am Rizwana Raheel
Submitted by: Group#1
Abera Siddique Ahtisham Farzand
Rimsha Waqar M. Umer
Sumbul Israr
2. LEARNING OUTCOMES:
Prefered Drugs Used To Treat Asthma.
Alternative Drugs Used To Treat Asthma.
Drugs Used To Treat Chronic Obstructive Pulmonary Disease.
Drugs Used To Treat Allergic Rhinitis.
Drugs Used To Treat Cough.
3. PREFERRED DRUGS USED TO TREAT ASTHMA
A. Goals of therapy:
Drug therapy for long-term control of asthma is designed to reverse and prevent airway
inflammation. The goals of asthma therapy are to decrease the intensity and frequency of
asthma symptoms, prevent future exacerbations, and minimize limitations in activity related to
asthma symptoms. First-line drug therapy based on classification of asthma is presented in
Figure 39.3.
Lippincott Illustrated Review Pharmacology 7th Edition
6. CONTINUE…
B. β2 -Adrenergic agonists
Inhaled β2 -adrenergic agonists directly relax airway smooth muscle. They are used for the
quick relief of asthma symptoms, as well as adjunctive therapy for long-term control of the
disease.
1. Quick relief:
Short-acting β2 agonists (SABAs) have a rapid onset of action (5 to 30 minutes) and provide
relief for 4 to 6 hours.
Lippincott Illustrated Review Pharmacology 7th Edition
7. CONTINUE…
They are used for symptomatic treatment of bronchospasm, providing quick relief of acute
bronchoconstriction. All patients with asthma should receive a SABA inhaler for use as needed.
β2 agonists have no anti-inflammatory effects, and they should not be used as monotherapy for
patients with persistent asthma. Monotherapy with SABAs may be appropriate for patients
with mild, intermittent asthma or exercise-induced bronchospasm.
Lippincott Illustrated Review Pharmacology 7th Edition
8. CONTINUE…
Direct acting β2-selective agonists include a/buterol [ai-BYOO-ter-all] and levalbuterol [leh-
vai-BYOO-ter-all]. These agents provide significant bronchodilation with little of the undesired
effect of a or β2 stimulation. Adverse effects, such as tachycardia, hyperglycemia,
hypokalemia, hypomagnesemia, and β2- mediated skeletal muscle tremors are minimized with
inhaled delivery versus systemic administration.
Lippincott Illustrated Review Pharmacology 7th Edition
9. CONTINUE…
2. Long-term control:
Salmeterol [sai-MEE-ter-all] and formoterol [for-MOE-ter-all] are long-acting β2-agonists
(LABAs) and chemical analogs of albuterol. Salmeterol and formoterol have a long duration of
action, providing bronchodilation for at least 12 hours. Use of LABA monotherapy is
contraindicated, and LABAs should be used only in combination with an asthma controller
medication, such as an inhaled corticosteroid (ICS).
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10. ICS remain the long-term controllers of choice in asthma, and LABAs are considered to be
useful adjunctive therapy for attaining control in moderate to severe asthma. Some LABAs are
available as a combination product with an ICS (see Figure 39.1 ). Although both LABAs are
usually used on a scheduled basis to control asthma, adults and adolescents with moderate
persistent asthma can use the ICS/formoterol combination for relief of acute symptoms.
Adverse effects of LABAs are similar to quick-acting β2-agonists.
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11. C. Corticosteroids
ICS are the drugs of choice for long-term control in patients with persistent asthma (Figure
39.3). Corticosteroids inhibit the release of arachidonic acid through inhibition of
phospholipase A2 thereby producing direct anti-inflammatory properties in the airways (Figure
39.4). To be effective in controlling inflammation, these agents must be used regularly.
Treatment of exacerbations or severe persistent asthma may require the addition of a short
course of oral or intravenous corticosteroids.
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14. Actions on lung:
ICS therapy directly targets underlying airway inflammation by decreasing the inflammatory
cascade (eosinophils, macrophages, and T lymphocytes), reversing mucosal edema, decreasing
the permeability of capillaries, and inhibiting the release of leukotrienes. After several months
of regular use, ICS reduce the hyperresponsiveness of the airway smooth muscle to a variety of
bronchoconstrictor stimuli, such as allergens, irritants, cold air, and exercise.
Lippincott Illustrated Review Pharmacology 7th Edition
15. Ill. ALTERNATIVE DRUGS USED TO TREAT ASTHMA
These drugs are useful for treatment of asthma in patients who are poorly controlled by
conventional therapy or experience adverse effects secondary to corticosteroid treatment. These
drugs should be used in conjunction with ICS therapy for most patients.
A. Leukotriene modifiers:
Leukotrienes (LT) 84 and the cysteinylleukotrienes, LTC4, LTD4, and LTE4, are products of
the 5-lipoxygenase pathway of arachidonic acid metabolism and part of the inflammatory
cascade.
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16. CONTINUE…
5-Lipoxygenase is found in cells of myeloid origin, such as mast cells, basophils, eosinophils,
and neutrophils. LTB4 is a potent chemoattractant for neutrophils and eosinophils, whereas the
cysteinyl leukotrienes constrict bronchiolar smooth muscle, increase endothelial permeability,
and promote mucus secretion. Zileuton [zye-LOO-ton] is a selective and specific inhibitor of 5-
lipoxygenase, preventing the formation of both LTB4 and the cysteinylleukotrienes.
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17. CONTINUE…
Zafirlukast [za-FIR-Ioo-kast] and montelukast [mon-te-LOO-kast] are selective antagonists of
the cysteinyl leukotriene-1 receptor, and they block the effects of cysteinyl leukotrienes (Figure
39.4). These agents are approved for the prevention of asthma symptoms. They should not be
used in situations where immediate bronchodilation is required. Leukotriene receptor
antagonists have also shown efficacy for the prevention of exerciseinduced bronchospasm.
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18. CONTINUE…
Pharmacokinetics:
These agents are orally active and highly protein bound. Food impairs the absorption of
zafirlukast. The drugs undergo extensive hepatic metabolism. Zileuton and its metabolites are
excreted in urine, whereas zafirlukast, montelukast, and their metabolites undergo biliary
excretion.
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19. CONTINUE…
B. Cromolyn:
Cromolyn [KRO-moe-lin] is a prophylactic anti-inflammatory agent that inhibits mast cell
degranulation and release of histamine. It is analternative therapy for mild persistent asthma
and is available as a nebulized solution. Because cromolyn is not a bronchodilator, it is not
useful in managing an acute asthma attack. Due to its short duration of action, this agent
requires dosing three or four times daily, which affects adherence and limits its use. Adverse
effects are minor and include cough, irritation, and unpleasant taste.
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20. CONTINUE…
C. Cholinergic antagonists
The anticholinergic agents block vagally mediated contraction of airway smooth muscle and
mucus secretion (see Chapter 5). Inhaled ipratropium [IP-ra-TROE-pee-um], a short-acting
quaternary derivative of atropine, is not recommended for the routine treatment of acute
bronchospasm in asthma, as its onset is much slower than that of inhaled SABAs. However, it
may be useful in patients who are unable to tolerate a SABA or patients with asthma-COPD
overlap syndrome.
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21. CONTINUE…
lpratropium also offers additional benefit when used with a SABA for the treatment of acute
asthma exacerbations in the emergency department. Tiotropium [tye-oh-TROE-pee-um], a
long-acting anticholinergic agent, can be used as an add-on treatment in adult patients with
severe asthma and a history of exacerbations. Adverse effects such as xerostomia and bitter
taste are related to local anticholinergic effects.
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22. CONTINUE…
D. Theophylline
Theophylline [thee-OFF-i-lin] is a bronchodilator that relieves airflow obstruction in chronic
asthma and decreases asthma symptoms. It may also possess anti-inflammatory activity,
although the mechanism of action is unclear. Previously, the mainstay of asthma therapy,
theophylline has been largely replaced with 132 agonists and corticosteroids due to its narrow
therapeutic window, adverse effect profile, and potential for drug interactions. Overdose may
cause seizures or potentially fatal arrhythmias.
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23. CONTINUE…
Theophylline is metabolized in the liver and is a CYP1 A2 and 3A4 substrate. It is subject to
numerous drug interactions. Serum concentration monitoring should be performed when
theophylline is used chronically.
E. Monoclonal antibodies
Omalizumab [OH-ma-LIZ -oo-mab] is a monoclonal antibody that selectively binds to human
immunoglobulin E (lgE).
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24. CONTINUE…
This leads to decreased binding of lgE to its receptor on the surface of mast cells and basophils.
Reduction in surface-bound lgE limits the release of mediators of the allergic response. The
monoclonal antibodies mepolizumab [MEP-oh-LIZ-ue-mab], benralizumab [ben-ra-LIZ-ue-
mab], and reslizumab [res-LIZ-ue-mab] are interleukin-5 (IL-5) antagonists. IL-5 is the major
cytokine involved in recruitment, activation, and survival of eosinophils in eosinophilic
asthma.
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25. CONTINUE…
These agents are indicated for the treatment of severe persistent asthma in patients who are
poorly controlled with conventional therapy. Their use is limited by the high cost, route of
administration (IV for reslizumab and subcutaneous for others), and adverse effect profile.
Inhaled ipratropium [IP-ra-TROE-pee-um], is not recommended for the routine treatment of acute
bronchospasm in asthma, as its onset is much slower than that of inhaled SABAs.
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26. CONTINUE…
It may be useful in patients who are unable to tolerate a SABA or patients with asthma-COPD
overlap syndrome. lpratropium offers additional benefit when used with a SABA for treatment
of acute asthma exacerbations in the emergency department. Tiotropium [tye-oh-TROE-pee-um],
can be used as an add-on treatment in adult patients with severe asthma and a history of
exacerbations.
Lippincott Illustrated Review Pharmacology 7th Edition
27. IV. DRUGS USED TO TREAT CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Drug therapy for COPD is aimed at relief of symptoms and prevention of disease progression.
A. Bronchodilators
Inhaled bronchodilators, including the P2-adrenergic agonists and anticholinergic agents
(muscarinic antagonists), are the foundation of therapy for COPD (Figure 39.5). These drugs
increase airflow, alleviate symptoms, and decrease exacerbations. The long-acting
bronchodllators,
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28. CONTINUE…
LABAs and long-acting muscarinic antagonists (LAMAs), are preferred as first-line treatment
of COPD for all patients except those who are at low risk with less symptoms. LABAs include
oncedaily indacaterol, olodaterol, and vilanterol, as well as the twice-daily inhaled
formulations of arformoterol, formoterol, and salmeterol. Aclidinium, tiotropium,
glycopyrrolate, and umeclidinium are LAMAs.
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29. CONTINUE…
The combination of an anticholinergic and a f32 agonist may be helpful in patients who have
inadequate response to a single inhaled bronchodilator and are at risk of exacerbations.
B. Corticosteroids
The addition of an ICS to a long-acting bronchodilator may improve symptoms, lung function,
and quality of life in COPD patients with FEV1 of less than 60% predicted or patients with
symptoms of both asthma and COPD.
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30. CONTINUE…
However, ICS treatment in COPD should be restricted to these patients, since use is associated
with an increased risk of pneumonia. Although often used for acute exacerbations, oral
corticosteroids are not recommended for long-term treatment of COPD.
C. Other agents:
Rof/umi/ast[roe-FLUE-mi-last] is an oral phosphodiesterase-4 inhibitor used to reduce
exacerbations in patients with severe chronic bronchitis.
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31. DRUGS USED TO TREAT ALLERGIC RHINITIS
The mast cells release mediators, such as histamine, leukotrienes, and chemotactic factors that
promote bronchiolar spasm and mucosal thickness.
A. Antihistamines
Oral antihistamine have a fast onset of action and are useful for the management of symptoms
of allergic rhinitis caused by histamine release, such as sneezing, watery rhinorrhea, and itchy
eyes/nose from edema and cellular infiltration.
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32. CONTINUE…
B. Corticosteroids
Intranasal corticosteroids, such as bec/omethasone, budesonide, fluticasone, cic/esonide,
mometasone, and triamcinolone, are themost effective medications for treatment of allergic
rhinitis. With anonset of action that ranges from 3 to 36 hours after first dose, intranasal
corticosteroids improve sneezing, itching, rhinorrhea, and nasal congestion.
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33. CONTINUE…
C. a-Adrenergic agonists
Short-acting a-adrenergic agonists ("nasal decongestants"), such as phenylephrine, constrict
dilated arterioles in the nasal mucosa and reduce airway resistance. When administered
intranasally, these drugs have a rapid onset of action and show few systemic effects.
Administration of oral a-adrenergic agonists results in a longer duration of action but also
increased systemic effects, such as increased blood pressure and heart rate.
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34. CONTINUE…
D. Other agents
Intranasal cromolyn may be useful in allergic rhinitis, particularly when administered before
contact with an allergen. To optimize the therapeutic effect, dosing should begin at least 1 to 2
weeks prior to allergen exposure. Although potentially inferior to other treatments, some
leukotriene receptor antagonists are effective for allergic rhinitis as monotherapy or in
combination with other agents.
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35. VII. DRUGS USED TO TREAT COUGH
A. Opioids
Codeine [KOE-deen], an opioid, decreases the sensitivity of cough centers in the central
nervous system to peripheral stimuli and decreases mucosal secretion. These therapeutic effects
occur at doses lower than those required for analgeIn addition, codeine has addictive potential,
which limits its use. Dextromethorphan [dex-troe-meth-OR-fan] is a synthetic derivative of
morphine that has no analgesic effects in antitussive doses.
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36. CONTINUE…
dextromethorphan has a low addictive profile. However, it is also a potential drug of abuse.
Guaifenesin [gwye-FENe- sin], an expectorant, is available as a single-ingredient formulation
and is commonly found in combination cough products with codeine or dextromethorphan.
B. Benzonatate
Suppresses the cough reflex through peripheral action. It anesthetizes the stretch receptors
located in the respiratory passages, lungs, and pleura.
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