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Anti-inflammatory agents (asthma)
- Glucocorticoids: beclomethasone (inhaled), Prednisone (oral)
- Cromolyn: (inhaled)
- Leukotriene modifiers: Montelukast (oral)
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Bronchodilators (asthma)
- Beta2 agonists: Albuterol (sa inhaled), Salmeterol (la inhaled)
- Methylxanthines: theopylline (oral)
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Types on inhalation devices
- MDI: metered dose inhalers, inhale prior to activating, spacers increase distribution
- DPI: Dry powder inhalers, breath activated, no propellant used
- Nebulizers: produce fine mist
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beta2 andrenergic agonists
- albuterol
- salmeterol
- Selective action on beta2 receptors in lung leads to bronchodilation: relieves acute bronchospasm; suppresses histamin release, increases ciliary motility, prevents exercise induced bronchospasm
- SE: can lead to systemic effects (HR ^)
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Glucocorticoids
- Beclomethasone: inhaled
- Prednisone: oral (for severe asthma)
- Suppress inflammation by inhibiting immune response reducing bronchial hyperreactivity
- Used for prophlaxis on a fixed schedule (1st line therapy)
- Not prn and not used for ongoing attack
- SE: adrenal suppression, bone loss, candidiasis and dysphonia ORAL: must give glucocorticoids at time of stress due to adrenal suppression
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Cromolyn
- Mast cell stabilizer, inhibits release of histamine which suppresses inflamation
- Not effective for acute episode, can be taken PRN in anticipation of episode
- 1st line for moderate asthma
- SE: safest of all antiasthma medications, occasional cough and bronchospasm
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Methylxanthines
- Theophylline: oral not inhaled
- Relaxes smooth muscle: bronchdilation
- narrow therapeutic index 10-20
- SE: >30 causes dysrhythmias, and convulsions, Multiple DDI's (caffeine etc)
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Leukotriene Modifiers
- Montelukast: oral
- Suppress effecs of leukotrienes by blocking leuko synth or leuko receptors which suppresses inflammation &bronchoconstriction
- SE: possible headache and GI. Possible liver toxicity and GC DDI
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Major drugs for allergic rhinitis
- Antihistamines: block H1 receptors
- Glucocorticoids: alters transcription of GR-mediated genes
- Cromolyn: stabilized membranes of mast cells
- Sympathomimetics: stimulate alpha1 receptors in nasal blood vessels
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Antihistamines For allergic Rhinitis
- Diphenhydramine (benadryl), Fexofenadine (allegra)
- H1 receptor antagonists
- prevents itching sneezing and rhinorrhea
- does not decrease nasal congestion, no value for cold treatmnt, best taken prophylactically
- SE: sedation (benadryl mainly), mild dry mouth, constipation, or urinary hesitancy
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Glucocorticoids for allergic rhinitis
- Beclomethasone (intranasal)
- Prevents inflammatory response
- may replace or join H1RA as first line therapy
- SE: nasal irritation and sensations of burning or itching, could get adrenocortical suppression
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cromolyn for allergic rhinitis
- intranasal
- acts on mast cells to suppress release of histamine and other mediators
- no benefit for nonalergic rhinitis
- must take ~1 week prior to onset of symptoms
- SE: occasionally cough and bronchospasm
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Sympathomimetics for allergic rhinitis
- oral/nasal
- Pseudoephedrine
- Phenylephrine
- Stimulate alpha1 on smooth muscle of nasal blood vessels leading to vasoconstriction
- SE: CNS stimulation, rebound congestion, vasoconstriction (oral) that can be hazardous for people with HTN or CAD, abuse potential
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Opioid antitussives
- Codeine: most effective to decrease frequency and intensity of cough
- Hydrocodone: more potent, increased risk of abuse
- Suppress cough by acting within CNS or peripheraly: all opiod analgesics have ability to suppress cough
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non-opioid antitussives
- Dextromethorphan (robitusin DM): most effective non opioid, acts in CNS, is a opiod derivative so it may produce analgesia euphoria or physical dependence, adverse effects at therapeutic concentrations are generally mild
- Diphenhydramine (benadryl): can also suppress cough, sedative and anticholinergic properties
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