Trully Sitorus Depart.

Of Pharmacology Medical Faculty Padjadjaran University

Drugs Used To Treat Asthma

Asthma is a chronic disease, characterized by episodes of acute bronchocontriction causing shortness of breath, cough, chest tightness, wheezing and rapid respirations. The goal therapy is to relieve symptoms and to prevent recurrence of asthmatic attacks.

Principles in the treatment of asthma

I. Anti-inflammatory Drugs - Chromolin sodium - Nedocromil sodium - Steroid II. Bronchodilator - Agonist adrenergic - Xanthines - Anticholinergic III. Avoidance of the causative factors, when possible.

Agonist Adrenergic
Mechanism: Increase cAMP levels in smooth muscle Effects Side effects Bronchodilation CV effects Metabolic effects Pulmonary effects: cough is possible reaction to aerosol preparation GI effect: nausea, vomiting Uterine: relaxed uterine smooth muscle

Bronchodilator Agonist Adrenergic

I. Selective (Beta 2 Adrenergic) Salbutamol (Albuterol) Terbutalin Metaproterenol Salmeterol Formoterol

II.

Non selective (Beta 1-2 Adrenergic) Isoproterenol Metoproterenol (Alfa Beta Adrenergic) Adrenalin Ephedrine

Methylxantine Bronchodilator
Theophylline Aminophylline
Mechanism Inhibiting enzyme phosphodiesterase Adenosin antagonist Indication Asthma bronchiale Reduce dependence on adrenergic Nocturnal control of symptom Status asthmaticus

Pharmacokinetics Therapeutic range: 10 20 ug/ml The variability biotransformation is large Numerous drug interaction Adverse effects Hypersensitivities Anorexia, nausea, vomiting, headache, palpitation, tachycardia. Nervousness, insomnia, anxiety Tremor, convulsion Toxic dose: arrhythmias, coma and death

Contra indication Arrhythmias cordis Coronary heart disease Ulcus pepticum

Drug interaction Erythromycin Cimetidine Propanolol Allopurinol

Phenobarbital Phenitoin Nicotine (smoking)

Anti Muscarinic Bronchodilators Ipatropium

Mechanism: Reduce bronchocontriction mediated by vagal reflexes Indication: Chronic Obstructive Pulmonary Disease, Asthma Bronchiale, esspecially in patiens with concurrent cardiac disease who cannt tolerate B adrenergic or methylxanthines

Adverse effects: Some atropine like effect Contraindication: Glaucoma Urinary outlet obstruction Dosage: Aerosol Nebulizer

CROMOLYN AND NEDOCROMIL

Mechanism Cromolyn inhibits the release of mediators of inflamation from mast cells . Cromolyn is not a bronchodilator. Major Indications Prophylaxis of Asthma Young patients with Extrinsic, irritant induced asthma.

 Other Indication Rhinitis Allergic conjungtivitis Hay Fever

CORTICOSTEROID
Mechanism Reduce the number and activity of inflammatory cells. Reduce the release of mediators (Leukotrienes) Corticosteroids may enhance the Beta adrenergic. Major Indication Asthma Bronchiale Combination with bronchodilator agent. Prophylaxis of asthma aerosol preparation.

 Other Indication lupus eritromatosus, Nephrotic syndrome, Hay fever, Dermatitis allergica. Adverse Effects Topical steroid : throat irritation, oral thrush, atrophy, pharyngeal candidiasis. Preparation Inhaler : Beclomethasone, Flunisolide, Triamcinolone.

DRUGS USED IN RHINITIS OR THE COMMON COLD

Pathophysiology Viral infection and other inflammatory conditions cause swelling and edema of the mucous membrane of nasopharynx. Symptom : Rhinorrhea and Congestion

DRUGS USED IN RHINITIS / COMMON COLD

I. Antihistamines (AH1) Sedative : cyclizine, dipenhydramine, ctm II. Alpha Adrenoreceptor Agonist Phenylephrine Ephedrine pseudoephedrine III. Cromolyn IV. Corticosteroid

DRUG USED FOR COUGH

Pathophysiology Cough is a non specific sign of upper or lower airway irritation or inflamation and is mediated through reflex vagal pathways. Cough : Non productive Productive

I. Antitusives Codeine, dexthromethorphan II. Expectorants Guaifenesin, terpin hydrate III. Mucolytics Acetylcystein, bromhexine