Upload
lio-hasse
View
217
Download
0
Tags:
Embed Size (px)
DESCRIPTION
ANTI-INFLAMMATORY DRUGS
Citation preview
Anti-Inflammatory DrugsSteroids and NSAIDs
RC 195
Corticosteroids, SteroidsNaturally-occurring hormones produced by the adrenal glandsGlucocorticoids: HydrocortisoneMineralcorticoids: AldosteroneSex Hormones: Testosterone
Actions of GlucocorticoidsAnti-inflammatorySupresses actions of kinins, cytokines, and other mediators of inflammationMaintains microcirculation and minimizes edemaMaintains cell membrane integrityInhibits macrophage movementInhibition of immune responseStabilizes mast cellsReduces histamine levelsBronchodilationPotentiates catecholamine activity by inhibiting COMT and increasing adenyl cyclase productionDecreased cholinergic and alpha stimulationDecreased phosphodiesterase production
Steroid UsesAcute InflammationOrgan TransplantAllergic Inflammation
Steroid Side Effects: Cushings SyndromeGluconeogenesisOsteoporosisPhysical changesIncreased fat production and redistributionAcneHirsutismFragile skinSodium retentionFluid retentionPotassium loss and metabolic alkalosis
Increased gastric acidityDecreased resistance to infectionMDI may cause candida albicans, thrushPatients need to rinse mouth after MDIDependencyBoth physical and psychologicalPatients may need to be weaned from steroid therapy
Interaction with other drugs
Increased breakdown in the presence of:Dilantin, barbiturates, certain tranquilizers, anti-histamines, ephedrineDecreased breakdown (and greater chance of severe side effects) in the presence of some antibiotics, eg erythromycin
Steroids in Respiratory CareFor prevention of inflammation aerosol
For relief of inflammation: systemic
HydrocortisoneBrand name(s): Solu-Cortef, CortefGiven orally or IVNot usually aerosolized because of side effects
Prednisone (Prednisolone)Brand: Deltasone, Delta-Cortef4X as potent as hydrocortisoneGiven orallySide effects minimized if given every other dayPatients usually need to be weaned from it
MethylprednisoloneBrand: Solu-MedrolOral or IVOften used to help relieve airway inflammation
TriamcinoloneBrands: Azmacort, KenalogMDI- to prevent airway inflammation
DexamethasoneBrand: DecadronOften nebulized for acute upper airway inflammationWhat else is used with it?
BeclomethasoneBrands: Vanceril, Beclovent, BecotideMDI to prevent airway inflammation
Mometasone FuroateBrand: AsmanexDPI Twisthaler 220mcg per pffStarted as one puff per day in then evening and may go as high two puffs BID
FlunisolideBrand: AeroBidMDI to prevent airway inflammationUsually effective when given only BID
FluticasoneBrand: FloventMDI (similar to Flunisolide)Fluticasone is also sold as a combo drug, Advair, which contains fluticasone and salmeterolTaken as a dry powder inhaler (DPI)
BudesonideBrand: PulmicortMDI to prevent airway inflammationSeems to get best effects with minimal side effects
NSAIDsDrugs that prevent airway inflammation but usually have less side effects than steroids
Cromolyn SodiumBrands: Intal, AaraneIs a mast cell stabilizer so used to prevent airway inflammationDoes not relieve airway inflammation!Often used as an alternative to aerosol steroids in childrenAdministered via Spinhaler (DPI), MDI, nebulizerUsually needs to be administered Q.I.D.May take at least two weeks before any effects are seen
Nedocromil SodiumBrand: TiladeSimilar to cromolyn sodium (used to prevent airway inflammation)MDI usually only needed B.I.D.
NSAIDs: Leukotriene Inhibitors
(used to prevent airway inflammation)Zafirlukast (Accolate)Taken as a pill B.I.D.Zileuton (Zyflo)Taken as a pill Q.I.D.Montelukast (Singulair)Taken as a pill just once a day
NSAIDs: Omalizumab (Xolair)Genetically engineered recombinant humanized monoclonal antibodyBinds to IgE and prevents it from attaching to mast cellsGiven sub-Q 1-2 times per month
Case Study Time!