1. Anti-Inflammatory Drugs
Steroids and NSAIDs
RC 195

2. Corticosteroids, “Steroids” Naturally-occurring hormones produced by the adrenal glands
Glucocorticoids: Hydrocortisone
Mineralcorticoids: Aldosterone
Sex Hormones: Testosterone

3. Actions of Glucocorticoids
Anti-inflammatory
Supresses actions of kinins, cytokines, and other mediators of inflammation
Maintains microcirculation and minimizes edema
Maintains cell membrane integrity
Inhibits macrophage movement
Inhibition of immune response
Stabilizes mast cells
Reduces histamine levels
Bronchodilation
Potentiates catecholamine activity by inhibiting COMT and increasing adenyl cyclase production
Decreased cholinergic and alpha stimulation
Decreased phosphodiesterase production

4. Steroid Uses
Acute Inflammation
Organ Transplant
Allergic Inflammation

5. Steroid Side Effects: “Cushing’s Syndrome”
Gluconeogenesis
Osteoporosis
Physical changes
Increased fat production and redistribution
Acne
Hirsutism
Fragile skin
Sodium retention
Fluid retention
Potassium loss and metabolic alkalosis
Increased gastric acidity
Decreased resistance to infection
MDI may cause candida albicans, “thrush”
Patients need to rinse mouth after MDI
Dependency
Both physical and psychological
Patients may need to be weaned from steroid therapy

6. Interaction with other drugs
Increased breakdown in the presence of:
Dilantin, barbiturates, certain tranquilizers, anti-histamines, ephedrine
Decreased breakdown (and greater chance of severe side effects) in the presence of some antibiotics, eg erythromycin

7. Steroids in Respiratory Care
For prevention of inflammation – aerosol
For relief of inflammation: systemic

8. Hydrocortisone Brand name(s): Solu-Cortef, Cortef Given orally or IV
Not usually aerosolized because of side effects

9. Prednisone (Prednisolone)
Brand: Deltasone, Delta-Cortef
4X as potent as hydrocortisone
Given orally
Side effects minimized if given every other day
Patient’s usually need to be weaned from it

10. Methylprednisolone Brand: Solu-Medrol Oral or IV
Often used to help relieve airway inflammation

11. Triamcinolone Brands: Azmacort, Kenalog
MDI- to prevent airway inflammation

12. Dexamethasone Brand: Decadron
Often nebulized for acute upper airway inflammation
What else is used with it?

13. Beclomethasone Brands: Vanceril, Beclovent, Becotide
MDI– to prevent airway inflammation

14. Mometasone Furoate Brand: Asmanex DPI “Twisthaler” 220mcg per pff
Started as one puff per day in then evening and may go as high two puffs BID

15. Flunisolide Brand: AeroBid MDI – to prevent airway inflammation
Usually effective when given only BID

16. Fluticasone Brand: Flovent MDI (similar to Flunisolide)
Fluticasone is also sold as a combo drug, Advair, which contains fluticasone and salmeterol
Taken as a dry powder inhaler (DPI)

17. Budesonide Brand: Pulmicort MDI – to prevent airway inflammation
Seems to get best effects with minimal side effects

18. NSAIDs
Drugs that prevent airway inflammation but usually have less side effects than steroids

19. Cromolyn Sodium Brands: Intal, Aarane
Is a mast cell stabilizer so used to prevent airway inflammation
Does not relieve airway inflammation!
Often used as an alternative to aerosol steroids in children
Administered via Spinhaler (DPI), MDI, nebulizer
Usually needs to be administered Q.I.D.
May take at least two weeks before any effects are seen

20. Nedocromil Sodium Brand: Tilade
Similar to cromolyn sodium (used to prevent airway inflammation)
MDI – usually only needed B.I.D.

21. NSAIDs: Leukotriene Inhibitors (used to prevent airway inflammation)
Zafirlukast (Accolate)
Taken as a pill B.I.D.
Zileuton (Zyflo)
Taken as a pill Q.I.D.
Montelukast (Singulair)
Taken as a pill just once a day

22. NSAIDs: Omalizumab (Xolair)
Genetically engineered recombinant humanized monoclonal antibody
Binds to IgE and prevents it from attaching to mast cells
Given sub-Q 1-2 times per month

23. Case Study Time!