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Drugs for Asthma : 

Drugs for Asthma

Objectives : 

Objectives State a reasonably accurate definition of asthma that includes an understanding of the roles and involvement of airway smooth muscle hyperresponsiveness and inflammation in the disease. Describe the typical signs and symptoms that would lead to the diagnosis of a respiratory disorder as asthma. State the criteria used to classify asthma (e.g., mild, moderate, etc.) based on symptom severity and frequency.

Objectives : 

Objectives Summarize the mechanisms of action, roles, and limitations of the following drugs in the therapy of long-term and acute asthma: Beta-adrenergic agonists (inhaled, oral, parenteral; rapidly acting agent versus long-acting agents such as salmeterol)   Corticosteroids (inhaled, oral, parenteral) Methylxanthines Mast cell stabilizers such as cromolyn or nedocromil Leukotriene synthesis inhibitors and leukotriene receptor blockers

Objectives : 

Objectives Explain what a theophylline salt is and how theophylline salts are similar to or different from one another and from anhydrous theophyllline. State characteristics of inhaled sympathomimetic use for rescue therapy that might constitute overuse. Identify and describe the drugs indicated for status asthmaticus, how they are used, and what they do. Compile a list of drugs or drug groups that are relatively or absolutely contraindicated for patients with asthma, and state their main problems.

Drugs for Asthma : 

Drugs for Asthma Asthma Chronic inflammatory disorder of the airway Characteristic signs and symptoms Sense of breathlessness Tightening of chest Wheezing Dyspnea Cough Cause: immune-mediated airway inflammation

Figure 74-1 Allergen-induced inflammation and bronchospasm in asthma. : 

Figure 74-1 Allergen-induced inflammation and bronchospasm in asthma.

Classification of Drugs for Asthma : 

Classification of Drugs for Asthma Two main pharmacologic classes: Anti-inflammatory agents Glucocorticoids (prednisone) Cromolyn [Intal] Bronchodilators Beta2 agonists (albuterol)

Inhalation Drug Therapy : 

Inhalation Drug Therapy Three obvious advantages Therapeutic effects are enhanced Systemic effects are minimized Relief of acute attacks is rapid Three types Metered-dose inhalers (MDIs) Dry-powder inhalers (DPIs) Nebulizers

Beta2-Adrenergic Agonists : 

Beta2-Adrenergic Agonists Most effective drugs for relief of acute bronchospasm and prevention of exercise-induced bronchospasm Use in asthma Quick relief Long-term control Adverse effects Inhaled preparations System effects—tachycardia, angina, and tremor Oral preparations Excessive dosage—angina pectoris, tachydysrhythmias Tremor

Inhaled Glucocorticoids : 

Inhaled Glucocorticoids Most effective antiasthma drugs available Adverse effects Oropharyngeal candidiasis Dysphonia Interventions Gargle after each administration Use a spacer

Figure 74-2 Impact of a spacer device on the distribution of inhaled medication. : 

Figure 74-2 Impact of a spacer device on the distribution of inhaled medication.

Cromolyn [Intal] : 

Cromolyn [Intal] Prophylaxis of asthma Suppresses inflammation Not a bronchodilator Route—inhalation Nebulizer MDI Adverse effects Safest of all antiasthma medications Cough Bronchospasm

Methylxanthines : 

Methylxanthines Theophylline Bronchodilators Narrow therapeutic index Plasma level 10 to 20 mcg/mL Toxicity

Leukotriene Modifiers : 

Leukotriene Modifiers Suppress effects of leukotrienes Zileuton [Zyflo] Zafirlukast [Accolate] Montelukast [Singulair]

Drugs for Allergic Rhinitis, Cough, and Colds : 

Drugs for Allergic Rhinitis, Cough, and Colds

Objectives : 

Objectives Review the basic pharmacology of sympathomimetics that are used for nasal decongestion and rhinitis, H1-histamine blockers (antihistamines), and corticosteroids. Apply that knowledge to the content of this chapter. Summarize the roles of antihistamines, glucocorticoids, and sympathomimetic decongestants in terms of managing the signs, symptoms, and underlying causes of the common cold. Discuss the use of zinc and vitamin C in children and adults colds.

Drugs for Allergic Rhinitis, Cough, and Colds : 

Drugs for Allergic Rhinitis, Cough, and Colds Allergic rhinitis—inflammatory disorder of the upper airway, lower airway, and eyes Symptoms Sneezing Rhinorrhea Pruritus Nasal congestion

Classes of Drugs Used for Allergic Rhinitis : 

Classes of Drugs Used for Allergic Rhinitis Oral antihistamines Intranasal glucocorticoids Intranasal cromolyn Sympathomimetics (oral/nasal)

Drugs for Cough : 

Drugs for Cough Antitussives Drugs that suppress cough Opioid antitussives Codeine and hydrocodone Nonopioid antitussives Dextromethorphan Diphenhydramine

Cold Remedies : 

Cold Remedies Combination cold remedies usually contain two or more of the following: Nasal decongestant Antitussive Analgesic Antihistamine Caffeine

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