기관지확장제와기관지천식 치료에쓰이는약물 이종호 한림의대약리학교실
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1 기관지확장제와기관지천식 치료에쓰이는약물 이종호 한림의대약리학교실
2 천식치료제 기관지확장제 Beta2 adrenergic agonists; terbutaline, albuterol, metaproterenol, salmeterol Muscarinic antagonists; Ipratropium Methylxanthines; theophylline 예방및항염증약물 비만세포안정제 ; cromolyn Glucocorticoids; beclomethasone, prednisone Leukotriene antagonist; zileuton, zafirlukast
3 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
4 Concepts 천식의면역학적발병기전 천식 (asthma) 의특징 Airway inflammation Bronchial hyperreactivity Episodic, reversible bronchospasm
5 증상완화 천식재발의예방 Concepts 천식치료의목적
6 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
7 Beta-adrenoceptor agonists 약동학및임상적사용 Short acting drugs; albuterol, terbutaline 약효시작시간 ; 분, 약효지속시간 ; 4-64 시간 가장효과적인기관지확장제 가볍고간헐적인천식 Long acting agonists; salmeterol 약효지속시간 ; 12 시간이상 예방목적으로만사용됨. 급성발작의증상완화에는사용되지않는다. Epinephrine( 피하주사 ) 심하고생명이위독한천식발작 금기 ; 노인, 심장질환자
8 Beta-adrenoceptor agonists Tachycardia, 부정맥 beta-1 효과 부작용 Skeletal muscle tremor beta-2 효과 Beta-2 반응의소실 (tolerance to the beta agonists effects)
9 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
10 Methylxanthines Theophylline Tea Orally active Rapid-release Slow-release Caffeine Coffee Theobromine Cocoa
11 Methylxanthines 약동학 Narrow therapeutic window; mg/l Should only be used where methods to measure theophylline blood levels are available Metabolized by liver P450 enzymes Clearance of methylxanthines is Decreased in liver disease Increased in cigarette smoking Increased in young adolescence
12 Methylxanthines 부작용 오심, 구토, 진전, 불면증 저혈압, 부정맥 치료 ; beta-blocker blocker 경련발작
13 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
14 Muscarinic antagonists Ipratropium bromide Quaternary anti-muscarinic agent 성인의만성폐쇄성폐질환 (COPD) 의일차선택약
15 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
16 Cromolyn & Nedocromil 작용기전 불명확함 비만세포 (mast cell) 에서의염증매개물질분비의감소 임상적사용 알러지성천식의예방
17 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
18 Corticosteroids 흡입용 corticosteroids Beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, mometasone 중등도 (moderate) 중증 (severe) 천식에사용 경구, 정맥투여 Prednisone, prednisolone 독성때문에심한중증의천식환자 (status asthmaticus) 에만사용
19 항염작용 Corticosteroids 작용기전 Phospholipase A2 를억제하여 arachidonic acid 생산감소 Cyclooxygenase-2 의발현을억제하여 prostaglandin 의생산감소 기타항염작용을가진물질의발현증가
20 Corticosteroids 부작용 흡입된 corticosteroids 구강 candida 증 경구, 정맥내투여 2주이상투여시 corticosteroid 에의한전신독성이생길수있다. 투여를중지할때부신장애를예방하기위해투여량을천천히줄여야한다. 갑자기투여를중지하면부신장애 (adrenal insufficiency) 로생명이위독할수있다.
21 Bronchial asthma Concepts Bronchodilators Beta-adrenoceptor agonists Methylxanthines Muscarinic antagonists Anti-inflammatory agents Cromolyn & Nedocromil Corticosteroids Leukotriene antagonists
22 Leukotriene antagonists 종류 Zileuton Block the synthesis of leukotriene by inhibition of 5-5 lipoxygenase Montelukast and zafirlukast Inhibition of the binding of LTD 4 to its receptor on target tissue 임상적이용 천식의예방 만성천식의치료
23 천식치료제 - 요약 기관지확장제 Beta2 adrenergic agonists; terbutaline, albuterol, metaproterenol, salmeterol Muscarinic antagonists; Ipratropium Methylxanthines; theophylline 예방및항염증약물 비만세포안정제 ; cromolyn Glucocorticoids; beclomethasone, prednisone Leukotriene antagonist; zileuton, zafirlukast
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