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Bronchodilators and other antiasthmatic drugs - Coggle Diagram
Bronchodilators and other antiasthmatic drugs
asthma
airway inflammation
episodic, reversible bronchospasm
severe shortness of breath
types
intrinsic
eg aspirin induced
extrinsic
external factors (allergies)
pathogenesis
antigen-antibody reactions
major role played by eosinophils
treatment
bronchodilators
beta agonists
muscarinic antagonists
methylxanthines
anti-inflammatory agents
release inhibitors
steroids
slow anti-inflammatory drugs
antibodies
leukotrine antagonists
no role in COPD
responsible for bronchoconstriction
lipoxygenase inhibitors
receptor inhibitors
parasympathetic nervous system more dominant
acute
sudden attack that needs emergency treatment
treatment
bronchodilators (relievers) : fast acting
beta 2 agonists (first line therapy)
SAB2A
short acting B2 agonist
salbutamol (albuterol)
terbutaline (not used anymore)
levalbuterol / metaproterenol / bitolterol
benim iki akcigerim var
I see a tiger, bronchioles dilate to provide enough oxygen
B2 agonists : bronchodilation
B2 antagonists do not exist
why would I want to stop breathing?
muscarinic antagonists (anticholinergic)
ipratropium
atropine (not used because it crosses blood-brain barrier)
tiotropium bromide (long acting - 24hrs)
methylxanthines (new group)
theophylline
inhibits phosphodiesterase
which degrade cAMP
adenosine : completely opposite actions
QUESTİON
adenosine has vasodilatory effects & vasoconstriction
causes bradycardia in high doses
used in tachyarrythmia treatment caused by overdose of theophylline
present in coffee, tea
need to collect a lot to have enough for treatment
roflumilast (PDE4 inhibitor/COPD)
increase cAMP concentration, relax bronchioles
chronic
controllers
long term preventative treatment, inhibit the inflammation of airways
corticosteroids
prednisone (oral)
prednisolone (IV preparation)
inhaled
beclomethasone
budesonide
fluticasone
side effects
osteoporosis
oropharyngeal candidiasis will happen if patients don't wash their hands
growth retardation in children
QUESTİON
instead, leukotriene receptor antagonists must be prescribed
long term B2 agonists (LAB2A)
cannot be used alone
monotherapy is contraindicated
must always be used in combination with inhaled corticosteroids. or muscarinic antagonists (to avoid building tolerance/tachyphylaxis)
salmeterol
salmeeeterol (long)
formoterol
used in prophylaxis
adverse effects
skeletal muscle tremor : common
excessive use : arrhythmias & tremor
loss of responsiveness : tolerance, tachyphylaxis
bambuterol
for brain, performing surgery
can increase succinylcholine
cholinesterase inhibitor
anti-İgE antibody therapy
expensive
preventors
prophylactic treatment
leukotriene receptor antagonists
montelukast
zafirlukast
used to treat aspirin-induced asthma
5-lipoxygenase inhibitor
zileuton, short half life
mast cell stabilisers
cromolyn & nedocromil
insoluble salts
capable of preventing both early and late responses to antigens
ketotifen
new approach
anti IgE monoclonal antibodies
omalizumab
mab stands for monoclonal antibody
expensive
neutralises free IgE in plasma + binds to IgE on sentisised mast cells
ketamine
potential bronchodilator in severe asthma
magnesium sulfate
severe asthma flare-ups
COPD (chronic obstructive pulmonary disease)
airflow limitation
irreversible
alveolar destruction, fibrosis
risk factors : tobacco smoke, air pollution
chronic bronchitis + emphysema = COPD
pathogenesis
major role played by alveolar macrophages
neutrophils
ROS
mucus hypersecretion
alveolar wall destruction (emphysema)
treatment
anti-inflammatory agents
steroids
bronchodilators
antibiotics
leukotriene antagonists have no role in COPD
muscarinic antagonists (bronchodilator) : drug of choice in COPD treatment
decrease mucous secretions
histamine (allergies)
stimulates gastric secretion
constriction of bronchial smooth muscle
histamine H1 antagonists
first generation
sedating
second generation
nonsedating
aspirin contraindicated in children below 12
Reye's syndrome
COVID19
favipiravir
contraindicated now
RNA -dependent RNA polymerase
viron prodution inhibited
tocilizumab
IL-6 receptor antagonist