Anti-inflammatory drugs

Question 1

Anti-inflammatory drugs

Answer 1

Mast cell stabilizers
Leukotriene receptor antagonists
Corticosteroids
Prednisone

Question 2

Mast Cell stabilizers

Answer 2

cromolyn sodium (intal, inhaler), nedocromil (Tilade, inhaler), omalizumab (Xolair, SQ)

Question 3

Kinetics of Mast Cell stabilizers

Answer 3

Low oral absorption, good resp absorption (inhaler/SQ)
Excreted unchanged in feces
2-4 weeks for therapeutic effect

Question 4

MOA of Mast Cell stabilizers

Answer 4

Exact mechanisms unknown
Inhibits mast cells from rupture
Inhibits release of inflammtory mediators from mast cells - histamines and leukotrines
Not a bronchodilator
Never use as a rescue drug

Question 5

Cautions with Mast Cell stabilizers

Answer 5

Do not use for acute brochospasm or status asthmaticus - Use only for prophylaxis
CV patienrs
Lactose intolerant patients

Question 6

Adverse effect with Mast Cell stabilizers

Answer 6

Cough, bad taste, irritation of oropharnx
Headache, dizziness, nausea, rhinitis, eosinophilic pneumonia
Brochospasms (Rebound effect with increase use or abrupt d/c)

Question 7

Education with Mast Cell stabilizers

Answer 7

Not used for managing acute symptoms - prophylaxis only
Must take daily if have symptoms or not
Take 15-20 min before activity that will induce bronchospasms or exposure to antigens

Question 8

Leukotreine receptor antagonists

Answer 8

Most effective for long term control of asthma
zafirlukast (Accolate): take orally on empty stomach (best absorption)
montelukast (Singulair): chewable and regular tablets (take at night for best absorption)
zileuton (Zyflo): oral (BID, TID, QID d/t short halflife)

Question 9

MOA of a Leukotreine receptor antagonists

Answer 9

NOT A BRONCHODILATOR
Zafirlukast and montelukast
- Block receptors for leukotreines bound to amino acid cysteine (Bronchoconstrictor)
zileutron
- inhibit first enzyme in lipoxygense pathway = Decrease production of leukotrienes = decrease inflammation

Question 10

Cautions with Leukotreine receptor antagonists

Answer 10

Liver disease patients (montelukast is the best choice)

Psych hx

Question 11

Adverse effects with Leukotreine receptor antagonists

Answer 11

Increased LFT’s (zafirlukast and zileuton), increased psych events (BB warning)
Fever, rash, anaphylaxis, headache, and dizziness (zafirlukast)

Question 12

Drug interactions with Leukotreine receptor antagonists

Answer 12

zafirlukast
- increased effects of warfarin
- Theophyline and erythromycin decrease levels of zafirlukast
Zileuton
- Increase effects of warfarin, theophylline and propranolol
montelukast
- decreased effectiveness when taken w/ phenobarbital and rifampin

Question 13

Corticosteroids

Answer 13

last resort tx d/t side effects
flunisolide: MDI
fluticasone: MDI
beclomethasone (Vanceril): MDI and nasal inhaler
prednisone: oral
methylprednisone (Solu-Medrol, Medrol): IV or oral

Question 14

Kinetics of Corticosteroids

Answer 14

Good absorption thru GI and resp tract
Highly protein bound
Liver metabolism, some renal clearance
Need to be continuously used to maintain effect
NOT DILATORS, NOT USED FOR ACUTE ATTACKS

Question 15

MOA of Corticosteroids

Answer 15

Suppresion of cytokine, leukotriene and prostoglandin production
Suppression of airway eosinophil recruitment
Suppression of release of inflammatory mediators
- All lead to decreased capillary dilation = decreased migration/activation of WBC’s = decreased inflammation
Increases number of beta receptors (Increased sensitivity to beta meds)

Question 16

Cautions with Corticosteroids

Answer 16

Live vaccine admin d/t immunocompromised
Systemic fungal infections
HTN
DM
Osteoporosis
Renal insuff
Resp tract infections
Ocular herpes simplex
CHF
GI. peptic ulcers

Question 17

Adverse effects with Corticosteroids

Answer 17

Inhaled
- Oral fungal infections (thrush)
Oral, laryngeal, pharyngeal irritation
- Dry mouth, hoarseness
- Resp infections
- LT use in kid could delay growth
Oral: (w/increased doses of long-term use)
- moon face
- weight gain
- edema (Increased Na and H2O retention)
Peptic ulcer (Increase HCl production in stomach)
Infections, Hyperglycemia
LT use in kids could delay growth
Most side effects occur within first 2 weeks but are reversible when d/c'd

Question 18

Education with Corticosteroids

Answer 18

Good oral hygeine
s/s oropharyngeal candidiasis (Thrush)
rinse mouth after each time to decrease fungal infections
do not abruptly d/c meds - must taper gradually

Question 19

Prednisone

Answer 19

Used for anti-inflammatory and immunosuppressive effects

Question 20

Indications for Prednisone

Answer 20

Asthma, allergies, RA, inflammatory bowel disease, skin disorders, tendonitis or bursitis, prevent organ transplant rejection

Question 21

MOA of Prednisone

Answer 21

Causes Na and H20 retention = edema and HTN
Anti-inflammatory retards leukocyte migration, suppresses tissue repair and decreased c-reactive protein
Does not affect antibody-antigen reactions
Immunosuppressive suppresses phagocytes, decreased eosinophils, lymphocytes, and immunoglobins

Question 22

Cautions of Prednisone

Answer 22

Systemic fungal infections
Administration of live viruses d/t immunocompromised
HTN
GI disorders
DM
Osteoporosis
Renal insuff

Question 23

Adverse effects of Prednisone

Answer 23

Anxiety, seizure, insomnia
Glucose intolerance, hyperglycemia, hyperlipidemia
Hirutism, obesisty, amenorrhea
HTN, CHF, pancreatitis
Ulcerative colitis, N/V, peptic ulcer with perforation or hemorrhage
Fluid/lyte imbalance, osteoporosis
Glaucoma, cataracts, acne, stiae

Question 24

Drug interactions with Prednisone

Answer 24

Azole antifungal (prednisome clearnace possibly decreased)
Barbituates
Oral anticoagulants
Contraceptives
Diuretics
Salicylates (ASA)
Theopylline
Warfarin

Question 25

Education with Prednisone

Answer 25

Do not abruptly stop = adrenal insuff

must be gradually tapered so body can resume secretions of cortisol at normal level and rate