3 groups of non-steroidal anti asthma agents
-cromolyn like drugs (mast cell stabilizers)
-antileukotrienes
-monoclonal antibodies
clinical indications for non steroidal antiasthma agents
-prophlactic management of mild persistent asthma
-cromolyn and anti-LT as alternative to ICS in asthma requiring step 2 care
-cromolyn is used with infants and younger children as alternatives to ICS in asthma requiring step 2 care
-anti-LT can be used in combination w/ ICS to reduce the steroid dose
define Cromolyn like agents
(mast cell stabilizer)
prevent mast cells from releasing inflammatory substances that lead to asthma symptoms
-anti-sickle cell effects
define antileukotrienes
-block leukotrienes chemicals that contribute to asthma symptoms
-block effects of leukotrienes effects on airway
-decrease use of corticosteroid and beta 2 agonist
-used in persistent mild, moderate and severe asthma
monoclonal anitbodies
target specific proteins in the immune system to prevent allergic reactions that can trigger asthma
example of cromolyn like agent (mast cell stabilzers)
-cromolyn sodium
brand name: intal
-delivered through SVN (common )
examples of antileukotrienes
-zalfirlukast
brand name: accolate
-montelukast
brand name: singular
-both taken orally to block effects of leukotrienes, reducing inflammation and manage asthma symptoms
3rd
*zileuton (mentioned on slide pic)
example of a monoclonal antibody
-omalizumab
brand: xolair
-injectable meds used to control serve allergic asthma by target the immunoglobulin IgE
dosage and administration of cromolyn sodium
SVN (nebulized) : 20 mg/ampule or 20 mg/2mL (1%) QID
mechanism of action for cromolyn sodium
-prevents mast cell degranulation
-stoping the release of substances like histamine and leukotrienes that cause inflammation
side effects of cromolyn sodium
-cough* common
-nasl congestion* common
-wheezing
-nasal itching
-epistaxis
-nose buring
how long does it take for cromolyn sodium to show clinical improvement in symptoms
2-4 weeks
dosage and administration of zalfirlukast (accolate)
oral admin
-10mg bid children 5-11
-20 mg bid 12yrs+
hazard/side effects of zalfirlukast (accolate)
-headaches
-infection
-nausea
-diarrhea
-abdominal pain
-interacts with theophyline, aspirin, and warfarin
dosage and administration of motelukast (singulair)
oral admin
-4mg, 5 mg and 10 mg
-ages 6 months+
hazard and side effects of montelukast (singulair)
-diarrhea
-laryngitis
-pharyngitis
-nausea
-otitis
-sinusitis
-viral infection
antileukortriene agents: advantages
-Oral admin, possible 1 daily dose
-Safe w/ few side effects to date
-Effective in aspirin sensitivity and often in exercise induced asthma
-Systemic distribution reaches entire lung through the circulation
-Additive effect with inhaled steroids
-May reduce steroid dose and prevent an increase in steroid dose
-Formulation approved for pediatric dosing (montelukast)
antileukotriene agents: disadvantages
-Antiinflammatory action limited to one mediator pathway
-Unknown long term toxicity
-Variable response, effective in about 50-70% of pt
-No predictor of pt who will respond
-Systemic drug exposure not limited to lung
-General not useful as monotherapy
dosage and admin of omalizumab (xolair)
- subcutaneous injection (parenteral)
-150/ 1.2 mL every 2-4 weeks - > 12 years old
-helps reduce ICS
mode of action for Omalizumab (xolair)
- stops IgE attachment of mast cells
hazard/side effects of Omalizumab (xolair)
-anaphylaxis
-malignancies
-injection site reaction
-viral infection
-URI
-pharyngitis
what effects on the body do leukotrienes exhibit when stimulated
-bronchoconstriction- muscles around airways to tighten
-when stimulate other cells:
-airway edema
-increase mucus secretions
-ciliary beat inhibition
-recruitment of other inflammatory cells
what are mast cells
connective tissue cell that contain heparin and histamine
-leukotrenes-bronchoconstriction
-prostaglandis-enhance inflammation
-proteases
-histamines- cause immediate allergic symptoms like itching and swellin
-cytokines-enhance inflammation
what type of asthma is associated with allergic reactions
type 2 care: mild persistant asthma
