MEDICATION OF ASTHMA
Clinical Pharmacy II
The goal of therapy of asthma is to provide
symptomatic control with normalization of
lifestyle and to return pulmonary function as close
to normal as possible.
Submitted By:
Freeha Rashid
Fatima Khan
Amna Naeem
Palwisha Ishfaq
Cynthia Sohail
Hafsa Faryad
Submitted To:
Mr. Uzair Afzal
Date: 6/24/2016
MEDICATION OF ASTHMA
Clinical Pharmacy II
CONTENTS
Drug classes used in treatment of Asthma.. 3
Mechanism of Action and Side effects of Anti-Asthmatic agents....... 4
Dosage Form and Adult Dose of Anti Asthmatic Agents 5
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MEDICATION OF ASTHMA
Clinical Pharmacy II
Drug Classes used in Treatment of Asthma
Drug Class
Therapeutic effect
MAJOR DRUG CLASSES
-agonist
These sympathomimetic agents relieve bronchoconstriction during acute asthma
exacerbations as well as during chronic therapy and prevent exacerbations from
occurring during exercise.
Corticosteroids
Corticosteroids suppress the inflammatory response and decrease airway hyper
responsiveness.
Leukotriene
modifiers
Newest agents with anti-inflammatory and bronchodilator activity. They are
categorized as 2nd line agents because less effective than corticosteroids but useful in
children for whom administration of inhaled drugs is challenging. Useful in patients
with concurrent allergic rhinitis and asthma.
Cromolyn
Only available as nebulizer solution. It is less effective in its anti-inflammatory
properties than the inhaled steroids but is sometime still used in children due to its
excellent safety profile. when used prophylactically it prevents early and late response
of asthma and when used as maintenance therapy of asthma, it suppresses nonspecific
airway reactivity.
Theophylline compounds produce bronchodilation to a lesser extent then agonist.
Other effects include reduced mucus secretion, enhanced mucocilliary transport,
improved diaphragmatic contractility, anti-inflammatory activity and possibly reduced
fatigability.
SUPPORTIVE THERAPEUTIC AGENTS
These drugs block postganglionic muscarinic receptors in the airways resulting in
bronchodilation.
They are useful for patients with coexisting allergic rhinitis.
Useful in some patients because of its bronchodilator activity. It also improves
respiratory muscle strength.
Used for severe asthma and concurrent allergies.
Theophylline
compounds
(methylxanthines)
Anti-cholinergic
Antihistamines
Magnesium sulfate
Anti IgE
compounds
Immunotherapy
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Improves asthma control in some patients by improving lung function, reduce
symptoms and decreased medication requirements in a significant no. of patients while
is rendered ineffective in others.
MEDICATION OF ASTHMA
Clinical Pharmacy II
Mechanism of Action and Side effects of AntiAsthmatic agents
Drug Class
Mechanism of Action
Adverse Effects
-agonist
2 agonists stimulate 2 receptors, activating
adenylyl cyclase, which increases intracellular
production of cyclic adenosine monophosphate
cAMP. Activation of cAMP results in
bronchodilation. Improved mucocilliary clearance
and reduced inflammatory cell mediator release.
Termer, palpitation, tachycardia,
nervousness, and headache.
Corticosteroids
Corticosteroids bind to glucocorticoid receptors
on the cytoplasm of cells. The activated receptor
regulates transcription of target genes. They
reduce inflammation via inhibition of
transcription and release of inflammatory genes
and increased transcription of anti-inflammatory
genes that produce proteins that suppress the
inflammatory process.
Local side effects associated with
inhaled corticosteroids include
hoarseness and fungal infection
(candidiasis) of mouth and throat,
careful monitoring is necessary in
patients with diabetes
hypertension, CHF, peptic ulcer,
depression & cataracts
Leukotriene
modifier
They are selective cyiestnyl Leukotriene 1
receptor antagonist therefore they prevent
Leukotriene from interacting with their receptors.
Cromolyn
It acts locally by stabilizing mast cells and thereby
inhibiting mast cell degranulation.
Theophylline
compounds
Theophylline induced phosphodiesterase
inhibition results in increased levels of cAMP.
Anti-cholinergic
Competitively inhibit binding of the
neurotransmitter, acetylcholine. They target
either muscarinic acetylcholine receptors or, less
commonly, nicotinic acetylcholine receptors
They compete with histamine for 1 receptor sites
on effectors cells and thus help prevent the
histamine mediated responses that influence
asthma
Omalizumab inhibits the binding of IgE to the
high-affinity IgE receptor (FcRI) on the surface of
mast cells and basophils. Reduction in surfacebound IgE on FcRI-bearing cells limits the degree
of release of mediators of the allergic response.
Flu-like symptoms, feeling nervous
or excitable, headache,
stomachache, nausea or vomiting,
and nasal congestion.
Paradoxical bronchospasm,
wheezing, coughing, nasal
congestion, dryness of throat.
Nausea, vomiting diarrhea,
anorexia, palpitations, insomnia,
nervousness, seizures
Dry mouth, blurred vision, urinary
retention.
Antihistamines
Anti-IgE
compounds
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Trouble urination or not being able
to urinate. Blurred vision,
Confusion, Dry mouth, Drowsiness,
Dizziness.
Headache, tired feeling, joint or
muscle pain, dizziness, ear pain,
hair loss, sore throat, cold
symptoms, injection site reactions
(or leg or arm pain.
MEDICATION OF ASTHMA
Clinical Pharmacy II
Dosage Form and Adult Dose of Anti-Asthmatic
Agents
Drug class
Agonist
Drugs
Albuterol (VENTOLIN)
Dosage Form
Bitolterol (TORNALATE)
Nebulizer (5 ug/ml)
MDI 0.09m/puff
Oral 4mg SR
Nebulizer (2mg/ml)
Adult Dose
Epinephrine (Adrenalin
MDI 0.37 mg/puff
SC (1ug/ml)
4-6 puffs every 20 min then prn
0.30.5 mg/dose q20min then prn
No recommendation
0.63 mg t.i.d up to 1.25mg t.i.d
4-8 puffs q20 min up to 4 hour then prn
No recommendation
Budesonide
DPI 12mg/cap for inhalation
Nebulizer 0.63mg: 1.25mg
MDI 0.2 mg/puff
MDI 0.025 mg/puff
DPI 0.05 mg/inhalation
MDI:0.2mg/puff
SC: 1ug/ml
CFC 42 or 84 ug/puff
HFA 40 or 80 ug/puff
DPI : 200ug/inhalation
Flunisolide (NASALIDE)
Fluticasone (FLIXOTIDE)
Chloride)
Formoterol (ATIMOS)
Levalbuterol (XOPENEX)
Pirbuterol (MAXAIR)
Salmeterol (SEREVENT)
Terbutaline (BRITANYL)
Corticosteroids
Beclomethasone
M: 504-840 ug
M: 250-480 ug
M:600-1200 ug
H: >840 ug
H: >480 ug
H: >1200 ug
MDI 250 ug/puff
L: 500-1000ug
H: > 2000ug
Mometasone (NASONEX)
Triamcinolone
MDI: 44. 110 ,220 ug/puff
DPI: 50.100,250 ug/inhalation
DPI: 200 ug/inhalation
MDI 100 ug/puff
L: 88-264 ug
L: 100-300 ug
L: 200 ug
M:10002000ug
M: 264-660 ug
M: 300-600 ug
M: 400 ug
M: 10002000ug
H: >2000 ug
Methylprednisolone
Intravenous
Prednisone (DELTASONE)
Oral tablet
Zafirlukast (ZUKAST)
Montelukast
Oral tablet
Oral tablet
60-80 mg in 3 or 4 divided doses for 48
hours
Acute: 40 mg orally every 12 hours.
Maintenance: 40 mg orally every other day.
20 mg twice daily
10 mg once daily
Zileuton (ZYFLO)
Cromolyn (INTAL)
Theophylline (RESPRO
Oral tablet
Nebulized Soln. 2 ml ampoule
SR tablets
IV bolus
IV maintenance
Inhalation
Nebulizer
400 mg q.i.d
20 mg via nebulizer q.i.d
10mg/kg/day Maximum to 800 mg/day
5mg/kg
0.4 mg/kg/hr.
8 puffs q20min PRN for 3 doses
500 mcg q20min for 3 doses, then PRN
Inhaler
2.5 mcg (2 actuations; 1.25 mcg/actuation)
inhaled PO qDay
(ARISTOCORT)
(SOLU MEDROL)
Cromolyn
Methylxanthine
s
Anti-cholinergic
agents
(MONTEGET)
SR)
Ipratropium (used with
short acting beta agonist)
(ATEM)
Tiotropium
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2 puffs t.i.d q.i.d p.r.n
0.25mg q20 min 3 doses
L: 168-504 ug
L: 80-240 ug
L:200-600 ug
(CLIPPER)
(PULMICORT)
Leukotriene
Modifiers
10-15mg/hr continuously
4-8 puffs q20 min then prn
No recommendation
10-15mg/hr
L: 400-1000 ug
H: >660 ug
H: >760 ug
H: >400 ug
MEDICATION OF ASTHMA
Clinical Pharmacy II
Anti-histaminic
agents
Ketotifen (used as
Syrup, Tablet
1 mg b.i.d
Anti IgE
compounds
Omalizumab (XOLAIR)
SC injection
150 to 375 mg SC injection every 2 or 4
weeks.
Combination
inhalers
salmeterol/fluticasone
inhaled powder
Inhaled aerosol
Inhaler
1 puffs q12hr
2 puffs q12hr
160 mcg/9 mcg (2 puffs of 80 mcg/4.5 mcg)
q12hr
3-4 puffs t.i.d q.i.d
supportive therapy)
(ZATOFEN)
(SERETIDE )
budesonide/formoterol
(COMBIVAIR)
Salbutamol/
Beclomethasone
Inhaler
(VENTIDE)
MDI: Metered Dose Inhaler
DPI: Dry Powder Inhaler
CFC: Chlorofluorocarbons
HFA: Hydroflouroalkanes
REFERENCE:
Comprehensive Pharmacy Review For NAPLEX Eight edition
www.medscape.com
Pakistan Drug Index
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