Anti-Inflammatory Drugs

Steroids and NSAIDs

RC 195

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

Glucocorticoids: Hydrocortisone
Mineralcorticoids: Aldosterone
Sex Hormones: Testosterone

Actions of Glucocorticoids
Anti-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 Inflammation
Organ Transplant
Allergic Inflammation

Steroid Side Effects: Cushings

Syndrome
Gluconeogenesis
Osteoporosis
Physical changes
Increased fat production and
redistribution
Acne
Hirsutism
Fragile skin

Sodium retention
Fluid retention
Potassium loss and metabolic
alkalosis

Increased gastric acidity

Decreased 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, antihistamines, 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, Cortef
Given orally or IV
Not usually aerosolized because of side effects

Prednisone (Prednisolone)
Brand: Deltasone, Delta-Cortef
4X as potent as hydrocortisone
Given orally
Side effects minimized if given every other day
Patients usually need to be weaned from it

Methylprednisolone
Brand: Solu-Medrol
Oral or IV
Often used to help relieve airway inflammation

Triamcinolone
Brands: Azmacort, Kenalog
MDI- to prevent airway inflammation

Dexamethasone
Brand: Decadron
Often nebulized for acute upper airway
inflammation
What else is used with it?

Beclomethasone
Brands: Vanceril, Beclovent, Becotide
MDI to prevent airway inflammation

Mometasone Furoate
Brand: Asmanex
DPI Twisthaler 220mcg per pff
Started as one puff per day in then evening and
may go as high two puffs BID

Flunisolide
Brand: AeroBid
MDI to prevent airway inflammation
Usually effective when given only BID

Fluticasone
Brand: Flovent
MDI (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: Pulmicort
MDI to prevent airway inflammation
Seems 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, Aarane
Is a mast cell stabilizer so used to prevent airway
inflammation
Does not relieve airway inflammation!

Often used as an alternative to aerosol steroids in

children
Administered 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: Tilade
Similar 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 antibody
Binds to IgE and prevents it from attaching to
mast cells
Given sub-Q 1-2 times per month

Case Study Time!