GENERIC NAME INDICATION MECHANISM OF ACTION ADVERSE DRUG

REACTION
SALBUTAMOL/AL They provide Stimulates intracellular Tremor
BUTEROL respiratory relief adenylate cyclase, an enzyme tachycardia
from conditions such that catalyzes conversion
as asthma, bronchitis, of adenosine triphosphate to
emphysema, or cyclic-3’, 5’-adenosine
bronchiectasis monophosphate
(cAMP). Increased cAMP levels
relax
bronchial smooth muscle and
inhibit
release of mediators of
immediate
hypersensitivity (especially from
mast cells).
Bronchodilators are used to open air passages and facilitate breathing as well as diminish
bronchospasms by relaxing the smooth muscles of the bronchioles.

Sympathomimetic drugs, such as metaproterenol, albuterol, terbutaline, isoetharine, pirbuterol, and

salmetrol, exert a preferential effect on B2-adrenergic receptors and mediate relaxation of the smooth
muscle of the respiratory tract. The bronchial muscles are controlled by the autonomic nervous system
with parasympathetic fibers predominating in number and effect.

Stimulation of parasympathetic nerves causes calcium-dependent contraction of the bronchi and

enhances the release of chemical mediators that induce bronchospasm.

It has weak B1 agonist activity. It is administered via oral inhalation through a metered-dose inhaler
or nebulizer (albuterol sulfate) or orally as a syrup or tablet (albuterol sulfate).

Albuterol is the only metered-dose inhaler currently FDA approved for use in children age 4 yr and
above.

It often is administered nebulized in the emergency room for the treatment of acute exacerbations of
asthma.

CASE COMMENT
Patient’s related problem: hypokalemia, hyperglycemia
FLUTICASONE Reduces mediators of act by their broad anti- The most common
inflammation and a inflammatory efficacy, mediated side effects include
powerful in part by inhibition of oral candidiasis
prophylaxis of production of inflammatory and hoarseness.
exacerbations of cytokines. They do not relax
asthma airway smooth muscle directly Higher doses of
but reduce bronchial reactivity inhaled fluticasone can
and reduce the frequency of suppress
asthma exacerbations if taken the hypothalamic-
regularly. Their effect on airway pituitary-adrenal axis.
 obstruction may be due in part
to their contraction of engorged Diabetes mellitus,
vessels in the bronchial mucosa osteoporosis,
and their potentiation of the psychological
effects of β-receptor agonists, disturbance,
but their most important action and hypokalemia can
is result from the long-
inhibition of the infiltration of term use of
asthmatic airways by corticosteroids.
lymphocytes, eosinophils, and
mast cells.
Corticosteroids (eg, beclomethasone dipropionate, dexamethasone, triamcinolone acetonide,
flunisolide, and fluticasone) not only are effective anti-inflammatory agents, but also potentiate the
bronchodilator effects of adrenergic drugs.

These corticosteroids are not direct bronchodilators and are not effective for rapid relief of bronchospasm.
Use of corticosteroid inhalers provides effective and localized anti-inflammatory activity within the
bronchial airways, while having minimal systemic effects

About 30% of the inhaled dose is absorbed from airways and is systemically available, with an elimination
half-life of about 14 hr.

Inhaled corticosteroids, including fluticasone and beclomethasone, are generally initiated after
use of albuterol/ipratropium is not sufficient to control symptoms.

Patients should be told to rinse the mouth after use of the inhaler to avoid drug-induced oral fungal
infections.

CASE COMMENT
Patient’s related problem: hyperglycemia, immunodeficiency might be responsible for the cause of
pneumonia
IBUPROFEN It is indicated for relief inhibit cyclooxygenase, Peptic ulceration
of symptoms of an enzyme needed for and GI bleeding
rheumatoid arthritis prostaglandin synthesis.
and Blurred or diminished
osteoarthritis. It also is vision, scotomata, and
indicated for the relief other
of mild-to-moderate changes in color
pain, for the treatment vision have been
of primary noted
dysmenorrhea, and as
an antipyretic.

An NSAID that possesses analgesic and antipyretic activities.

This drug, like aspirin and other NSAIDs, can inhibit platelet function and prolong bleeding time, but the
effects are reversible and not as long lasting as those of aspirin. Nevertheless, it should be administered
with caution to patients on anticoagulants.

It is not recommended for use in pregnant women or nursing mothers.

APAP that reduce elevated Acetaminophen [a-SEET-a- potential liver

body temperature MIN-oh-fen] (N-acetyl-p- injury
(fever) to normal aminophenol or APAP)
levels. inhibits prostaglandin synthesis
in the CNS. This explains its
antipyretic
and analgesic properties.
Acetaminophen has less effect
on cyclooxygenase
in peripheral tissues (due to
peripheral inactivation), which
accounts for its weak anti-
inflammatory activity.
The analgesic efficacy of acetaminophen is essentially equivalent to that of NSAIDs, but a
acetaminophen is not anti-inflammatory.

The mechanism of action of acetaminophen is unknown, but the prevailing evidence suggests that
involves a central component. Several possible actions have been proposed on the basis of in vitro
studies. The oldest proposal is that acetaminophen inhibits COX-1, but rather than in the periphery.
Another proposal is that acetaminophen inhibits a specific type of COX activity or under select conditions.
Other reports suggest that descending modulatory mechanisms are involved, possibility involving 5-HT or
endogenous opioid pathways.

Taken together, the findings suggest that acetaminophen has a direct action at the level of the
spinal cord and in addition stimulates a supraspinal system that modulates neurotransmitters at the level
of the spinal cord. This dual mechanism may explain why it has previously been so difficult to elucidate
the basis for the analegesic effect of acetaminophen.

Treatment of overdosage includes administration of acetylcysteine to help conjugate the hepatotoxic

metabolite plus symptomatic and supportive care.

The label on its dosage forms carries the following (or equivalent) statement: Warning—Do not use more
than 10 days unless directed by a physician. Keep this medication out of reach of children.