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- –Decrease airway reactivity
- •Inhibit phosphediesterase -> more cycle AMP
- •-> bronchodilation
- – inhibit mast cell degranulation
- –Stimulate ciliary apparatus
Methylxanthines Drugs (Lline & Caffein)
- •Theophylline [theo-Dur] po. Smoking & pot increases elimination
- •aminophylline IV
- •Oxtriphylline [Choledyl]
- •Caffeine- Crosses BBB, mainly used for Neonates to stimulate breathing. Strong coffee can help with asthma attack.
Methylaxanthines Adverse Reactions
- -GI :Diarrhea, cramps, insomnia
- -CNS: Restlessness, Irritability, Anxiety, Insomnia
- –CV: tachycardia, palpitations, hypotension
- –Mild diuresis
- –Crosses breast milk, Baby will get SE.
What does Beta Agonist Do?
- •Mimic SNS
- •Stimulate beta2 (Lungs) receptors -> activation of adenylate cyclase -> increased cAMP -> bronchodilation
- •Beta 1 (Heart) = positive chronotropic/positive inotropic
- •Beta 2 = bronchodilation Selective only work on Lungs
- •Alpha = vasoconstriction in brocho blood vessels, decreased brocho edema
- Non-selective work on both lungs and heart & Stimulation of Alpha receptors
Beta Agnoists Side Effects
- -Beta 2 (Lungs): Nervousness, restlessness, tremor
- -Beta 1 (Hearts): arrhythmias, tachycardia, palpitations, HA, insomnia
- -Alpha: Insomnia, restlessness, anorexia, tremor, HA, Cardiac Stimulation
- Interactions: Aviod Other sympathomimetics
What does Anticholinergics do?
-Inhibit cholinergic receptors in brocho smooth muscles->decreased concentration of cGMP
cGMP=brochoconstriction. If you have less cGMP causes Brochodilation.
What are Anticholinergics drugs?
SE for Anticholinergics?
- -Dry mouth, GI problems, HA, Cough, Anxiety
- no interactions known
What Does Corticosteroids do?
- -Antiimflammatory Stabilize cell membranes to prevent release of histamine that causes bronchoconstricution
- -Help restore responsiveness to beta agnoists
- -Systemic vs Inhaled
- -Problem with longterm steroids shuts down your own adrenal glands & doesn't produce steriods, MOONFACE! ;)
- -When taken by inhalation you can remove SE!
What are the SE to corticosteroids?
Oral Fungal Infections (thrush) to aviod rinse your mouth, sore throat, cough, dry mouth
What drugs are corticosteroids?
What do Leukotriene (Bronchoconstrictors) Antagonists?
- -Zafirlukast=selective leukotriene receptor antagonist (Prototype drug)
- -Helps mild to mod asthma
- -Take on empty stomach
- -Take BID, food helps absorb all of drugs
- -Eliminated in feces, Avoid constipation!
- -NOT for acute attack, Peak 13-14 days
- -Produce lots of mucos
Leukotriene Antagonists Zafirlukast SE?
- •HA, infection (people over 55), nausea
- •Churg-Strauss syndrome:
- –Pulmonary infiltrates
- –Interactions: coumadin (Bleeding), phenytoin, Ca channel
- blockers, erythromycin, ASA
Leukotriene Antagonist Zileuton Do?
- •Zileuton [Zyflo]
- –Inhibits leukotriene synthesis by inhibiting enzyme
- –Contraindicated in acute liver disease
- -Used for Prevention ONLY!
- -Use less of inhaled steriods, this is PO
What are SE Zileuton?
- -Inc Liver enzymes, check ALT
- -Take QID
- -Peak effect weeks to months!
Leukotriene Antagonists Monteleukast [Singulair]?
- -Receptro Antagonist
- -Selective inhibitor of CysLT1 receptors (Don't need to remember)
- -Once daily dosing-Take in evening so that peak effect is at 3-4am. Approved for use of children
Mast Cell Inhibitors does?
- -Stabilize Cell membranes
- -Prophylaxis Only! Ask how many attacks do they have on a daily basis? Are they having fewer attacks now?
Mast Cell SE?
- -Cough, Sore Throat, Rhinitis, bronchospasm
- -Taste Changes
- -Dizziness, HA
Mast Cell Drugs?
- -Cromolyn: inhaler, PO main drug, powerful oral inhalation. Onset 1 month
- -Nedocromil: Inhaler
- -Omalizumab-IgG antibody binds to IgE receptor Site & stabilizes mast cells by binding. Given SQ every 2-4 weeks.
Alpha 1 Proteinase (Prolastin, Antitrypsin) Deficiency
- -Prevents destruction of elastase
- -SE: uncommon
- Facilitate movement of mucus
- Best & cheapest expectorant is WATER. Don't need to drink 8 glasses of water it's a myth.
- –Guafenesin [Robitussin] – OTC, makes you spit out dry mucos/cough
- –Iodides: Organidin, SSKI (Taste Horrible-OJ)
- –Terpin hydrate
- –Interactions: coumadin
- –Adverse: rare with guafenesin
- –Iodides can -> iodism
- -Terpin hydrate - drowsiness
Mucolytic: Acetylcysteine (Mucomyst):
- -Alters molecular composition of mucus
- -Given via Nebulizer
- -Interaction: many
Mucolytic Adverse Reactions:
- -Rotten Egg odor-> nausea
- -stomatits, N/V
- -bronchospasm=have albuterol just incase if you cause bronchospasms
- Antibotics for respiratory tract infections