Cortocosteroids, cromoglicate, leukotriene, antihistamines and hyposensitisation

CORTICOSTEROIDS
-Beclometasone Dipropionate (Clenil, Asmabec, Beclazone, Becodisks, Qvar, Fostair).
-Budesonide (Novolizer, Pulmicort, Symbicort).
-Ciclesonide (Alvesco).
-Fluticasone Propionate (Flixotide, Seretide).
-Mometasone Furoate (Asmanex).

CROMOGLICATE AND RELATED THERAPY AND LEUKOTRIENE RECEPTOR ANTAGONISTS

1. Cromoglicate and related therapy:
-Sodium cromoglicate (Intal).
-Nedrocromil sodium (Tilade).

2. Leukotriene receptor antagonists:
-Montelukast (Singulair).
-Zafirlukast (Accolate).

ANTIHISTAMINES, HYPOSENSITISATION AND ALLERGIC EMERGENCIES

1. Antihistamines:
-Cetirizine Hydrochloride
-Desloratadine (Neoclarityn).
-Fexofenadine Hydrochloride (Telfast).
-Levocetirizine Hydrochloride (Xyzal).
-Loratadine.
-Mizolastine (Mizollen).
-Alememazine Tartrate (Vallergan).
-Chlorphenamine Maleate (Piriton).
-Clemastine (Tavegil).
-Cyproheptadine Hydrochloride (Periactin).
-Hydroxyzine Hydrochloride (Atarax, Ucerax).
-Ketotifen (Zatiden).
-Promethazine Hydrochloride (Phenergan).

2. Allergen Inmunotherapy:
-Bee and wasp allergen extracts: Pharmaigen.
-Grass and tree pollen extracts: Pollinex, Grazax.
-Omalizumab: for prophylaxis of severe persistent allergic asthma (Xolair).

3. Allergic emergencies:

-Adrenaline (epinephrine) provides physiological reversal of the inmediate symptoms associated with hypersensitivity reactions such as anaphylaxis and angioedema (Anapen, EpiPen, Minijet Adrenaline)
-Icatibant: for acute attacks of hereditary angioedema in patients with C1 esterase inhibitor deficiency (Firazyr).

Source:
-BNF 57 March 2009

BRONCHODILATORS

ASTHMA

Asthma is a chronic disease that affects your airways. Your airways are tubes that carry air in and out of your lungs. If you have asthma, the inside walls of your airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that you are allergic to or find irritating. When your airways react, they get narrower and your lungs get less air.

Symptoms of asthma include:

-Wheezing

-Coughing, especially early in the morning or at night

-Chest tightness

-Shortness of breath

Not all people who have asthma have these symptoms. Having these symptoms doesn't always mean that you have asthma. Your doctor will diagnose asthma based on lung function tests, your medical history, and a physical exam. You may also have allergy tests.

When your asthma symptoms become worse than usual, it's called an asthma attack. Severe asthma attacks may require emergency care, and they can be fatal.

COPD
COPD (chronic obstructive pulmonary disease) makes it hard for you to breathe. The two main types are chronic bronchitis and emphysema. The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. This is usually cigarette smoke. Air pollution, chemical fumes, or dust can also cause it.

At first, COPD may cause no symptoms or only mild symptoms. As the disease gets worse, symptoms usually become more severe. They include:
-A cough that produces a lot of mucus
-Shortness of breath, especially with physical activity
-Wheezing
-Chest tightness

Doctors use lung function tests, imaging tests, and blood tests to diagnose COPD. There is no cure. Treatments may relieve symptoms. They include medicines, oxygen therapy, surgery, or a lung transplant. Quitting smoking is the most important step you can take to treat COPD.

CROUP
Croup is breathing difficulty and a "barking" cough. Croup is due to swelling around the vocal cords. It is common in infants and children.

PHARMACOLOGY
BRONCHODILATORS

1. Adrenoceptor agonists:

-Selective beta agonists: Bambuterol Hydrochloride (Bambec), Fenoterol Hydrobromide, Formoterol Fumarate (Atimos, Foradil, Oxis), Salbutamol (Ventolin, Ventmax, Airomir, Asmasal, Salbulin), Salmeterol (Serevent) and Terbutaline Sulphate (Bricanyl). 

-Other adrenoceptor agonists: Ephedrine Hydrochloride and Orciprenaline Sulphate (Alupent).

2. Antimuscarinic bronchodilators:

-Ipratropium Bromide (Atrovent, Respontin).

-Tiotropium (Spiriva).

3. Theophylline:

-Theophylline (Nuelin, Slo-Phyllin).

-Aminophylline (Phyllocontin Continus).

4. Compound bronchodilator preparations:

-Combivent (ipratropium bromide + salbutamol).

-Duovent (fenotrol hydrobromide + ipratropium bromide).

5. Peak flow meters, inhaler devices and nebulisers:

-Peak flow meters: standard range (MicroPeak, Mini-Wright, Personal Best, Piko-1, Pocketpeak and Vitalograph) and low range (Mini-Wright and Pocketpeak).

-Drug delivery devices: inhaler devices (pressurised metered dose inhalers, breath-actuated inhalers and dry powder inhalers) and spacer devices (Able Spacer, AeroChamber, Babyhaler, Haleraid, Nebuchamber, Nebuhaler, Optichamber, Volumatic, Pocket Chamber and PARI Vortex Spacer).

-Nebulisers: e.g: Medix Lifecare Nebuliser:

Source:
-http://www.nlm.nih.gov/medlineplus/
-BNF 57 March 2009

LIPID-REGULATING DRUGS AND LOCAL SCLEROSANTS

Cholesterol is a fatty substance known as a lipid and is vital for the normal functioning of the body. It is mainly made by the liver but can also be found in some foods.

Having an excessively high level of lipids in your blood (hyperlipidemia) can have an effect on your health. High cholesterol itself does not cause any symptoms, but it increases your risk of serious health conditions.

Cholesterol is carried in your blood by proteins, and when the two combine they are called lipoproteins. There are harmful and protective lipoproteins known as LDL and HDL, or 'bad' and 'good' cholesterol:

-Low-density lipoprotein (LDL): LDL carries cholesterol from your liver to the cells that need it. If there is too much cholesterol for the cells to use, it can build up in the artery walls, leading to disease of the arteries. For this reason, LDL cholesterol is known as "bad cholesterol".

-High-density lipoprotein (HDL): HDL carries cholesterol away from the cells and back to the liver, where it is either broken down or passed out of the body as a waste product. For this reason, it is referred to as "good cholesterol" and higher levels are better.

LIPID-REGULATING DRUGS

-Statins:

They are more effective than other lipid-regulating drugs at lowering LDL-cholesterol concentration but they are less effective than the fibrates in reducing triglyceride concentration. However, statins reduce cardiovascular disease events and total mortality irrespective of the initial cholesterol concentration.

-Atorvastatin (Lipitor).

-Fluvastatin (Lescol).
-Pravastatin sodium (Lipostat).
-Rosuvastatin (Crestor).
-Simvastatin (Zocor, Inegy).
-Bile acid sequestrants: used in the management of hypercholesterolaemia.
-Colesevelam hydrochloride (Cholestagel).
-Colestyramine (Questran).
-Colestipol hydrochloride (Colestid).
-Ezetimibe: inhibits the intestinal absorption of cholesterol (Ezetrol).

-Fibrates: act mainly by decreasing serum triglycerides, they have variable effects on LDL-cholesterol.

-Bezafibrate (Bezalip).

-Ciprofibrate (Modalim).

-Fenofibrate (Lipantil, Supralip).

-Gemfibrozil (Lopid).

-Nicotinic acid group:

-Acipimox: indicated for hyperlipidaemias of types IIb and IV (Olbetam).

-Nicotinic Acid: adjunt to statin in dyslipidaemia or used alone if statin not tolerated (Niaspan).

-Omega-3- fatty acid compounds:

-Omega-3-Acid Ethyl Esters: indicated for hypertriglyceridaemia (Omacor).

-Omega-3-Marine Triglycerides: adjunt in the reduction of plasma triglycerides in severe hypertriglyceridaemia (Maxepa).

LOCAL SCLEROSANTS

-Ethanolamine oleate: indicated for sclerotherapy of varicose veins.
-Sodium Tetradecyl Sulphate: indicated for sclerotherapy of varicose veins (Fibro-vein).

Source:
-http://www.nlm.nih.gov/medlineplus/cholesterol.html
-BNF 57 March 2009