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.