ANTI ASTHMATIC DRUGS

Medicines that used to treat and control asthma.

1. PHARMACEUTICS 1 (DR. (H) YUNUS BIN ALI AS-SHIFA AD-DAIE AL-ABDULLAHI) FATIN SYAZWANI AZAM (DPM40/515/0773) NURHANANI BINTI ABD HALIM (DPM40/515/0815) AZYAN NABIHAH BT JAMALUDIN (DPM40/515/0793)

2. Anti-asthmatic drugs are medicines that treat or prevent asthma attacks. The phrase "drugs for asthma" means drugs that help open up the airways when they become narrowed due to disease. Other drugs may be used in people  with  asthma and COPD, such as antibiotics for infection, but they are not used to directly "open up" the airways. DEFINITION

3. The classification of Anti-Asthmatic Drug is based on its mechanism of action (MOA) and route of administration (ROA). ‘To open up’ the airways, all available medications can be classified by one of two fundamental mechanisms of action: bronchodilation and anti-inflammatory The bronchodilator larger airways delivering air inside the lungs and act on smooth muscle in the walls of the bronchi. While anti-inflammatory drugs, by contrast, act to decrease the inflammation inside the airways; in this case "inflammation" means fluid and cellular debri that tends to clog up the airways of people with asthma and COPD. CLASSIFICATION

4. classification Classification

5. Liquid : suspension, syrup, spray Solid : tablet, powder DOSAGE FORM

6. ROA Oral Tablets, capsules, and liquids are swallowed . Inhalation a powder or fine mist delivered from a machine hand-held device (spray) Subcutaneous / Intramuscular  injection either under the skin (sub- cutaneous ) or into the muscle (intra-muscular). Intravenous fine tube placed safely in a vein or tissues. this route is reserved for hospitalized patients .

7. Their route of administration are nebulizer inhalation and inhalation chamber, or direct intratracheal route in patients receiving artificial ventilation. Inhalation  is the preferred route of administration as this allows the drug to be delivered directly into the airways in smaller doses. This causes fewer side effects than if given systemically or parenterally . When delivered by inhalation, bronchodilators also have a faster onset of action and give better protection from bronchoconstriction . Persons with mild asthma may use quick relief medication as needed. Those with persistent asthma should use preventative medicine on a regular basis to prevent asthma attacks. Medication is added in a step-up progression depending on the severity and frequency of attacks. It is also important to step-down the treatment when control is good. ROUTE OF ADMINISTRATION

8. Alcohol intoxication Misuse/excessive use of drug Depression Tobacco smoking Poisoning by breathing drug Theophylline Multiple organ failure high blood pressure CONTRA INDICATION Chronic cannabis smoker Heart attack Disease of arteries Abnormal heart rhythm Chronic heart failure Temporarily stop breathing while sleeping Fever for many days Fast heartbeat Diabetes

9. TYPE OF EXIPIENT USE Disintegrant : sodium bicarbonate Tartaric acid Diluent : Microcrystalline cellulose 200 Sodium starch glycolate Binder : Hydroxyprophyl cellulose EXF Pro- Banthine 15 mg Tablets (anti muscarinics ) List of excipient (s) Lactose monohydrate Maize starch Talc Light liquid paraffin Magnesium stearate Coating Sucrose Cosmetic red oxide (E172) Cosmetic ochre No. 1624 (E172) Calcium carbonate Saccharin sodium Titanium dioxide (E171) Talc Carnauba wax Magnesium carbonate Castor oil virgin

10. There are two types of anti-asthmatic drug : quick-relief medication and long term medication. Quick-relief medications: they are used as needed for rapid, short-term symptom relief during an asthma attack. Long-term asthma control medications: they work to reduce the amount of inflammation in the airways and prevent asthma attacks occurring. ADVANTAGES AND DISADVANTAGES

11. NAME ADVANTAGES DISADVANTAGESS Short acting beta 2 agonist quick-relief bronchodilators act within minutes to rapidly ease symptoms during an asthma attack Do not relieve the swelling or inflammation of the breathing tube Antimuscarinics act quickly to immediately relax the airways, like other bronchodilators, making it easier to breathe Mostly dry mouth, constipation Systemic Corticosteroids relieve airway inflammation caused by severe asthma. Have serious side effects when used long term, the systemic routes are used only on a short-term basis to treat severe asthma symptoms. Intravenous Xanthines relax smooth muscle and to relieve bronchial spasm and are indicated for severe asthma attack stimulant effects on respiration and have anti-inflammatory QUICK –RELIEF MEDICATION

12. NAME ADVANTAGES DISADVANTAGESS Inhaled Corticosteroids most effective preventers need to use these medications for several days to weeks before they reach their maximum benefit Long-acting agonists open the airways . may increase the risk of a severe asthma attack, unless they are used in combination with an inhaled corticosteroid Leukotriene Inhibitors act against one of the inflammatory components of asthma and provide protection against bronchoconstriction *when taken before exercise or exposure to allergen or to cold air . Jaundice,  headache Xanthines form relaxation of bronchial muscle and relief of bronchial spasm. stimulant effects on respiration and have anti-inflammatory LONG-TERM MEDICATION

13. Over the past years, inhaled glucocorticoids have become established as a cornerstone of maintenance therapy because of their demonstrated clinical efficacy, ability to reduce bronchial inflammation and good tolerability. However, many patients (especially children and the elderly ) find inhalers difficult to use, and poor inhalation technique can affect the amount of drug reaching the lungs and response to therapy . Oral drug administration is simple, but, until recently, oral asthma therapy has primarily consisted of sustained release theophylline and glucocorticoids . Theophylline has a narrow therapeutic index, necessitating regular monitoring of serum drug concentrations, and long term oral glucocorticoid therapy is associated with potentially serious adverse events including osteoporosis with bone fracture .

14. Leukotriene Modifiers Block the effects of Leukotrienes Help to prevent the symptoms for up to 24 hours THERAPEUTIC USE Theophylline Relaxes the airways and decrease the lungs response to irritant Helpful for night time asthma symptoms Long-acting B eta Agonist Open airways and reduce swelling at least 12 hours Must be taken in combination with Inhaled Corticosteroids Inhaled Corticosteroids Reduced swelling and tightening in your airways Used several months before get their maximum benefit Antimuscarnics Taken using inhaler Cause the airways to dilate by blocking cholinergic nerve The nerve release chemical that cause the muscle lining of the airways tighten Short-acting Beta Agonist Relaxing the tightening of the muscle bands around the airways Very effective in opening the airways

15. SPECIAL PRECAUTION Beta 2 agonist : Should be used with caution in patients with hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension Should also be used with caution in diabetic patients - monitor blood glucose may be required due to the risk of ketoacidosis , especially when beta 2 agonist given intravenousl y Antimuscarinics : Should be used with caution in patients with prostatic hyperplasia, bladder outflow obstruction, and those susceptible to angle-closure glaucoma Corticosteroids Inhaled corticosteroids : Monitor the height and weight of children annually . Association with adrenal crisis and coma in children , thus avoid excessive dose Leukotriene Inhibitors : Should not be used for the treatment of acute asthma attacks . Caution in pregnancy and breastfeeding Xanthines : Should be used with caution in patients with heart failure, hepatic impairment and viral infections, in the elderly, smokers and alcoholics . Should avoid the concurrent use of intravenous and other routes of administration of xanthines

16. DRUG MUST BE AVOIDED Ibuprofen