Anti-Inflammatory Drugs

Steroids and NSAIDs

RC 195

Corticosteroids, “Steroids”Naturally-occurring hormones produced by the adrenal glands

Glucocorticoids: HydrocortisoneMineralcorticoids: AldosteroneSex Hormones: Testosterone

Actions of GlucocorticoidsAnti-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

Steroid Uses

Acute InflammationOrgan TransplantAllergic Inflammation

Steroid Side Effects: “Cushing’s Syndrome”

GluconeogenesisOsteoporosisPhysical changes– Increased fat production and

redistribution– Acne– Hirsutism– Fragile skin

Sodium retention– Fluid retention– Potassium loss and metabolic

alkalosis

Increased gastric acidityDecreased 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

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

Steroids in Respiratory Care

For prevention of inflammation – aerosol

For relief of inflammation: systemic

Hydrocortisone

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

Prednisone (Prednisolone)

Brand: Deltasone, Delta-Cortef4X as potent as hydrocortisoneGiven orally– Side effects minimized if given every other day– Patient’s usually need to be weaned from it

Methylprednisolone

Brand: Solu-MedrolOral or IV– Often used to help relieve airway inflammation

Triamcinolone

Brands: Azmacort, KenalogMDI- to prevent airway inflammation

Dexamethasone

Brand: DecadronOften nebulized for acute upper airway inflammation– What else is used with it?

Beclomethasone

Brands: Vanceril, Beclovent, BecotideMDI– to prevent airway inflammation

Mometasone Furoate

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

Flunisolide

Brand: AeroBidMDI – to prevent airway inflammationUsually effective when given only BID

Fluticasone

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

Budesonide

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

NSAIDs

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

Cromolyn Sodium

Brands: Intal, AaraneIs a mast cell stabilizer so used to prevent airway inflammation– Does not relieve airway inflammation!

Often used as an alternative to aerosol steroids in childrenAdministered via Spinhaler (DPI), MDI, nebulizer– Usually needs to be administered Q.I.D.– May take at least two weeks before any effects are seen

Nedocromil Sodium

Brand: 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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