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DRUGS USED IN THE TREATMENT OF ASTHMA - Coggle Diagram

- - - - Long term - prevent acute asthma attack (8 wks - effective)
    - - effects on endocrine systems- less used nowadays
    - - ICS (rare)
      - Systemic corticosteroids effects on endocrine systems
  - - - Clinical uses
        
        • Prevent asthma attack (mild level asthma)
        
        • Effective for treatment allergic and exercise induced asthma
      - Side effects
        
        Churg-Strauss vasculitis
    - - Clinical uses
        
        Prevent acute asthmatic attack
      - Side effects
        
        Hepatotoxicity
    - - Zafirlukast interacts with warfarin and produces a clinically significant
        increase in the prothrombin time.
  - - - • Cromolyn & nedocromil
        --Prevent asthma attack (mild to moderate asthma)
        --More than 2 months of usage -- sensitivity of the bronchi to stimulation decrease
      - • Cromolyn can be used in patients of all ages.
      - • Nedocromil can be used in patients above 12 years of age.
      - • Ketotifen (H1 antihistamine) -- chronic asthma in children (mild asthma)
    - - • Rare
      - • Cough, joint pain, headache, nausea, vomiting
  - - - Used in patients above 12 years of age
      - Used for moderate to severe asthma, allergy & chronic urticaria
    - - Anaphylaxis
      - Injection-site reaction
- - - - Rapid/short-acting drugs
        
        Salbutamol (albuterol)
        
        Levalbuterol,
        
        Pirbuterol
        
        Terbutaline,
        
        Procaterol
        
        Fenoterol
      - . Long-acting drugs
        
        Salmeterol
        
        Formoterol
        
        Arformoterol
        
        bambuterol
      - Ultralong-acting drugs
        
        Indacaterol
        
        olodaterol
        
        vilanterol
      - Side effects
        
        High dose activates β1
        -receptor in the heart
        
        HR & contractility increace
        
        arrhythmia
        
        tachycardia
        
        palpitation
        
        BP inreace or decreace
        
        angina
        
        Activate CNS
        
        headache
        
        anxiety
        
        nervousness
        
        dizziness
        
        insomnia
        
        seizure
        
        Muscular system
        
        tremor
        
        Hormonal (endocrine) system
        
        hyperglycemia
        
        hypokalemia
        
        lactic acidosis
        
        Tachyphylaxis
    - - Epinephrine
      - Isoproterenol
  - - - Metered-dose inhaler, oral inhalation, nebulization or nasal spray
      - Albuterol is more effective than ipratropium on acute asthma
        (equally effective in treating COPD)
      - Combined with albuterol → increased bronchodilation
    - - Long-acting antimuscarinic drugs
        (tiotropium 24 h, aclidinium 12 h)
      - COPD
    - - Respiratory system
        bronchitis & risk of infection increase
      - Cardio system – palpitation, tachycardia
      - CNS- dizziness, insomnia
      - Urinary system- urinary retention
      - GI – nausea, dry mouth, stomachache, constipation
      - Etc.- blurred vision, intraocular pressure increase
      - Nasal spray
  - - - COPD, asthma & apnea in premature infants
      - PO, IV
    - - High toxic
        
        CNS stimulation
        – headache, anxiety nervousness, dizziness, insomnia,
        tremor & seizure
        
        GI distress - stomach pain, nausea, vomiting
        
        Cardiac stimulation – hypotension, increased heart rate
      - Aminophylline
        if the injection is too rapid, and sudden deaths have been reported.
    - - Cimetidine – Inhibit CYP1A2
      - Drugs decrease theophylline clearance
        e.g. erythromycin, fluoroquinolones, isoniazid & verapamil