Corticosteroids Beta-2 agonists

LTB4 is a potent bronchoconstrictor, as are several other leukotrienes. A 5-lip-oxygenase inhibitor, Zileuton, is approved for therapy of asthma (though it is not much used for this purpose) as is a leukotriene blocker, montelukast, marketed as Singulair. Singulair is widely used by asthmatics as a preventive for asthma attacks. Certain corticosteroids are employed for the same purpose. Neither montelukast nor the steroids are effective in terminating an established asthmatic attack. Beta agonists are employed for that purpose (see chapter 17). 

An important feature of thyrostats, beta-agonists, and corticosteroids is that they are in general orally active. This means that they can be given via the fodder or drinking water, leaving no trace of percutaneous administration, which is one of the annoying indications when orally inactive steroids are injected. 

Remington TL, Digiovine B. Long-acting beta-agonists anti-inflammatory properties and synergy with corticosteroids in asthma. Curr Opin Pulm Med. 2005 11 74-78. 

Decontamination and Treatment Remove animal from affected areas. If any coughing or respiratory distress, monitor blood gases and Sp02- Provide oxygen and assisted ventilation as needed. Nebulized beta agonists and possibly corticosteroids can be used to treat bronchospasm. Monitor electrolytes and PCV as there can be fluid shifts out of the vasculature (Goldfrank et al, 2002). Urine arsenic levels may be measured, but are not clinically useful due to the lag time before results are obtained. Watch for liver and kidney failure. 

Chlorine. Lacrimation. Rhinorrhea. Conjunctival irritation. Cough. Sore throat. Hoarseness Laryngeal edema. Dyspnea. Stridor. ARDS. Pulmonary edema Decontamination Copious water irrigation of the skin, eyes, and mucosal membranes to prevent continued irritation and injury Symptomatic care (no antidote) Warm/moist air, supplemental oxygen, positive pressure O2 for pulmonary edema Bronchospasm Beta-agonists (albuterol) Severe bronchospasm Corticosteroids (prednisone) (also used for PTS with H/0 asthma but use unproven) Analgesia and cough Nebulized lidocaine (4% topical solution) or nebulized sodium bicarbonate (use unproven)... 

Phosgene. Transient irritation (eyes, nose, throat, and sinus). Bronchospasm. Pulmonary edema. Apnea. Hypoxia Decontamination Wash away all residual liquid with copious water, remove clothing Symptomatic care ABCs, hydrate, positive pressure O2 for pulmonary edema Bronchospasm Beta-agonists (albuterol), corticosteroids INH/IV, furosemide contraindicated Hypoxia Oxygen... 

Taylor DR, Wilkins GT, Herbison GP, Flannery EM. Interaction between corticosteroid and beta-agonist drugs. Biochemical and cardiovascular effects in normal subjects. Chest 1992 102(2) 519-24. 

Because of their growth-promotion properties, the veterinary use of steroids, especially corticosteroids and anabolic steroids, is attractive. Within the EU, the use of growth-promoting substances (thyreostats, anabolics, and beta-agonist) in animal fatteiting is forbidden. Considerable effort has been put in the development in appropriate methods for tracing the use of illegal steroid hormones [6, 65]. 

Emphysema is treated by using bronchodilators such as anticholinergic and beta agonists (ipratropium bromide, theophylline) to open the airway by relaxing muscles around the bronchi. Corticosteroids are used to reduce the inflammation that is associated with emphysema. 

Aminoglutethimide, rifampin, barbiturates, charcoal, ketoconazole, smoking (cigarettes and marijuana), sulfinpyrazone, and sympathomimetics (beta-agonists)—all decrease the plasma levels of theophylline, whereas allopu-rinol, beta-blockers (nonselective), calcium-channel blockers, cimetidine, contraceptives, corticosteroids, disulfiram, ephedrine, interferon, macrolides, mexiletine, quinolones, and thiabendazole all increase the plasma levels of theophylline. 

Yes. It is often useful in combination with inhaled corticosteroids or beta-agonists. 

Tantisira K G, Small K M, Litonjua A A, et al. (2005). Molecular properties and pharmacogenetics of a polymorphism of adenylyl cyclase type 9 in asthma interaction between beta-agonist and corticosteroid pathways. Hum. Mol. Genet. 14 1671-1677. 

Beta agonists (e.g. fenoterol, salbutamol (albuterol), terbutaline) can cause hypokalaemia. This can be increased by other potassium-depleting drugs such as the corticosteroids, diuretics (e.g. bendroflumethiazide, furosemide) and theophylline. The risk of serious cardiac arrhythmias in asthmatic patients may be increased. 

Bosley CM, Parry DT, Cochrane GM. Patient compliance with inhaled medication—does combining beta-agonists with corticosteroids improve compliance Eur Respir J 1994 7 504-509. 

Salpeter SR, Wall AJ, Buckley NS. Long-acting beta-agonists with and without inhaled corticosteroids and catastrophic asthma events. Am J Med 2010 123(4) 322-8.e2. 

Ni Chroinin M, Lasserson TJ, Greenstone I, Ducharme FM. Addition of long-acting beta-agonists to inhaled corticosteroids for chronic asthma in children. Cochrane Database Syst Rev 2009 (3) CD007949. 

Gibson PG, Powell H, Ducharme FM. Differential effects of maintenance long-acting beta-agonist and inhaled corticosteroid on asthma control and asthma exacerbations. J Allergy Clin Immunol 2007 119(2) 344-50. 

Thomas M, von Ziegenweidt J, Lee AJ, Price D. High-dose inhaled corticosteroids versus add-on long-acting beta-agonists in asthma an observational study. J Allergy Clin Immunol 2009 123(1) 116-21, elO. 

Rodrigo GJ, Moral VP, Marcos LG, Cas-tro-Rodriguez JA. Safety of regular use of long-acting beta agonists as monotherapy or added to inhaled corticosteroids in asthma. A systematic review. Pulm Pharmacol Ther 2009 22(1) 9-19. 

Horita N, To M, Araki K, Haruki K, To Y. Risk fectors of local oropharyngeal and laryngeal adverse effects from use of single inhaled corticosteroids and long-acting beta-agonists. AUer Intern 2012 61(4) 583-8. 

Adjunctive pharmacological therapies, aimed primarily at the cardio-respiratory system, will have a modest role initially, but as the disease becomes more chronic, there is a reduction in the potential for medications to contribute substantially. Therefore, although medications are prescribed in an attempt to optimize performance, it is important to do so in a way that minimizes the possibility of detrimental effects that can occur, for example, from corticosteroids or short-acting beta agonists. The following comments highlight some of the adjunctive therapies for the ventilated patient. 

Hanania, N. A. (2008). The impact of inhaled corticosteroid and long-acting beta-agonist combination therapy on outcomes in COPD. Pulmonary Pharmacology Therapeutics, 21(2), 540-550. 

Bronchospasm Beta-agonists (albuterol), corticosteroids INH/IV, furosemide contraindicated... 

Ghanei and Harandi recommend the use of corticosteroids in all forms of SM-induced chronic lung injury. However, side effects of their continued use may limit their long-term use. Additionally, beta-agonists and anticholinergics are effective in improving lung function. ... 

Q12 It is recommended that a trial of a short-acting beta-2-agonist (/S)-agonist) inhaler be made for a few weeks as some COPD patients do benefit from bronchodilation. Although his doctor has prescribed a bronchodilator previously, it may be useful for Bill to try this again. There should also be a trial of a corticosteroid inhaler, as this diminishes the inflammatory component of COPD. If there is no appreciable benefit after four weeks, the steroid should be discontinued. 

THEOPHYLLINE CORTICOSTEROIDS Risk of hypokalaemia Additive effect. The CSM notes that this effect occurs with beta-2 agonists, theophyllines and corticosteroids, all of which may be given during severe asthma hypoxia exacerbates this effect Monitor blood potassium levels prior to concomitant administration and during therapy (monitor 1—2-hourly during parenteral administration). Administer potassium supplements to prevent hypokalaemia, which may also be worsened by hypoxia during severe attacks of asthma... 

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