This is chapter three respiratory and asthma treatment I. I'm sure I'll make more videos about asthma
from Memorizing Pharmacology. We'll start with the two main classes of medications - the bronchodilators,
which treat the
bronchospasm or bronchoconstriction, and then on the other side, the anti-inflammatory, the steroids are to treat the inflammation.
Albuterol
the rescue inhaler, Proair HFA. The HFA is that hydrofloroalkane. It used to be cold, used to be a
chlorofluorocarbon, but that hurt the ozone layer, so they changed the repellent .
That's the short-acting Beta-2 agonist.
The long-acting beta 2 agonist is salmeterol.
I like salmeterol because it's a metered dose inhaler, but you can remember it either way.
This is Severent Diskus, and you'll notice that
you just don't see that on the internet anymore. You just don't see it on the shelf. We'll talk about why that is.
The steroid anti-inflammatories - fluticasone,
which is Flovent discus if it's by itself or
fluticasone with salmeterol
which is Advair if you add them together to get air, I think is what they were going for.
Careful, these
stems, a lot of times people say well, if it's got '-sone', it's a
steroid. That's sometimes true,
but in this case, it's not an actual
World Health Organization stem or United States adopted names council stem, so if there's a stem,
I try to put an underline if I remember. I just didn't remember to do it here for the salmeterol over here, but
these are steroids. This is the beta-2 agonist, so the anti-inflammatory and then the combination
anti-inflammatory, Beta-2 agonist.
The first question, we just do this with drug classes.
We want to see what are the four drug classes that were going to work with.
'An asthmatic asked which medicine he can take to stop his asthma attack?' and we're talking immediately.
'You tell them to take a?'
Is it the short-acting Beta-2 agonist, the long-acting beta 2 agonist, the glucocorticoid or steroid, or is it the combination?
Only one of these is
the rescue inhaler, and that's the short-acting Beta-2 agonist for immediate relief . All three of the other ones are for prophylaxis,
they're meant to prevent asthma attacks from happening in the first place,
but these are I think the toughest questions because it's really tough to anchor in your memory some kind of
drug class by itself, so we're going to switch to the drugs with our second practice question.
It's the exact same question - 'An asthmatic asks which medicine you can take to stop his asthma attack?' but now
we've got
albuterol, which is the short-acting Beta-2 agonist versus salmeterol,
which is the long-acting, and then the two steroids. For immediate relief, it's an albuterol inhaler,
ProAir HFA, and
the first dose should go about a minute before the second dose. The first dose opens up the lungs and then the second dose
goes into the
lungs that are hopefully less spastic, less constricted, and more medicine gets to the lungs in the bronchi where it needs to go.
I understand some of these questions are a bit fictional, but the
principle behind it is instead of looking at a bunch of rationales, let's change the question so that it makes another one of them right.
'An asthmatic asks which medicine he should not take by itself for asthma?'
A patient is probably not going to ask that but
the lesson that we want to take away is that
there was a trial that showed that these long-acting
Beta 2 agonists
or LABAs if you want to use the acronym
were dangerous to the patient if you just took them alone.
B) salmeterol or Severent Discus,
and you won't see this on the net, you shouldn't see it on the shelf. These are contraindicated by themselves.
It's okay to take a rescue inhaler by itself, the albuterol, no problem.
The fluticasone for inflammation you can take it by itself, and when I say by itself I mean
you're going to still give the patient a rescue inhaler, and you're going to give this
anti-inflammatory, but I'm saying that it's okay for this to be in a preparation by itself. Now we see okay
well, we have fluticasone and salmeterol
together, and it's okay to put that in combination,
that's safer way to do it.
Make C) correct for practice question four:
'An asthmatic asks which medicine just reduces the inflammation in asthma you tell them to take a?' and
that's grammatically wrong. You tell them to take A) she's getting rid of that A),
but it's fluticasone.
Fluticasone by itself just reduces the inflammation
Albuterol and salmeterol, these are both for that bronchospasm. D) has an additional component
that helps with the bronchospasm. To make the last one right,
I kind of,
It's like 2:30 in the morning or 3:00 in the morning, so I kind of fudged this one, but 'An asthmatic asks which medicine
he needs to wash his mouth out with to avoid thrush and you tell them?'
If you think of steroids, it is something that
reduces the immune system's ability
and
If you think of it locally in the mouth doing that, then it allows fungus to grow and that fungus ends up being thrush.
This makes D) correct but it also makes C) correct. It's this
steroid component,
fluticasone,
that can cause thrush if the patient doesn't wash their mouth out with water just after they take the medicine.
Another way to
avoid this thrush or to reduce the thrush is to use a spacer.
The spacer,by making it so that more gets into the lungs rather than into the mouth,
it helps avoid
that side effect, but this is a
question I've seen on many many
test preps,
this
fungal side effect that you need to watch out for. Again, understanding this is a rescue inhaler, the albuterol.
Salmeterol shouldn't be used by itself and this is long-acting and it was for prophylaxis.
Fluticasone is the glucocorticoid for inflammation.
Fluticcasone / salmeterol, it's okay to use them in combination,
the steroid for the inflammation in asthma and salmeterol is for the bronchoconstriction,
but again, this is for prophylaxis.