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MEDICATIONS FOR ASTHMA

Medications for asthma generalized into 2 general classes: o long-term control medications used to achieve and maintain control of persistent asthma o quick relief medications used to treat acute symptoms & exacerbations Long-Term Control Medications: o CORTICOSTEROIDS most potent & effective anti-inflammatory medication currently available MOA: block late phase reaction to allergen / reduce airway hyper-responsiveness / inhibit inflammatory cell migration & activation Inhaled Corticosteroids (ICS): Beclomethasone dipropionate / Budesonide / Flunisolide / Fluticasone propionate / Moetasone furoate / Triamcinolone acetonide Use: 1st line therapy for treatment of persistent asthma inhaled corticosteroids are most effective long term therapy available for persistent asthma long term oral systemic corticosteroid used for severe persistent asthma o LONG ACTING -AGONISTS (LABA) Salmeterol & Formoterol MOA: bronchodilation Duration of at least 12 hours after a single dose Use: treatment of choice for use as adjunctive therapy to combine with ICS for long term control & prevention of symptoms in moderate or severe persistent asthma o LEUKOTRIENE MODIFIERS Leukotriene Receptor Blockers Montelukast o Use: patients > 1yo Zafirlukast o Use: patients > 7yo Use: alternative therapy for treatment of mild persistent asthma 5-Lipoxygenase Inhibitor Zileuton o Use: patients > 12 yo can be used as an alternative but are not the preferred adjunctive therapy o IMMUNOMODULATORS Omalizumab sub-q shot every 2 or 4 weeks MOA: anti-IgE o monoclonal antibody that prevents binding of IgE to high affinity receptors on basophils & mast cells AE: anaphylaxis has been reported in 0.2% of treated patients Use: o adjunctive therapy for patients >12 yo who have allergies or severe persistent asthma o CROMOLYN SODIUM & NEDOCROMIL MOA: stabilize mast cells & interfere with chloride channel function therapeutic response may take 2-4 weeks Use: not a preferred choice of treatment may be used as an alternative for treatment of mild persistent asthma can be used as preventative treatment prior to exercise or unavoidable exposure to known allergens o METHYLXANTHINES Theophylline MOA: mild to moderate bronchodilator + mild anti-inflammatory effects

Use: as alternative (but not preferred) adjunctive therapy with ICS monitoring is essential due to narrow therapeutic indecx Quick Relief Mediciations o ANTICHOLINERGICS - Ipatropium MOA: inhibit muscarinic cholinergic receptors & reduce intrinsic vagal tone of airway USE: additive benefit to SABA in moderate to severe asthma exacerbations alternative bronchodilator in those who do not tolerate SABA o SHORT ACTING -AGONISTS (SABA) Albuterol / Levalbuterol / Pirbuterol MOA: relax bronchial smooth muscle bronchodilation Use: TOC for relief of acute symptoms & prevention of exercise induced bronchospasm use as needed regular scheduled chronic use not recommended o SYSTEMIC CORTICOSTEROIDS Methylprednisolone / Prednisolone / Prednisone USE: oral systemic steroids used for moderate to severe asthma exacerbations as adjunct to SABA to speed recovery and prevent recurrence

Sources: Cvetnic, William G., Eduardo Pino, Christine E. Koerner, and Carla McWilliams. USMLE Step 2 CK: Pediatric Lecture Notes. New York: Kaplan, 2008. Print "Expert Panel Report 3 (EPR3): Guidelines for the Diagnosis and Management of Asthma." NHLBI, Diagnosis and Management of Asthma. N.p., 2007. Web. 14 Feb. 2013.