Mechanism: stimulates Beta-1 receptors, takes 15min for maximum bronchodilation and lasts 60-90min

Treatment: bronchodilator injected or inhaled

Adverse Effects: tachycardia, arrhythmias, worsening of angina pectoris

same as Epineprhine but longer duration of action with oral activity and lower potency

Adv Effects: more pronounced central effects

Mechanism: Beta receptor selective, lacks alpha adrenergic activity, maximal in 5 min and lasts 60-90 min

Albuterol

Levalbuterol

Terbutaline

Metaproterenol

Pirbuterol

Short acting Beta-2 selective agonists

Bronchodilation max in 30min and lasts 3-4hours.

Treatment: acute symptoms and exercised induced bronchospasms. All can beinhaled but only terbutaline can be injected subQ.

Salmeterol

Formoterol

Long acting beta-2 agonists

Mechanism: duration 12 hrs or more, locally dissolved drug functions as "slow release depot" providing drug to beta receptors

Tx: slow onset unsuitable for acute bronchospasm, used for maintenance tx of inhaled corticosteroid (better than inc dose of corticosteroid)

anticholinergic agent

Mechanism: selective quaternary ammonium derv of atropine, does not readily enter CNS, enhanced when used with beta2-agonist, more effective for COPD than beta agonist

Tx: selective asthmatics

prednisone

prednisolone

methylprednisolone

oral corticosteroid

Mechanism: reduce bronchial reactivity, reduce freq of asthma exacerbations, and potentiates effects of Beta-agonists

Tx: reserved for urgent short term tx,

Mechanism: competitive for adenosine, inc.cAMP (and cGMP) leading to relax of bronchial smooth muscles

Tx: asthma (narrow therapeutic index)

beclomethasone

budesonide

flunisolide

fluticasone

mometasone

triamcinolone

ciclesonide

inhaled corticosteroids

Mechanisms:

ciclesonide-is a prodrug converted by esterases upon inhalation and forms conjugates with fatty acids in the lungs. more than 99% protein bound thus unable to bind to receptors on skin or eyes (minimize toxicity)

 beclomethasone-same dose as oral prednisone but far fewer side effects

Adverse Effects: oropharyngeal candidiasis (reduced with spacer), osteoporosis, cataracts, growth retardation in children possible (not proven)

Mechanism: insoluble salts, no effect on smooth muscle tone, ineffective once attack starts, alters delayed chloride channels inhibiting airway nerves, mast cells, eosinophils

Tx: inhibits antigen and exercise induced asthmas, chronic use reduces bronchial reactivity, used prophylactically, insoluble must inhale, combine with inhaled corticosteroid

Adverse Effects: minor due to poor absorption, localized to site of deposition: throat irritation, cough, wheezing, reversible dermatitis, myositis, gastroenteritis

leukotriene modifier

Mechanism: inhibiition of 5-lipoxygenase preventing LT synthesis, less effective than corticosteroids but effective in reducing exacerbations

Tx: oral (better for children compliance) 4x daily dose

Adverse Effects: symptomatic hepatitis, dyspepsia, interactions as it inhibits CYP1A2,2C9,3A4

Zafirlukast

Montelukast

leukotriene modifier

Mechanism: inhibition of binding of LTD4 to its receptor, less effective than inhaled corticosteroids but as effective in reducing exacerbations

Tx: oral (better children compliance) 1-2x daily

Adverse Effects: Zafirlukast is well tolerated but Gi disturbances, mild headache, and drug interactions as it inhibits CYP2C9, 3A4

Montelukast has no hepatic toxicity and does not inhibit CYP450 enzymes (other drugs that affect CYP might affect montelukast metabolism; mood swings, suicide, etc.)

anti-IgE therapy

Mechanism: prevents IgE interaction with receptorson mast and other inflammatory cells

Tx: subQ administration

Adverse Effects: infrequent hypersensitivity reactions with anaphylaxis