ALLIANZE COLLEGE OF MEDICAL SCIENCES

DIPLOMA IN PHARMACY JULY 08

CLINICAL PHARMACY
PPL 237 / 3
Group Member
Farah Hani Bt.Rohizam
(PH003/08)
Nazrina Bt.Nasir Ahamed
(PH021/08)
Lecturer
Mr.Saminathan
DRUGS AFFECTING THE
RESPIRATORY SYSTEM
PRESENTED & PREPARED BY
FARAH HANI ROHIZAM
POINTS OF VIEW

• ANATOMY OF THE RESPIRATORY

REGION
• INTRODUCTION INTO THE
RESPIRATORY SYSTEM
• COMMON DISEASE DISORDER OF
RESPIRATORY SYSTEM
• DRUGS AFFECTING THE
RESPIRATORY SYSTEM
RESPIRATORY REGION
PARTS OF RESPIRATORY REGION
RESPIRATORY SYSTEM

• Consist of : Upper respiratory airways

Lower respiratory airways
Lungs
Thoracic cavity
• Mechanism of action for exchange of oxygen
and carbon dioxide
• Any change in status will affect every bodily
system All cells need adequate supply of
Oxygen for optimal functioning
Division Of The Respiratory System
COMMON DISEASE DISORDER
I. UPPER RESPIRATORY REGION
II. LOWER RESPIRATORY REGION
UPPER RESPIRATORY REGION

• The common disease disorder in this

region are :

– Infections
– Allergic Rhinitis
– Coughs
– Common Cold
– Congestion
LOWER RESPIRATORY REGION

• The common disease disorder in this

region are :
– Asthma
• Chronic Inflammatory Disease Of the
Airways
– Emphysema
• Lung disorder where alveoli becomes
enlarged & plugged with mucus
– COPD
• Chronic Obstructive Pulmonary Disease
LOWER RESPIRATORY REGION
• ASTHMA
– Airway Constriction
• Bronchospasm
• Bronchoconstriction
– Periods of exacerbation alternating with
periods of normal lung function
– Caused by environmental exposure of
allergens
• House dust mites
• Tobacco smoke
• Pets & pet dander
• Mold
• Cockroach wastes
• Physical exercise (most important factor)
LOWER RESPIRATORY REGION
LOWER RESPIRATORY REGION
• COPD
(Chronic Obstructive Pulmonary Disease)
– Slowly progressive disease of the airways
– Gradual loss of lung function
– Symptoms are
• Chronic cough
• Sputum production
• Severe, disabling, shortness of breath
LOWER RESPIRATORY REGION
DRUGS THAT AFFECT THE
RESPIRATORY SYSTEM
For Upper Respiratory System
For Lower Respiratory System
 UPPER RESPIRATORY
SYSTEM
□ The infections here are typically treated with an
antibiotic if bacteria are involved
□ When condition is viral, comfort measures are
used
 Antihistamines
 To relieve allergy symptoms
 Decongestants
 To reduce nasal edema
 Antitussive, Mucolytics & Expectorants
 To treat accompanying cough
 LOWER RESPIRATORY
SYSTEM
□ Bronchodilator
 B2 Adrenergic Agonists
 Have sympathomimetic properties
 Xanthine Derivatives

□ Anti Asthma Drugs

 Corticosteroids

 Leukotriene Modifiers

 Mast Cell Stabilizers

 COPD & ASTHMA
□ COPD
No known cure
Treatment usually supportive
Designed to relieve symptoms & improve life quality
□ ASTHMA
Anti-inflammatory drugs are important
□ To prevent Asthma attacks by
• Decrease swelling & mucus production in the airways
• Makes airways less sensitive to asthma triggers
 Overview…
DRUGS THAT
AFFECT THE
RESPIRATORY
SYSTEM

ANTIHISTAMINE
ANTITUSSIVES, BRONCHODILATO
S&
MUCOLYTICS & RS & ANTI
DECONGESTAN
EXPECTORANTS ASTHMA DRUGS
TS
ANTIHISTAMINES &
DECONGESTANTS

Treatment in the more common

disorders affecting the Upper
Respiratory System
ANTIHISTAMINES
• Produced in response to allergic reaction
or tissue injury
• Acts on area
Vascular system & smooth muscle
Producing dilation of arterioles
Increased permeability of capillaries & venules
• Dilation of Arterioles
Results in localized redness
Increased permeability of small blood vessels
 Promotes an escape of fluid into surrounding
tissue
 Produced localized swelling
ANTIHISTAMINES

Histamine Cell Receptors

Histamine Type 1 (H1)
Contract smooth muscle & dilate
capillaries
Histamine Type 2 (H2)
When actrivated, heart rate & gastric
secretions increase
Histamine Type 3 (H3)
Located throughout the nervous system
 ANTIHISTAMINES
• Used to block the cell receptors
• Counteracting the effects of histamines on
body organs and structures ☺Minimally
penetrate the
• Examples blood-brain
1st Generation barrier
 Diphenhydramine (Benadryl) ☺Little drugs
2nd Generation distributed in
the CNS
 Loratadine (Claritin)
 Fexofenadine (Allegra) ☺Fewer
 Cetirizine (Zyrtec) sedating effect
(less side
Topical Corticosteroid Nasal Spray effects)
 Fluticasone Propionate (Flonase)
 Triamcinolone Acetonide (Nasacort)
ANTIHISTAMINES
ACTIONS
• H1 Receptor Antagonists
Block most, but not all of the effects of
histamines
Competing with histamine@histamine
receptor sites
Prevent Histamine from entering the
receptor sites, produce effect on body
tissue
ANTIHISTAMINES
ACTIONS
• 1st Generation Antihistamines

 Binds selectively to central & peripheral H1

receptors
 Results in CNS stimulation or depression
(usually occurs with higher dose & allows to
be used for sedation)
• 2nd Generation Antihistamines
 Selective for peripheral H1 receptors
 Less sedating
 Less side effects
ANTIHISTAMINES
USES
• Relief of the symptoms of seasonal & perennial allergies
• Allergic & Vasomotor rhinitis
• Allergic Conjunctivitis
• Mild & uncomplicated angioneurotic adema & urticaria
• Relief of allergic reactions to drugs, blood, or plasma
• Relief of coughs caused by colds or allergy
• Adjunctive therapy in anaphylactic shock
• Treatment of parkinsonism
• Relief of nausea & vomiting
• Relief of motion sickness
• Sedation
• Adjuncts to analgesic
ANTIHISTAMINES
ADVERSE REACTIONS
• Central Nervous System Reactions
 Drowsiness or sedation
 Disturbed coordination
• Respiratory System Reactions
 Anticholinergic actions of antihistamines affect the
respiratory system and include the following
Dryness of the mouth, nose, and throat
Thickening of bronchial secretions
• Drug Allergy
 Skin rash
 Urticaria
 Anaphylactic shock
 ANTIHISTAMINES
CONTRAINDICATIONS
• Pregnancy Category B & C
 However they are contraindicated during pregnancy &
lactation
• 1st Generation Antihistamines
 Patients with known hypersensitivity
 Newborns & Premature Infants
 Individuals undergoing Monoamine Oxidase Inhibitor
Antidepressant (MAOI) therapy
 Angle-closure glaucoma, stenosing peptic ulcer,
symptomatic prostatic hypertrophy & bladder neck
obstruction
• 2nd Generation Antihistamines
 Patient with known hypersensitivity
 Cetirizine in patients hypersensitive to hydroxyzine
ANTIHISTAMINES
PRECAUTIONS
• Patients with
 Bronchial asthma
 Cardiovascular disease
 Narrow-angle glaucoma
 Symptomatic prostatic hypertrophy
 Hypertension
 Impaired kidney function
 Peptic ulcer
 Urinary retention
 Pyloroduodenal obstruction
 Hyperthyroidism
ANTIHISTAMINES
• INTERACTIONS
• EXAMPLES OF ANTIHISTAMINE DRUGS
Drugs Brand Specific Side Effects Dosage Contra- Pregnanc
Name Class Forms indication y
s Category
Diphen- Benadryl Amino- CVS and CNS Capsule, Prematur B
hydrami Allerin alkyl effects, Syrup, e&
ne AH Ethers previous IV, newborn
*1st
Biogeneri allergy, GI IM infants;
Generati
cs disturbance asthma
on
Caladryl attack;
lactation.
Loratadi Claritin systemic Drowsiness, Tablets, Hepatic B
ne Allerta sympath headache, Oral Diseases,
Allerclear o psychomotor Suspensi renal 2nd
Claricort mimetic impairment, on, impairme Generati
Clarinase prepara and Syrup nt on
tions antimuscarinic
effects such as
urinary
retention, dry
mouth, blurred
vision, and
DECONGESTANTS
DRUG THAT
• Reduces swelling of the nasal passages
• Opens clogged nasal passages
• Enhances drainage of the sinuses
• Temporary relief of nasal congestion
caused by:
 Common cold
 Hay fever
 Sinusitis
 Other respiratory allergies
DECONGESTANTS
DECONGESTANTS
ACTIONS
• Sympathomemitic-produce localized
vasoconstriction of the small blood
vessels of the nasal memebranes
• As in adrenergic-blocking drugs
• Vasoconstriction reduces swelling in
the nasal passages (decongestive
activity)
DECONGESTANTS

USES
• Treatment of the congestion
associated with:
Common cold
Hay fever
Sinusitis
Allergic rhinitis
Congestion associated with rhinitis
DECONGESTANTS
ADVERSE REACTIONS
• Minimal effects when used topically
 Nasal burning
 Stinging
 Dryness

• Oral decongestants
 Tachycardia & other cardiac arryhthmias
 Nervousness, restlessness, insomnia
 Blurred vision
 Nausea & vomiting
DECONGESTANTS
CONTRAINDICATIONS
• Patients with known hypersensitivity

• Patients taking MAOI

Antidepressants
• Sustained-released pseudoephedrine
is contraindicated in children
younger than 12 years
DECONGESTANTS
PRECAUTIONS
• Thyroid disease
• Diabetes Mellitus
• Cardiovascular disease
• Prostatic hypertrophy
• Coronary artery disease
• Peripheral vascular disease
• Hypertension
• Glaucoma
• Pregnancy (Category C), consult primary
healthcare before use
DECONGESTANTS
• INTERACTIONS
EXAMPLES OF DECONGESTANT DRUGS
Drugs Brand Specific Side Effects Dosage Contra- Pregnanc
Name Class Forms indications y
Category
Ephedri Quelidrin Plant Nasal Nasal Hyper- C
ne Alkaloids burning, drops sensitivity or
ePretz-D
Derivative stinging, ,IV, IM Hyper-
dryness, sensitive to
rebound other
nasal sympathomi
congestion metics,
nursing
mothers
Pseudo- Sudafed systemic Anxiety, Tablet Severe C
ephedrin sympatho- restlessness, hyper-
e mimetic anorexia, tension,
preparatio arrythmias, phaeochro-
n nervousness, mocytoma
nausea,
vomiting,
blurred
BRONCHODILATORS &
ANTIASTHMA DRUGS

Treatment in the more common

disorders affecting the Lower
Respiratory System
 LOWER RESPIRATORY
DISORDER
• COPD
 Asthma (cause spasmodic constriction of the
bronchi)
 Chronic Bronchitis

 Chronic Obstructive Bronchitis (Emphysema)

 Combination of these conditions

 LOWER RESPIRATORY
DISORDER
• Patients Of COPD
 Experiences dyspnea (breathing difficulty)
with physical exertion
 Difficulty in inhaling & exhaling – may have

chronic cough
 These disorders interfere with the exchange

of gaseous in the lung alveoli

DURING INFLAMMATORY
PROCESS
• Large amount of Histamine is released from mast
cells of respiratory tract
• Lung bronchi constrict
 Become hyper-responsive to the bronchoconstriction
 Edema occurs
• With Asthma
 Airways become narrow
 Muscles around the airways tighten
 Extra mucus clogs the smaller airways
 DURING INFLAMMATORY
PROCESS
Characterized by
 Experience of anxiety in asthma
 Periods of exacerbation of symptoms alternating
with normal respiratory functions
─ Begins abruptly, preceded by increasing symptoms
 Cough (worse at night or early morning)
 Generalized wheezing (a whistle or squeking sound on
inspiration or expiration)
 Generalized chest tightness (may feel like someone is sitting
on the chest)
 Dyspnea (shortness of breath of feeling of breathless)
 Tachypnea (rapid breathing)
ASTHMA MEDICATIONS
• 2 Major Groups
─ Long-Term Control Medication/Management
 Use step care approach (medication & frequency
adjusted according to severity)
 Most effective that – Reduce inflammation (Inhaled
corticosteroids ICSs being 1st line intervention)
─ Quick-Relief Medications
 Inhaled Short Acting Beta-2(B2)(Adrenergic)
Agonists (SABAs)
 Oral steroids
STEP CARE APPROACH
BRONCHODILATORS
• Mainstay treatment for COPD
• SABA bronchodilator used-relieve
bronchospasm associated with respiratory
disorders
 Bronchial asthma
 Chronic bronchitis

 Emphysema

• Example of B2 agonist bronchodilators

 Albuterol (Ventolin)
 Epinephrine (Adrenalin)

 Salmeterol (Serevent)

 Terbutaline (Brethine)
 ANTIASTHMA DRUGS
• ICSs
• Mast Cell Stabilizer
• Leukotriene Formation Inhibitors
• Leukotriene Receptor Agonists
• Immunomodulators
BRONCHODILATORS

I. ADRENERGIC
BRONCHODILATORS
II. XANTHINE DERIVATIVES
 ADRENERGIC BRONCHODILATORS
• Alpha (α)-adrenergic receptors (the sympathetic
system) in the lungs is stimulated,
bronchoconstriction results
• Bronchodilation occurs when β-adrenergic receptors
are stimulated
• Divided to
β2-adrenergic agonists (short acting – albuterol &
terbutaline)
β2-adrenergic agonists (long acting – salmeterol)
 ADRENERGIC BRONCHODILATORS
ACTIONS
• When bronchospasm occurs
Decrease in lumen (inside diameter) of bronchi
Decrease amount of air taken into the lungs with each
breath
Results in respiratory distress
• Brochodilating drugs
Open bronchi by relaxing the smooth muscles
Allows more air to enter the lungs
Results in completely/partially relieves of respiratory
distress
 ADRENERGIC BRONCHODILATORS
USES
• β2-adrenergic drugs (which mimic the sympathetic nervous
system) for treatment of COPD due to bronchoconstriction
such
Bronchospasm associated with acute & chronic bronchial asthma
Exercise-induced bronchospasm (EIB)
Bronchitis
Emphysema
Bronchiectasis (chronic dilation of the bronchi & bronchioles)
Other obsructive pulmonary disease
 ADRENERGIC BRONCHODILATORS
ADVERSE REACTIONS
• Cardiovascular System Reactions
Tachycardia, palpitations, or cardiac arrythmias
Hypertension
• Other Reactions
Nervousness, anxiety
Insomnia
• If taken by inhalation, excessive use may result in
paradoxical bronchospasm
 ADRENERGIC BRONCHODILATORS
CONTRAINDICATIONS
• Patients with known hypersensitivity
• Cardiac arrythmias associated with tachycardia
• Organic brain damage
• Narrow-angle glaucoma
• Salmeterol is contraindicated during acute
bronchospasm
 ADRENERGIC BRONCHODILATORS
PRECAUTIONS
• Used cautiously in patients with
Hypertension
Cardiac dysfunction
Hyperthyroidism
Glaucoma
Diabetes
Prostatic hypertrophy
History of seizures
• Used cautiously during
Pregnancy (all in category C except Terbutaline in category B)
Lactation
 ADRENERGIC BRONCHODILATORS
INTERACTIONS
EXAMPLES OF ADRENERGIC BRONCHODILATOR DRUGS
Drugs Brand Specific Side Effects Dosage Contra- Pregnanc
Name Class Forms indications y
Category
Albutero Proventil, selective Headache, Tablets, Threatened C
l beta-2- tremor, Syrups, abortion
Ventolin
adreno- tachycardia Evohaler, during 1st or
receptor , Respirato 2nd trimesters
agonists palpitations r of pregnancy.
, dizziness, solutions/ Toxaemia of
shakiness, Nebules, pregnancy,
hyperactivit IV placenta
y praevia,
antepartum
haemorrhage,
placenta
praevia
Salmeter Serevent selective Tremor, Tablet Patients with C
ol Diskus beta-2- headache, /Metered a history of
adreno- cough dose hypersensitivi
receptor inhaler or ty to any of
agonists dry the
powder ingredients of
 XANTHINE DERIVATIVE
BRONCHODILATORS

• Also known as Methylxanthines

• Have bronchodilating activity
• Examples
Theophylline (The-Dur)
Aminophylline (Phyllocontin)
 XANTHINE DERIVATIVE
BRONCHODILATORS
ACTIONS
• Stimulate the central nervous system (CNS)
• Promote bronchodilation
• Cause direct relaxation of the smooth muscles of bronchi
USES
• Symptomatic relief or prevention of bronchial asthma
• Treatment of reversible bronchospasm associated with
chronic bronchitis & emphysema
 XANTHINE DERIVATIVE
BRONCHODILATORS
ADVERSE REACTIONS
• Central Nervous System Reactions
Restlessness, irritability, headache
Nervousness, tremors
• Cardiac & Respiratory System Reactions
Tachycardia
Palpitations
Electrocardiographic changes
Increased respirations
• Other Reactions
Nausea, vomiting, fever
Hyperglycemia, flushing, aloecia
 XANTHINE DERIVATIVE
BRONCHODILATORS
CONTRAINDICATIONS
• Known hypersensitivity
• Peptic ulcers
• Seizure disorders (unless well controlled with appropriate anticonvulsant medication)
• Serious uncontrolled arrythmias
PRECAUTIONS
• Used precautiously in patients with
Cardiac disease
Hypoxemia
Hypertension
Congestive heart failure
Liver disease
• Used cautiously in elderly patients & those who use alcohol habitually
• Aminophylline, dryphylline, oxtriphylline & theophylline are pregnancy category C &
used cautiously during pregnancy & lactation
 XANTHINE DERIVATIVE
BRONCHODILATORS
• INTERACTIONS
EXAMPLES OF XANTHINE DERIVATIVE BRONCHODILATOR DRUGS

Drugs Brand Specific Side Effects Dosage Contra- Pregnanc

Name Class Forms indications y
Category
Theo- Theo- Methylate Nausea, vomiting, Tablets, Hypersensitivity C
phylline Dur, d Xanthine abdominal pain, Syrups, to xanthine
Theolair, Derivative diarrhoea, IV derivatives,
Sio-Bid, headache, porphyria
Uniphyll insomnia,
dizziness, anxiety,
restlessness,
tremor,
palpitations.

Ipra- Atrovent Anti- Dryness of the Inhalatio Hypersensitivity B

tropium cholinergic oropharynx, n to atropine or
drugs nervousness, solutions its derivatives
irritation from
aerosol, dizziness,
headache, GI
stress, dry mouth,
exacerbation of
symptoms,
nausea,
ANTIASTHMA DRUGS
Long term medication used to control asthma
persistently, best to reduce the underlying
inflammation of asthma
ANTIASTHMA DRUGS

• Inhaled Corticosteroids
• Mast Cell Stabilizers
• Leukotriene Modifiers
• Immunomodulators
INHALED CORTICOSTEROIDS
(ICSs)
• Most consistently effective long-term medications
for persistent asthma
• ICS & LABA (Long Acting Beta Agonists) may be
combined to ease administration & produce positive
outcomes
• ACTIONS
– Anti-inflammatory that reduces airway
hyperresponsiveness
 Reduce number of mast cells in airway
 Block reaction to allergens
– Beclomethasone (QVAR), flunisolide (AeroBid), &
triamcinolone (Azmacort) are given by inhalation
 Decrease the inflammatory process directly in the airways
– Corticosteroid increase sensitivity of β2 receptors
 Increase the effectiveness of β2 receptor agonist drugs
USES OF ICSs
• Management & prophylactic treatment of
the inflammation associated with chronic
asthma
• Some may be used intranasally for
treatment of nasal polyps & rhinitis
ADVERSE REACTIONS

• Respiratory System Reactions

Throat irritation
Hoarseness
Upper respiratory tract infection
Fungal infection of the mouth & throat
CONTRAINDICATIONS
• Known hypersensitivity to corticosteroids
• Acute bronchospasm
• Status asthmaticus
• Other acute episodes of asthma
• Beclomethasone is contraindicated for the relief of
symptoms that can be controlled by a bronchodilator &
other NSAIDs & in treatment of nonasthmatic bronchitis
PRECAUTIONS
• Used cautiously in patients with
 Compromised immune systems
 Glaucoma
 Kidney disease
 Liver disease
 Convulsive disorders
 Diabetes
• Combining ICSs & systemic corticosteroids can increase the risk
of hypothalamic-pituitary-adrenal (HPA)
• Used with caution during
 Pregnancy (Category C)
 Lactation (Category B-Budesonide)
CONTRAINDICATIONS
• Ketoconazole may increase plasma levels of budesonide & fluticasone
EXAMPLES OF XANTHINE DERIVATIVE BRONCHODILATOR DRUGS

Drugs Brand Specific Side Effects Dosage Contra- Pregnanc

Name Class Forms indication y
s Category
Bude- Pulmicort Topical Oral, Powder for Chicken- C
sonide Terbuhaler, corticost laryngeal, inhalation, pox or
Respules, eroids pharyngea Liquid measles
Rhinocort irritation, /Aerosol
Aqua fungal (Nasal
infections, spray)
suppression of
HPA functions
Beclome QVAR Topical Oral, Topical Hyper- C
-thasone corticost laryngeal, cream sensitivity.
eroids pharyngeal /ointment, Acute
irritation, Liquid for infections
fungal inhalation un-
infections, controlled
suppression of by anti-
HPA functions microbial
chemo-
MAST CELL STABILIZERS

• ACTIONS
 They are thought to stabilize the mast cell membrane
 Possibly by preventing calcium ions from entering mast
cells
 Preventing release of inflammatory mediators such as
histamines & leukotrienes
• USES
 Used in combination with other drugs
 In treatment of Asthma & allergic disorders
 Includes allergic rhinitis (nasal solution)
 Used to prevent EIB (Exercise-Induced Bronchospasm)
 Typically used in step 2 care for chronic asthma
ADVERSE REACTIONS
• Respiratory System Reactions
 Throat irritation & dryness
 Unpleasant taste sensation
 Cough or wheeze
 May cause nauseated feeling
CONTRAINDICATIONS & PRECAUTIONS
 Patients with
 Known hypersensitivity
 During attacks of acute asthma cause may worsen bronchospasm
 Used to cautiously in
 Pregnancy (Category B)
 Lactation
 Patients with impaired renal or hepatic function
 EXAMPLES OF MAST CELL STABILIZERS DRUGS

Drugs Brand Specific Side Effects Dosage Contra- Pregnanc

Name Class Forms indications y
Category
Cromolyn Intal, Topical Cough, wheeze, Powder Childn. B
Nasal- anti- unusual taste, for inha- Pregnancy &
Crom, allergic dizziness, lation, lactation
Gstro- pre- headache, Liquid /
crom, parations nausea, dry & Aerosol
Cromal , irritated throat, (Nasal
AQ excludin rash, joint spray)
g cortico- swelling & pain
steroids
Nedocromil Tilade Topical Cough, nausea, Inha- Pregnancy B
anti- pharyngitis, lation, and lactation.
allergic rhinitis, Nasal Not for use in
pre- vomiting, spray acute asthma
parations headache, attacks; acute
, bronchospasm, bronchospasm
excludin unusual taste . Children
g cortico-
LEUKOTRIENE MODIFIERS &
IMMUNOMODULATORS

• Leukotriene receptor antagonists include:

Montelukast (Singulair)
Zafirlukast (Accolate)
• Zileuton (Zyflo) is classified as a leukotriene
formation inhibitor
• Omalizumad (Xolair) is a monoclonal
antibody used to treat asthma
ACTIONS
• Leukotriene
 Released from mast cells during asthma attacks
 Responsible for bronchoconstriction
 When inhibitedbronchodilation is facilitated
• Zileuton (an inhibitor)
 Decrease formation of leukotrienes
• Montelukast & Zafirlukast
 Leukotriene receptor agonists
 Inhibit leukotriene receptor sites in respiratory tract
 Preventing airway edema & facilitating bronchodilation
• Omalizumad
 Modulate immune response by
 Preventing the binding of immunoglobulin to the receptor on
basophils & mast cells
 Limiting allergic reaction
USES
• Used in prohylaxis & treatment of chronic asthma
in adults & children older than 12 years old
• Omalizumad I used as adjunctive therapy for
patients 12 of age, who are sensitive to allergens &
require step 5 or 6 care
ADVERSE REACTIONS
 Central Nervous System Reactions
 Headache
 Generalized Body System Reactions
 Flu-like symptoms
 Immunomodulators may cause anaphylactic reactions,
emergency equipment should be available when administering
this medication
CONTRAINDICATIONS & PRECAUTIONS

• Patients with know hypersensitivity

• Bronchospams in acute asthma attacks
• Liver disease (zileuton)
• Used cautiously in
Pregnancy (Zafirlukast, montelukast & omalizumad
[category B] & Zileuton [category C])
INTERACTIONS
EXAMPLES OF LEUKOTRIENE MODIFIERS & IMMUNOMODULATORS DRUGS

Drugs Brand Specific Side Effects Dosage Contra- Pregnanc

Name Class Forms indications y
Category
Montelukast Singulai Leukotriene Abdominal pain, Tablets Hypersensitivity B
r receptor headache & thirst;
antagonists diarrhea,
hyperkinesia,
asthma,
eczematous
dermatitis & rash;
somnolence
Zileuton Zyflo Leukotriene Dyspepsia, Tablets Hypersensitivity C
formation nausea, headache , active liver
inhibitors disease
Omalizumad Xolair Immuno- Injection site IM Previous severe B
modulators reaction, hypersensitivity
anaphylaxis reaction, acute
bronchospasm,
status
asthmaticus