Anti-asthmatic Drugs
Session 37: Anti-asthmatic Drugs
Total Session Time: 120 minutes
Prerequisites
Learning Tasks
By the end of this session students are expected to be able to:
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Objectives
Presentation Introduction to Essential Anti-asthmatic
2 10 minutes
Brainstorming Drugs
Presentation/
3 15 minutes Indications of Essential Anti-asthmatic Drugs
Buzzing
Dose, Dosage and Course of Treatment of
4 30 minutes Presentation
Essential Anti-asthmatic Drugs
Presentation/ Side Effects and Adverse Effects of Essential
5 20 minutes
Buzzing Anti-asthmatic Drugs
Presentation/ Contraindications of Essential Anti-asthmatic
6 10 minutes
Brainstorming Drugs
Interactions, Warning and Precautions of
7 20 minutes Presentation
Essential Anti-asthmatic Drugs
8 05 minutes Presentation Key Points
9 05 minutes Presentation Evaluation
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STEP 1: Presentation of Session Title and Learning tasks (5 minutes)
READ or ASK students to read the learning objectives and clarify
ASK students if they have any questions before continuing.
STEP 2: Introduction to Essential Anti-asthmatic Drugs (10 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
Asthma
obstruction in response to irritant stimuli that are too weak to affect non-asthmatic
subjects, characterized by attacks of wheezing, shortness of breath and often nocturnal
cough.
o Airway inflammation, which causes bronchial hyper-responsiveness, which in turn
results in recurrent reversible airway obstruction
Essential Anti-Asthmatic Drugs
o Bronchodilators
o Anti-inflammatory agents
agents (bronchodilators) and corticosteroids (used as ‗controllers‘ or anti-inflammatory)
bronchodilators also have some anti-inflammatory effect
aminophylline, beclomethasone inhalation, cromoglycate nasal spray, salbutamol,
ipratropium aerosol and adrenaline
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STEP 3: Indications of Essential Anti-asthmatic Drugs (15 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
o Is used for treating active symptoms and blockage of airway due to asthma or other
lung diseases such as emphysema or bronchitis.
o It improves contraction of the diaphragm (the major breathing muscle).
o It is used in combination with other medicines.
o It can be used to treat asthma and other allergic conditions
o It is used to treat asthma and other allergic conditions
o It is considered a breakthrough drug in management of asthma, as the patients can be
freed from steroids in many cases; however, it is mainly effective as a prophylaxis for
allergic and exercise induced asthma, not as a treatment for acute attacks
o Salbutamol is typically used to treat bronchospasm (due to any cause, allergen asthma
or exercise-induced), as well as chronic obstructive pulmonary disease.
o It is used to relieve bronchospasm in bronchial asthma, chronic bronchitis,
emphysema and other airway resistance diseases
o Is indicated as a bronchodilator for maintenance treatment of bronchospasm
associated with chronic obstructive pulmonary disease (COPD), including chronic
bronchitis and emphysema.
o Adrenaline is the drug of choice for allergic emergencies
o In general this drug is used to treat life-threatening emergencies such as severe
allergic reactions (anaphylaxis) such as acute asthmatic attack, cardiac arrest and
cardiopulmonary resuscitation (when the heart stops beating and/or the patient stops
breathing).
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STEP 4: Dose, Dosage and Course of Treatment of Essential Anti-
Asthmatic Drugs (30 minutes)
Aminophylline
Beclomethasone Inhalation
patients who previously received inhaled steroids
o Children over 12 years of age:
patients who previously received inhaled steroids
Cromoglycate Nasal spray
Salbutamol
o For chronic asthma 4mg tablet 3-4 times a day by mouth. Or aerosol inhalation
200micrograms (two puffs) 3-4 times a day
day increased to 5mg if necessary
o For children with mild to moderate asthma give salbutamol orally, 1-5years 1mg t.i.d
(three) times day, over five years 2mg t.i.d times a day
o For children with acute severe asthma give nebulized salbutamol 0.1mg every 4 hours
o Prophylaxis in exercise-induced bronchospasm, 200 micrograms (2 puffs), child 100
micrograms (1 puff), increased to 200 micrograms (2 puffs) if necessary.
Ipratropium Bromide Aerosol
o Ipratropium bromide aerosol 20 – 80mg, 6 – 8 hourly
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STEP 5: Common Side Effects and Adverse Effects of Essential Anti-
Asthmatic Drugs (20 minutes)
Activity: Buzzing (5 minutes)
ASK students to pair up and buzz on the following question for 2 minutes
drugs?
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below
Side effects of Aminophylline
body red, swollen skin, scaly skin, skin rash, chest pain or discomfort, dizziness, fainting,
fast, slow, or irregular heartbeat, increase in urine volume, lightheadedness, persistent
vomiting, pounding or rapid pulse, seizures, shakiness
Side effects of Beclomethasone
difficulty with breathing, dryness or soreness of the throat, fever, hoarseness, runny nose,
tender, swollen glands in the neck
changes in behavior, chills, darkening of the skin, decreased vision, diarrhea, dizziness,
eye pain, fainting, headache, loss of appetite, lower back or side pain mental depression,
nausea or vomiting, painful or difficult urination, skin rash, sore mouth or tongue, tearing,
thoughts of killing oneself
Side effects of Sodium Cromoglycate Nasal spray
breathing, fine tremor, anxiety, headache, muscle cramps, dry mouth, and palpitation.
(rare), and disturbances of sleep and behavior
urticaria, angioedema, hypotension, and collapse
patients with renal failure and those on certain diuretics and xanthine derivatives
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Side effects of Ipratropium Bromide Aerosol
precipitation or worsening of narrow-angle glaucoma. Therefore should be used with
caution in patients with narrow-angle glaucoma
patients with prostatic hyperplasia, or bladder-neck obstruction
therefore patients should be cautioned about engaging in activities requiring balance and
visual acuity such as driving a car or operating appliances or machinery
Adverse effects of Adrenaline
paleness, dizziness, weakness, tremor, headache, anxiety and restlessness, irregular
heartbeat rhythm (arrhythmias), chest pain, hypoglycaemia, cold extremities, pulmonary
oedema, bleeding in the brain (cerebral haemorrhage)
STEP 6: Contraindications of Essential Anti-asthmatic Drugs (10 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
ALLOW few students to respond?
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
o Is contraindicated to person who is allergic to any ingredient in aminophylline
(including ethylenediamine), similar medicines (eg, theophylline), or xanthines (eg,
caffeine, chocolate)
o Contraindications include hypersensitivity
o Is contraindicated in persons with a history of hypersensitivity reaction (urticaria,
angioedema, rash) to salbutamol, or any of its components.
o Salbutamol is also contraindicated in patients with pre-existing cardiac
tachyarrhythmias (too fast heart beat, may be regular or irregular)
o Is contraindicated to persons with history of hypersensitivity to ipratropium bromide
or its components and atropine or any of its derivative
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STEP 7: Interactions and Precaution of Essential Anti-asthmatic Drugs
(20 minutes)
;
o Can interact with aminoglutethimide, barbiturates (eg, phenobarbital), beta-blockers
(eg, propranolol), carbamazepine, hydantoins (eg, phenytoin), isoproterenol,
moricizine, propafenone, rifampin, or sulfinpyrazone because the effectiveness of
aminophylline may be decreased
o Also can interact with allopurinol, cimetidine, disulfiram, enoxacin, estrogen,
fluvoxamine, interferon alpha, macrolide antibiotics (eg, clarithromycin,
erythromycin), methotrexate, mexiletine, oral contraceptives (birth control pills),
pentoxifylline, quinolone antibiotics (eg, ciprofloxacin), tacrine, thiabendazole,
ticlopidine, troleandomycin, verapamil, viloxazine, or zileuton because the risk of side
effects of aminophylline may be increased
o Sodium cromoglicate should be used with caution in pregnant and breastfeeding
women
o People on steroids or who have recently stopped taking a steroid and their asthma is
getting worse (inhaler)
o People suffering from, stress, trauma, infection or other illness (inhaler)
o It should not be used in people with an allergy to sodium cromoglicate, or any of the
ingredients in the medicine
o Should be used with caution in patients with cardiac arrhythmia, hypertension,
hyperthyroidism, convulsive disorders and diabetes mellitus
o It should be taken with extreme caution in persons taking tricyclic antidepressants,
monoamine oxidase inhibitors, loop diuretics or thiazide diuretics
o Beta-receptor blocking drugs should be avoided during salbutamol therapy because
these drugs block the bronchodilator effect of salbutamol
o Hypersensitivity reactions including urticaria, angioedema, rash, bronchospasm,
anaphylaxis, and oropharyngeal edema may occur after the administration of
o It can produce paradoxical bronchospasm that can be life threatening
o There is potential for an additive interaction with concomitantly used anticholinergic
medications
o Should be administered with caution in patients who have heart disease, including
patients with cardiac arrhythmias, coronary artery or organic heart disease,
cerebrovascular disease, or hypertension
In such patients, or in patients who are on drugs that may sensitize the heart to
arrhythmias, epinephrine may precipitate or aggravate angina pectoris as well
as produce ventricular arrhythmias
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o Epinephrine should be administered with caution to patients with
hyperthyroidism, Parkinson's disease, diabetes mellitus, pheochromocytoma,
elderly individuals, and pregnant women
Patients with Parkinson's disease may experience psychomotor agitation or
notice a temporary worsening of symptoms. Diabetic patients may experience
transient increases in blood sugar
o Adrenalin® contains sodium bisulfite which may cause mild to severe allergic
reactions including anaphylaxis or asthmatic episodes in susceptible individuals
o Epinephrine should be administered cautiously to patients taking other
sympathomimetic agents because of the possibility of additive effects
o Administer epinephrine cautiously to patients receiving halogenated hydrocarbon
general anesthetics, such as halothane, as coadministration may result in
arrhythmias
STEP 8: Key points (5 minutes)
cromoglycate nasal spray, salbutamol, ipratropium aerosol and adrenaline
or other lung diseases such as emphysema or bronchitis
pressure. This may result in precipitation or worsening of narrow-angle glaucoma
hyperthyroidism, convulsive disorders and diabetes mellitus
STEP 9: Evaluation (5 minutes)
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References
Katzung, Bertram G, Masters, Susan B, Trevor& Anthony J. (2006). Basic & clinical
Pharmacology (10th Ed).
Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines & National
Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam, Tanzania
government printers.
Rang, H. P., Ritter, J. M., Flower, R. J., & Henderson, G. (2014). Rang & Dale's
Pharmacology: Elsevier Health Sciences.
Sally, S.R, Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed) New York,
The Royal Pharmaceutical Society of Great Britain. (2009). British National Formulary
(59th ed). London, BMJ Group and RPS Publishing.
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