Respiratory drugs - Asthma pharmacology

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 Asthma= chronic disease characterized by Hyperresponsive airway, characterized by Bronchoconstriction, shortness of breath, cough, chest tightness, wheezing, rapid respiration

COPD= Irreversible obstruction of airway include Emphysema and chronic Bronchitis

Allergic Rhinitis

Inflammation of mucous memb. Of nose characterized by itchy, watery eyes, runny nose, unproductive cough, nasal congestion

Cough

defensive respiratory response to irritants Meterd –dose inhaler= contain Ozone-depleting Chlorofluorocarbons...SLOWLY & DEEPLY technique ….Nedocromil, Metaproterenol, Cromolyn, Flunisolide,

Albuterol/Ipratropium, Pirbuterol

New formulations are environment friendly include HydrofuoroAlkanes & Dry powder inhaler (DPIs) ….DPI technique QUICKLY, DEEPLY

Drugs for Asthma

Symptoms treatment pronunciation definition attack and prevention


Epinephrine DOC in Acute Anaphylaxis & Status Asthmaticus

Quick relief= by Short-acting β2- Agonists e.g ALBUTEROL 5-30min onset, 6-4hr t1/2 not catecholamine , not hydrolyzed by COMT…

S.E; Hypokalemia, Hypomagnesemia, Hyperglycemia

Long-term control (LABAs) 

Salmeterol, Xinafoate, Formoterol long acting β2 agonist… Salmeterol & Formoterol 12hr bronchodilation…single agent used is contraindicated... used in Adjunct therapy…

Corticosteroid DOC in long duration

Corticosteroid

Inhaled Corticosteroid (ICS) DOC in persistent Asthma…NHLBI national Heart, Lung, Blood institute provide “SET UP” therapy; 

Dose of ICS therapy

according to Patients Asthma Classification

MDI Slowly, Deeply for ICS….DPI Quickly, Deeply for ICS…”Swish & Spit” with H2O to reduce side effects

Leukotrienes Antagonists

Leukotriene (LT) B4 and Cysteinyl Leukotriene , LTC4, LTD4, LTE4…..products of 5-Lipoxygenase pathway of Arachidonic Acid metabolism….5-Lipoxygenase found in Mast cells, Basophil, Eoisniophil , Neutrophil…..

LTB4 potent Chemoatractant for Neutrophil & Eosinophil

Cysteinyl Leukotriene constricts Bronchiolar Smooth Muscle, increase Endothelial Permeability, and promote Mucus secretion

Zileuton is Selective inhibitor of 5-Lipoxygenase, prevent formation of LTB4 & Cyteinyl Leukotriene…

Zafirleukast & Montelukast Selective & Reversible Inhibitor of Cysteinyl Leukotriene-1 receptor…

Montelukast Market Leader in this class due to; 1) Dosing recommendation in children of 6 month & older, 

2) Available in Chewable tab & Granule formation….improved for Exercise-Induced Asthma

All these medicines used for Prophylaxis of Asthma but not for immediate effect

S.E= increase LFTs, Eosinophilic vasculitis (Churg-Strauss Syndrome), Dyspepsia,

Cromolyn

Prophylactic Anti-inflammatory Agent…not useful in managing Acute Asthma Attack… not Direct Bronchodilator…. Inhibit Mast cell Degranulation & Release of Histamine…. Block initiation of Immediate & Delayed Asthmatic reaction …

Pretreatment

prevent Allergen & Exercise-induced Asthma

Nebulizer from….

Short duration, frequent dosing

Cholinergic Antagonists (Tiotropium, Ipratropium)

Inhaled Ipratropium= Quaternary derivative of Atropine….Block Vegally mediated

Contraction of Airway Smooth muscle & Mucus Secretion…..free of side effect….

Effective for patient having Asthma with COPD 

Theophylline

Bronchodilator…Block Phosphodiestrase , Increase cAMP, Block Adenosine ,

Decrease Ca++ in smooth muscle……used in Chronic Asthma…..FDA not recommend it now…

cause Seizure, Arrhythmia….drug interaction due to CYP1A2,3A4 substrate

Omalizumab

Recombinant DNA Monoclonal antibody….selectively bind to IgE….decrease binding of

IgE to mast cell & Basophil receptor….decrease release of Allergic mediator

Used in moderate to severe Allergic Asthma

Treatment Guidelines of Asthma

Pharmacology respiratory mcqs pdf slideshare books for mbbs


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