1. Anti-inflammatory agents (asthma)
    • Glucocorticoids: beclomethasone (inhaled), Prednisone (oral)
    • Cromolyn: (inhaled)
    • Leukotriene modifiers: Montelukast (oral)
  2. Bronchodilators (asthma)
    • Beta2 agonists: Albuterol (sa inhaled), Salmeterol (la inhaled)
    • Methylxanthines: theopylline (oral)
  3. 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
  4. 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 ^)
  5. 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
  6. 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
  7. 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)
  8. 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
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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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