Anti-Inflammatory DrugsSteroids and NSAIDs

RC 195

Corticosteroids, SteroidsNaturally-occurring hormones produced by the adrenal glandsGlucocorticoids: HydrocortisoneMineralcorticoids: AldosteroneSex Hormones: Testosterone

Actions of GlucocorticoidsAnti-inflammatorySupresses actions of kinins, cytokines, and other mediators of inflammationMaintains microcirculation and minimizes edemaMaintains cell membrane integrityInhibits macrophage movementInhibition of immune responseStabilizes mast cellsReduces histamine levelsBronchodilationPotentiates catecholamine activity by inhibiting COMT and increasing adenyl cyclase productionDecreased cholinergic and alpha stimulationDecreased phosphodiesterase production

Steroid UsesAcute InflammationOrgan TransplantAllergic Inflammation

Steroid Side Effects: Cushings SyndromeGluconeogenesisOsteoporosisPhysical changesIncreased fat production and redistributionAcneHirsutismFragile skinSodium retentionFluid retentionPotassium loss and metabolic alkalosis

Increased gastric acidityDecreased resistance to infectionMDI may cause candida albicans, thrushPatients need to rinse mouth after MDIDependencyBoth physical and psychologicalPatients may need to be weaned from steroid therapy

Interaction with other drugs

Increased breakdown in the presence of:Dilantin, barbiturates, certain tranquilizers, anti-histamines, ephedrineDecreased breakdown (and greater chance of severe side effects) in the presence of some antibiotics, eg erythromycin

Steroids in Respiratory CareFor prevention of inflammation aerosol

For relief of inflammation: systemic

HydrocortisoneBrand name(s): Solu-Cortef, CortefGiven orally or IVNot usually aerosolized because of side effects

Prednisone (Prednisolone)Brand: Deltasone, Delta-Cortef4X as potent as hydrocortisoneGiven orallySide effects minimized if given every other dayPatients usually need to be weaned from it

MethylprednisoloneBrand: Solu-MedrolOral or IVOften used to help relieve airway inflammation

TriamcinoloneBrands: Azmacort, KenalogMDI- to prevent airway inflammation

DexamethasoneBrand: DecadronOften nebulized for acute upper airway inflammationWhat else is used with it?

BeclomethasoneBrands: Vanceril, Beclovent, BecotideMDI to prevent airway inflammation

Mometasone FuroateBrand: AsmanexDPI Twisthaler 220mcg per pffStarted as one puff per day in then evening and may go as high two puffs BID

FlunisolideBrand: AeroBidMDI to prevent airway inflammationUsually effective when given only BID

FluticasoneBrand: FloventMDI (similar to Flunisolide)Fluticasone is also sold as a combo drug, Advair, which contains fluticasone and salmeterolTaken as a dry powder inhaler (DPI)

BudesonideBrand: PulmicortMDI to prevent airway inflammationSeems to get best effects with minimal side effects

NSAIDsDrugs that prevent airway inflammation but usually have less side effects than steroids

Cromolyn SodiumBrands: Intal, AaraneIs a mast cell stabilizer so used to prevent airway inflammationDoes not relieve airway inflammation!Often used as an alternative to aerosol steroids in childrenAdministered via Spinhaler (DPI), MDI, nebulizerUsually needs to be administered Q.I.D.May take at least two weeks before any effects are seen

Nedocromil SodiumBrand: TiladeSimilar to cromolyn sodium (used to prevent airway inflammation)MDI usually only needed B.I.D.

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

NSAIDs: Omalizumab (Xolair)Genetically engineered recombinant humanized monoclonal antibodyBinds to IgE and prevents it from attaching to mast cellsGiven sub-Q 1-2 times per month

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