PHARMACOLOGY FINALS PT 2

DIABETES MELLITUS DRUGS

Diabetes is defined as a condition defined by persistently

high glucose levels in the blood ○ Type 1 Diabetes
Mellitus (DM)
■ Lack of insulin production
● Usually caused by autoimmune
diseases
○ Type 2 Diabetes Mellitus (DM)
■ ↑ insulin resistance ● Oral Agents
● May be caused by several factors ➔ Metformin
○ Metabolic Syndrome ■ First Line Drug
○ Genetic factors ■ Mechanisms
● Inhibits gluconeogenesis
DIAGNOSING DIABETES ● Increases glycolysis● Increases peripheral glucose
● Fasting Blood Sugar > 126 mg/dL uptake ■ Adverse Effects
● Random Blood Sugar > 200 mg/dL ● Lactic Acidosis● B12 deficiency
● Glucose Tolerance Test > 200 mg/dL● HbA1C > 6.5% ● GI upset

Clinica Manifestation of Diabete ➔ Sulfonylureas

● Hyperglycemia ■ Glimepiride, Glipizide,
○ Polyuria Gliclazide ■ Mechanism ●
■ ↑ urination Increases release of insulin by
■ Due to glycosuria blocking potassium channels ■
Adverse Effects
○ Polydipsia
● Hypoglycemia
■ ↑ thirst
● Weight Gain
■ Due to hyperosmolar blood
○ Polyphagia ● Disulfiram-like reaction
■ ↑ hunger
■ Due to lack of ATP ➔ Meglitinides
■ Nateglinide, repaglinide
● Complications associated with diabetes ■ Rapid onset compared
○ Atherosclerosis to sulfonylureas
■ Coronary Artery Disease ■ Mechanism ● Increases
■ Peripheral Artery Disease release of insulin by blocking
■ Stroke potassium channels ■ Adverse
○ Diabetic Retinopathy Effects
■ Cataracts ● Hypoglycemia
○ Nephropathy
■ DM is the most common cause of ➔ DPP-4 Inhibitors
Chronic Kidney Disease (CKD) ■ Linagliptin, Saxagliptin, Sitagliptin
○ Gastroparesis ■ Mechanism ● Inhibits DPP-4
○ Urine Retention thereby potentiating GLP-1 ■
○ Orthostasis Adverse effects
○ Paresthesia → Foot Ulcers ● Urinary infections
● Respiratory infections
Drug for Diabete
● Insulins ➔ GLP-1 Agonists
○ Rapid Acting (Peak: 1-1.5 hours; Duration: 3- ■ Exenatide, Liraglutide
4 hours) ■ Mechanism
■ Insulin Lispro ● Pot
■ Insulin Aspart entiates GLP-1■
■ Insulin Glulisine Adverse effects
■ Used when eating a meal ○ Short ● Pa
Acting (Peak: 2.5 hours; Duration: 4-6 hours) ncreatitis
■ Regular Insulin
○ Intermediate Acting (Peak: 8 Hours; Duration: 0 SGLT-2 Inhibitors
10-16 hours) ➔ Dapagliflozin, Canagliflozin, Empagliflozin
■ NPH Insulin ■ Mechanism
○ Long Acting (Peak: NONE; Duration: 24 ● Inhibits the sodium-
hours) glucose-cotransport er-2
■ Insulin Glargine ○ ↓ Reabsorption of
■ Insulin Detemir glucose ■ Adverse effects
■ Taken once a day ● Glucosuria
 ● UTI
● Vaginal yeast infections
● Hyperkalemia
● Dehydration

0 Alpha-glucosidase Inhibitors
➔ Acarbose, Miglitol ■ Mechanism
● Inhibits alpha-glucosidase
enzymes○ ↓ conversion of
complex carbohydrates to
glucose ■ Adverse effects
● GI upset ● Bloating ● Gas

➔ Thiazolidinedione
Drug for H erlipidemi
■ Pioglitazone, Rosiglitazone
■ Mechanism ● HMG CoA Reductase Inhibitors aka statins
● ↑ insulin sensitivity 0 Inhibits HMG-CoA Reductase
bybinding to PPAR-γ ■ ■ ↓ cholesterol
Adverse effects ■ Reabsorbs LDL baka into the liver
● Heart failure● Weight Gain ● ↓ LDL in blood
● Peripheral Edema● 0 Statin Classifications
Increased risk for bone ■ High Intensity Statins: \
fractures ● > 20 mg Rosuvastatin
● > 40 mg Atorvastatin■ Low Intensity Statins:
● Type 1 DM ● < 20 mg Rosuvastatin
0 Insulin ● < 40 mg Atorvastatin
● Type 2 ● Simvastatin
○ Diet + Exercise
○ Oral Agents ● HMG CoA Reductase Inhibitors aka statins○ Adverse
○ Insulin Effects:
■ Slight elevation in SGPT/ALT levels
■ Reduction in Coenzyme Q10
– (CoQ10)
● Myopathy →
CHOLESTEROL DRUGS
Rhabdomyolysis ○ Myoglobin
deposit in kidneys
What is Hyperlipidemia? leading to renal failure
● Hyperlipidemia is a condition in which there is either:○ ↑
Triglycerides (TG)
● Niacin (Vitamin B-3)
■ >200 mg/dL
○ Inhibits hormone sensitive lipase
0 ↑ Low Density Lipoprotein (LDL)■ > 160
■ ↓ TG
mg/dL
■ ↓ LDL
○ ↓ High Density Lipoprotein (HDL)
○ Not used as first line ■ Usually used as
■ < 40 mg/DL
an “add-on” to statins
○ Adverse Effects
● Hyperlipidemia may either genetic or acquired: ■ ↑ uric acid levels
0 Excess calorie intake ■ ↓ insulin release
○ Lack of exercise
■ ↑ histamine levels in body
○ Smoking
● Flushing
○ Other comorbidities such as CKD, diabetes or
● Pruritus
HIV
● Fibrates
Clinica Manifestatio of H erlipidemi ○ Gemfibrozil, Fenofibrate
● Fatty Liver ○ Enhances lipoprotein lipase activity ■ ↑ TG
● Pancreatitis deposition into adipose tissues and
● Atherosclerosis skeletal muscles
● Stroke ● Net effect is lower TG inthe blood
● Angina/Myocardial Infarction ■ ↑ HDL
● Peripheral Artery Disease ○ Adverse effects
■ ↑ myopathy when taken with statins
● Monitor patients for signs
and symptoms of myopathy
if the patient is taking this
together with statins
■ Gallstones

● Bile acid sequestrants

○ Cholestyramine, Colestipol ○ Elevation of basal metabolic rate ○
○ Not used as first line ■ Usually used as Increases oxygen consumption → increases
an “add-on” to statins oxygen demand
○ Sequestrants bind to bile to feces ○ Increases heat production
■ ↓ Free Fatty Acid absorption ○ Increases cardiac output
■ ↓ VLDL synthesis ○ Promotes brain development
○ Adverse Effects ○ Promotes growth
■ ↓ absorption of certain substances
● Lipid soluble vitamins HYPOTHYROIDISM
● Warfarin ● Hypothyroidism is a condition caused by a deficiency
● Digoxin■ ↑ TG intriiodothyronine (T3) and thyroxine (T4) ● Signs and
synthesis ● Monitor patient’s TG levels Symptoms of Hyperthyroidism
0 Pale, Puffy Face
● Ezetimibe ○ Cold and Dry Skin
○ Inhibits NPC1L1 receptor in the gastrointestinal tract ■ Low body temperature →
■ ↓ cholesterol absorption in the liver Intolerance to Cold
○ Adverse Effects ○ Brittle hair → hair loss
■ Mild ↑ liver function markers ○ Low Heart Rate
■ Mild diarrhea ○ Lethargy
○ Fatigue
Approache t Dru erap ○ Enlarged thyroid gland → Goiter
● First Line Therapy ○ Impaired Mental State
○ Patients with athesclerotic carviovascular diseases ○ Weight Gain
(stroke, MI, PAD)
■ If patient is > 75 years old, use moderate ● Causes of Hypothyroidism
intensity statins 0 Iodine Deficiency
■ If patient is < 75 years old, use high intensity ○ Thyroid malfunction
statins ○ Surgical removal of thyroid gland ○
○ Patients with LDL > 190 mg/dL Destruction of thyroid via radioactive
■ Regardless of age, use high intensity statins substances ● Treatment options
○ Patients with Diabetes Mellitus ○ Lifelong thyroid replacement therapy
■ Intensity depends on other risk factors ■ Levothyroxine
● If patient is high risk, use high
intensity statins
HYPERTHYROIDISM
● If patient is moderate, use moderateintensity
● Hyperthyroidism is a condition caused by an excess
statins
intriiodothyronine (T3) and thyroxine (T4) ○ The
elevation of thyroid hormones is called thyrotoxicosis
● Combo Therapy
● Signs and Symptoms of Hyperthyroidism
○ If patient is on statins, but LDL is still high
○ High Heart Rate
■ Add Niacin or Bile Acid
○ Increased heat production
Sequestrants
■ High body temperature →
○ If patient cannot tolerate statins but LDL is
Intolerance to Heat
high
○ CNS Stimulation
■ Use ezetimibe ○ If patient is
■ Anxiety
on statins, but TG is still high and/or HDL
■ Rapid thought flow
is low
■ Rapid speech
■ Add Niacin
○ Skeletal muscle atrophy and weakness
○ If patients cannot tolerate statins and TG is
○ Increased basal metabolic rate
high
○ Increased appetite
■ Use Fibrates
○ Weight loss
● Supplement
○ Exophthalmos
Considerations
○ CoQ10
● Causes of Hyperthyroidism○ Graves’ disease
■ Reduces risk of myopathy
■ An autoimmune disease that forms
○ Fish Oil
thyroid stimulating immunoglobulins
■ Increases HDL
→ elevation of T3 and T4

● Treatment options
–
○ Surgical removal of thyroid gland
HORMONE DRUGS ○ Iodine-131
■ Radioactive iodine
THYROID HORMONES ○ Methimazole ○
Propylthiouracil
● Thyroid hormones such as triiodothyronine (T3) and
thyroxine (T4) functions include Drug for thyroi disorder
➔ Levothyroxine
○ Treats all forms of hypothyroidism regardless of cause “Pot belly”, “Moonface”
○ Given orally etc
■ 30 to 60 minutes before breakfast ○ Increases blood pressure
○ Adverse Effects ○ Increase RBC count
■ Bone tissue loss → Bone fractures ○ Decrease WBC count
■ Atrial fibrillation ○ Perfuses blood to skeletal
○ Drug Interactions muscles ○ Has certain effects to the
■ Lowers absorption of levothyroxine CNS ■ Deficiency
● H2 receptor blockers ● Lethargy, Depression,
● Proton pump Inhibitors Irritability
● Bile acid sequestrants ■ Excess
● Antacids ● Euphoria
● Calcium, Iron, Magnesium
CUSHING’S SYNDROME
➔ Methimazole ● Cushing’s syndrome is a disease of excessive levels
○ First line agent for Hyperthyroidism ofglucocorticoids in the body
■ Safer than Propylthiouracil ● Signs and Symptoms
● Except in pregnancy ○ Hyperglycemia
○ Uses ○ Glycosuria
■ Therapy for Graves’ disease ○ Osteoporosis
■ Add-on to radiation therapy ○ Muscle weakness and myopathy
○ Adverse Effects ○ Hirsutism
■ Teratogen ○ Menstrual Irregularities
● Causes congenital hypothyroidism ○ Decreased resistance to infection
■ When taken in high doses, methimazole may ○ “Potbelly” “Moon face”
convert hyperthyroidism to hypothyroidism ● Causes
○ Pituitary adenoma
➔ Propylthiouracil ○ Adrenal adenoma
○ Used as an alternative to methimazole if ○ Over-administration of glucocorticoids to treat
■ Patient is pregnant arthritis and other non endocrine disorders
■ Patient cannot tolerate methimazole ● Treatment
○ Surgical removal of adenomas
➔ Iodine-131 ○ ➔ Ketoconazole
Radioactive Iodine ■ 600 to 800 mg/day
○ Destroys thyroid gland tissue in order to lower
thyroid hormone secretion ■ Effects start to ADDISON’’S DISEASE
show only after 2-3 months of consistent dosing ● Also known as Primary adrenocortical insufficiency●
○ Should NOT be given to pregnant women or It is a condition in which the adrenal glands are
children damaged and unable to make glucocorticoids ●
Signs and symptoms
ADRENOCORTICAL DISEASES 0 Anorexia
● The adrenal gland is responsible for secretion of the ○ Nausea
following ○ Weight Loss
○ Glucocorticoids ○ Hypotension
■ Mainly cortisol ● Causes
○ Mineralocorticoids ○ Autoimmune destruction of adrenal tissue
■ Aldosterone ○ Tuberculosis
○ Androgens ○ Adrenal hemorrhage
○ Cancers
GLUCOCORTICOIDS ○ Abrupt glucocorticoid withdrawal
● The main glucocorticoid in our body is Cortisol. And ● Treatment
itsfunctions include the following: 0 Replacement therapy
○ Carbohydrate metabolism ■ Hydrocortisone
■ Ensures that brain has enough food ■ Prednisone
○ Protein metabolism
■ Stimulates conversion of GLUCOCORTICOIDS IN NONENDOCRINE
protein sources into carbohydrates ● May DISORDERS
cause muscle ● Prednisone, Betamethasone, Dexamethasone,
wasting if cortisol is Hydrocortisone, Methylprednisolone, Prednisolone,
chronically high Triamcinolone
○ Lipid metabolism ● When administered in high doses,
■ Stimulates lipolysis ● glucocorticoidsproduce anti-inflammatory and
May cause fat immunosuppressive effects ■ Suppresses immune
redistribution if cortisol responses → ↓ inflammation
is chronically high ○
● Glucocorticoids produce greateranti-inflammatory ○ Breast cancer
effects than NSAIDs ■ Also suppresses prostaglandins ○ Cardiovascular thromboembolic events
and histamine ○ Nausea
● Therapeutic Uses of High-Dose Glucocorticoids ■ Most common response
0 Rheumatoid Arthritis ○ Migraines
○ Systemic Lupus Erythematosus ○ Fluid retention
○ Inflammatory Bowel Disease ● Contraindications
○ Miscellaneous Inflammatory Disorders ■ ○ Patients with history of blood clots ■ Patients with
Bursitis, tendinitis, osteoarthritis, history of myocardial infarction secondary to
gouty arthritis blood clots
○ Asthma ○ Pregnant women
○ Skin disorders ○ Breast cancer
■ Psoriasis, contact dermatitis, ○ Liver Disease
hemorrhoids, etc
● Adverse Effects PROGESTERONE
0 Adrenal Insufficiency
● Progesterone is a hormone naturally found in
○ Osteoporosis → Fractures humans.Its functions include
○ Infections
○ During menstrual cycle ■ Fall in
■ Candidiasis is most common progesterone causes onset of
○ Hyperglycemia → Diabetes menstrual bleeding ■ Breast
○ Glycosuria tenderness
○ Myopathy ■ Increase in body temperature
○ Growth delay in children ■ Changes in mood
○ Psychological Disturbances ● Depression
■ Insomnia, Anxiety, Irritability, ■ Sleepiness
Depression, Suicidal-tendencies ○ During pregnancy
○ Cataracts and Glaucoma ■ Sustains pregnancy by suppressing
○ Peptic Ulcer Disease contraction of uterine smooth muscle
○ Cushing’s Syndrome ● Also suppresses contraction of GI
● Notes on Withdrawal of Glucocorticoids○ Taper dosage smooth muscle → constipation
to physiologic range over 7 days ■ Promotes breast growth
0 Switch from multiple daily doses to ● Therapeutic Uses
singledoses ○ Menopausal Hormone Therapy ■ Used to
○ Taper dosage to 50% of physiologic values counteract adverse effects of
over the next month estrogen
● Abrupt stoppage of Glucocorticoids may cause ○ Dysfunctional Uterine Bleeding
Addison’s Disease ○ Amenorrhea
○ Infertility
ESTROGEN ○ Prematurity Prevention
● Estrogen is a hormone naturally found in humans.
Itsfunctions include BIRTH CONTROL
0 Development of female reproductive tract ● These are drugs that interfere with
andsexual characteristics the reproductiveprocesses
■ Essential in growth of uterus, ● Birth control could come in the form
vagina, fallopian tubes and breasts ■ of the following
Directs pigmentation of nipples and ○ Pharmacological
genitalia ■ Oral contraceptives
○ Influences reproductive processes ■ Etonogestrel implants ■
○ Increases vaginal acidity ○ At the end of the Injectable medroxyprogesterone
menstrual cycle, a decrease in estrogen acetate ■ Intrauterine devices
causes menstruation ■ Decrease in ■ Transdermal patches
progesterone causes bleeding
○ Non-Pharmacological
○ Prevents bone tissue breakdown
■ Surgical sterilization
○ Promotes vasodilation
● Tubal Ligation
○ Lowers LDL levels
● Vasectomy
○ Increases insulin sensitivity
■ Mechanical Devices
● Therapeutic Uses
● Condoms
0 Menopausal Hormone Therapy■ Most
● Diaphragm
common noncontraceptive use of estrogens
● Cervical Cap
■ Commonly used together with
■ Periods of abstinence
Progestin
● Calendar method
○ Estrogen deficiency
● Temperature method
○ Acne
● There are two main categories of oral
○ Cancer Palliation
contraceptives
● Adverse Effects
○ Estrogen + Progestin aka Combination Oral
0 Endometrial hyperplasia
Contraceptives
○ Endometrial cancer
 ○ Progestin only aka Minipills ○ Adverse Effects
■ Irregular bleeding
● Combination Oral ● Depot Medroxyprogesterone Acetate
Contraceptives ○ Depo-Provera®
➔ Ethinyl estradiol + Norethindrone ○ Injected IM or SQ, protects against pregnancy
■ Actions for 3 months
● Inhibits ovulation● Thickens ○ Adverse effects ■ Similar to those
cervical mucus to create a seen in progestin-only
barrier to the penetration of contraceptives ■ Mild weight
sperm gain
● Alters endometrium ■ Decreased Libido
■ Adverse Effects ■ Depression
● Blood clots ■ Abdominal bloating
○ Myocardial infarction ● Intrauterine Devices (IUD)
○ Stroke ○ Types of IUDs
● Hypertension ■ Copper IUD
● Elimination of menstrual flow ● Acts as a spermicide in the
● Breast tenderness uterine
● Edema ■ Levonorgestrel IUD
● Nausea ● Same mechanism of action
● Increased Appetite asprogestin-only oral contraceptives
● Depression ○ May last between 3-10 years depending on the brand
● Combination Oral ○ Increased risk of pelvic infections
Contraceptives
○ Ethinyl estradiol + Norethindrone GROWTH HORMONE
■ Dosing Schedule ● Growth Hormone is a hormones that stimulate the
○ 21 days with pills that contain active release of insulin-like growth factor-1 (IGF-1) in the liver
ingredients + 7 days with placebo pills ■ What ● Effects IGF-1 and GH ○ Increases bone-length of
to do if doses are missed children if given before epiphyseal closure
● If 1 or more pills are missed in the first week ○ Increases muscle mass
○ Take 1 pill ASAP then continue with the pack ○ Increases blood glucose levels
■ Use additional form of contraception for 7 ■ May lead to type-2 diabetes
days (e.g. condoms)
● If 1 or 2 pills are missed during the second or third
GROWTH HORMONE DEFICIENCY
week○ Take 1 pill ASAP and then continue with the
● Effects
active pills in the pack — skip the placebo pills and go
○ In Children
straight to a new pack once active pills have been taken
■ Short Stature
● If 3 or more pills are missed during second or third week
○ Adults
○ Follow instructions for 1 or 2 pills
■ Reduced muscle mass
○ Use additional form of contraception
■ Reduced exercise capacity
● Progestin-Only Oral Contraceptives
■ Increased mortality due from cardiovascular
○ Aka “minipills”
causes
○ Produces a thick, sticky mucous that acts as a barrier to
■ Impaired psychosocial function
sperm
● Treatment
○ Advantages over Combination Oral Contraceptives
○ Growth hormone replacement therapy ■
■ Less chance for blood clots
Adverse Effect
■ Less instances of headaches
● Hyperglycemia
■ Less instances of nausea
○ Disadvantages
■ Slightly less effective than combination GROWTH HORMONE EXCESS
OCs ● More likely to cause irregular bleeding ○ Dosing ● Effects
Schedule ○ In Children
■ Take 1 pill daily at the same time each day ● ■ Gigantism
Uses additional form of ● Excessive bone growth
contraception in first week ● If 2 or ○ May cause growth up to 7-9 feet ○
more pills are missed during the In Adults
cycle and no menstrual bleeding ■ Acromegaly
occurs, a pregnancy test should be ● Coarse Facial Features
done ● Splayed Teeth
● Large Hands and Feet
LONG TERM CONTRACEPTIVES ○ In both
● Subdermal Etonogestrel Implants ■ Cardiomegaly ■ Hypertension ■ Arthralgia ■ Diabetes
● Treatments
➔ Nexplanon®
○ Surgical removal of pituitary gland
○ Implanted subdermally in the groove between the
○ Radiation therapy
biceps and triceps in nondominant arm
○ Drugs
○ Provides contraception for 3 years
➔ Octreotide, Sandostatin, Pegmisovant
● Adverse effects ● Adverse Effects
○ Nausea ○ Cramps ○ Vomiting ○ Flatulence ○ Rapid reduction in blood volume aka
hypovolemia
DIABETES INSIPIDUS ■ May lead to hypotension,
● Diabetes Insipidus is caused by a deficiency of shock, cardiac arrhythmias ○ Electrolyte
antidiuretic hormone (ADH) imbalances
○ ADH is responsible for renal conservation of ■ Hyponatremia
water ○ Signs and Symptoms ■ Hypokalemia
■ Polydipsia ■ Hypocalcemia
○ Ototoxicity
■ Large volume of dilute urine ○
○ Hyperuricemia → Gout
Causes
■ Genetics
■ Head trauma ❖ THIAZIDE DIURETICS
■ Neuro surgery ➔ Hydrochlorothiazide, Chlorothiazide
■ Cancer ● Acts on the Distal Convoluted Tubule● Considered as a
○ Treatments weak diuretic but also has vasodilatory effects
➔ Vasopressin, Desmopressin ● ● Adverse Effects
Adverse Reactions ○ Electrolyte imbalances
○ Water intoxication; reduce water intake when ■ Hyponatremia
taking -pressins ■ Drowsiness ■ Hypokalemia
■ Convulsions ■ Hypercalcemia
■ Coma ○ Hyperuricemia → Gout
■ Higher risk of water intoxication if patient has ○ Hyperglycemia
kidney injury ○ Hyperlipidemia

– ❖ POTASSIUM-SPARING DIURETICS
DIURETICS
What are diuretics?
● These are classes of drugs that stimulate excretion
ofwater from the body ● Uses
0 Management of hypertension
○ Treatment of fluid retention aka edema
○ Reduction of intracranial pressure
● Classifications of diuretics
0 Carbonic anhydrase inhibitors
○ Loop diuretics
○ Thiazide diuretics
○ K-Sparing Diuretics
○ Osmotic Diuretics
➔ Amiloride, Triamterene, Spironolactone
● Acts on Aldosterone Receptors in the collecting duct ●
Considered as a weak diuretic; often used as an add-on
to other diuretics ● Adverse Effects
○ Electrolyte imbalances
■ Hyperkalemia
○ Menstrual irregularities in females
○ Gynecomastia in males
❖ OSMOTIC DIURETICS
➔ Mannitol
● Directly stimulates excretion of water rather
thanexcretion of sodium ● Mainly used for
0 Reduction of intracranial pressure
○ Urination of toxic substances
○ Urine production in patients with acute kidney
failure
● Adverse Effects
0 Dehydration

–
ASTHMA AND COPD DRUGS

● Asthma and Chronic Obstructive Pulmonary

CARBONIC ANHYDRASE INHIBITORS
➔ Acetazolamide
● Acts on the Proximal Convoluted Tubule
● Has very weak diuretic effect
○ Therefore it is preferred for other uses such
as treatment of glaucoma ● Adverse Effects
○ Malaise ○ Anorexia ○ Fatigue ○ Restlessness
❖ LOOP DIURETICS
● Furosemide, Ethacrynic Acid
● Acts on the Thick Ascending Loop of Henle
● Considered as the strongest diuretic
Disease(COPD) are both diseases marked by
inflammation and narrowing of airways
● Asthma is caused by elevation of histamine
andleukotrienes → bronchospasms
● COPD is mostly caused by inflammation of
airways duesto irritants such as cigarette smoke
TREATMENTS - B2 AGONISTS
● Short-Acting B2 Agonists (SABAs)
➔ Salbutamol, Albuterol
○ Used to treat acute asthma attacks
● Long-Acting B2 Agonists (LABAs)
➔ Formoterol, Salmeterol
○ Used as maintenance therapy
■ for prevention of asthma attacks
TREATMENTS - MUSCARINIC ANTAGONISTS
● Short-Acting Muscarinic Antagonists (SAMAs)
➔ Ipratropium
○ Used to treat acute asthma attacks
● Long-Acting Muscarinic Antagonists (LAMAs)
➔ Tiotropium ○ Used as
maintenance therapy
■ for prevention of asthma attacks

TREATMENTS - LEUKOTRIENE MODIFIERS

● LT-1 Receptor Blockers
➔ Montelukast, Zafirlukast ■
Adverse Effects
● Zafirlukast
○ Mild liver damage
○ Churg-Strauss Syndrome
■ Weight loss
■ Flu-like symptoms
■ Pulmonary vasculitis
○ Headache
○ GI disturbances
● Montelukast
○ Churg-Strauss Syndrome
● 5-Lipoxygenase Inhibitors
➔ Zileuton
■ Adverse Effects
● Liver damage
● Psychological effects
○ Depression, anxiety, insomnia, irritability,
abnormal dreams, hallucinations

TREATMENTS - CORTICOSTEROIDS
● Commonly administered with LABAs or LAMAs
● Inhaled agents
➔ Budesonide
➔ Fluticasone
➔ Mometasone
➔ Triamcinolone
● Oral Agents
➔ Dexamethasone
➔ Methylprednisolone
➔ Prednisone
➔ Prednisolone