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Anti-Inflammatory Drugs

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Presentation on theme: "Anti-Inflammatory Drugs"— Presentation transcript:

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!

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