Clinpharm SGD Bronchial Asthma
Clinpharm SGD Bronchial Asthma
Clinpharm SGD Bronchial Asthma
ASTHMA
Asthma is a heterogeneous disease, usually characterized by
chronic airway inflammation.
DIAGNOSIS OF ASTHMA
SYMPTOMS
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
PHYSICAL EXAMINATION
ATOPY
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
Intrinsic asthma represents a small amount of all cases
Exercise
EIA
Occupational asthma
PHARMACOLOGIC TREATMENT
o
o
o
How?
o
When?
Beta agonist
Anticholinergic
Theophyllines
Controllers
o
o
o
Relievers (bronchodilators)
Corticosteroids
Antileukotrienes
C
CLASSIFICATION
Bronchodilators
o B sympathomimetics
Theophylline (anhydrous),
Aminophylline, Choline, Theophyllinate,
Hydroxyethyl theophylline,
Theophylline ethanolate of piperazine,
Doxophylline
o Anticholinergics (muscarinic receptor
antagonist)
Montelukast, Zafirilukast
o Mast cell stabilizers
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
Systemic: Hydrocortisone, Prednisolone
and others
Inhalational: Beclomethasone
dipropionate, Budesonide, Fluticasone
propionate, Flunisolide, Circlesonide
Anti-IgE antibody
Omalizumab
METHYXANTHINES
MECHANISM OF ACTION
SYMPATHOMIMETICS
SALBUTAMOL
o Selective B2 agonist with less cardiac side
effects
o Inhaled salbutamol produce bronchodilation
within 5 min and the action lasts for 2-4h
o Used for acute asthmatic attack. Not suitable for
prophylaxis
o Side effect: Palpitation, restlessness,
nervousness, throat irritation
o Metabolism: metabolized in gut; oral
bioavailability is 50%
o Duration of action: Oral salbutamol acts 4-6h
o Dose: 2-4mg/oral; 100-200ug/inhalation
TERBUTALINE
o Similar to salbutamol.; regular use dose not
reduce bronchial hyper-reactivity
o Dose: 5mg/oral; 0.25mg/ip or sc;
250ug/inhalation
SALMETEROL
o First long acting selective B2 agonists with slow
onset of action
o Twice daily for maintain therapy/nocturnal
asthma, but not for acute asthma
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
METHYXANTHINES THEOPHYLLINE
INTERACTIONS
INDICATIONS
ANTICHOLINERGICS
CORTICOSTEROIDS
MAST CELL STABILIZERS (Sodium Cromoglycate, Ketotifen)
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
9.
NEBULIZERS
patients who are not able to coordinate or cooperate and they are
able to administer several substances mixed together in one same
solution. The minimal inspiratory flow needed for the aerosol
produced by a nebulizer to reach the lungs is 6-81/min. However,
there are high amounts of drug lost as much of the medication is
retained in the nebulizer dead-space, or it is lost in the room air
during expiration. It has been estimated that only 10% of the
dose that is initially placed in the nebulizer will be effectively
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
BRONCHODILATORS
B agonist
o Salbutamol
Bricanyl, Pulmoxcel
o Procaterol
Meptin
o Procaterol
Meptin
o Salmeterol
Onbrez
CLINICAL PHARMACOLOGY
SGD CASE 4: BRONCHIAL ASTHMA
LECTURE NOTES (Dr. Cesar Mendoza)
CORTICOSTEROIDS
Prednisone
o Pred, Prolix
Methylprednisolone
o Medrol, Medcort, Medixon
Hydrocortisone
o Solucortef, Pharmacort, Hycortil, Hydrovex
Fluticasone
o Seretide, Adeflo, Combiwave, Salmed, Salmeflo,
Flutiform
Budesonide
o Symbicort, Budecort, Obucort
Beclomethasone
o Foster