Asthma Mnemonics Part 2 Theophylline, Cromolyn, Montelukast, Methylpred, Omalizumab

Some oddball additional medications in asthma treatment, including theophylline, montelukast, cromolyn, methylprednisolone, omalizumab

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Welcome to the Memorizing Pharmacology podcast. I'm Tony Guerra, pharmacist and author of the Memorizing Pharmacology book series, bringing you mnemonics, cases, and advice for succeeding in Pharmacology. Sign up for the email list at memorizingfarm.com to get your free suffixes cheat sheet or find our mobile-friendly self-paced online pharmacology review course at residency.teachable.com. Let's get started with the show.

Okay, I wanted to go over a couple of 'oddball' asthma medications. It's more that they're just not used as much as that kind of beta 2 Agonist or anticholinergics or inhaled steroids and so we just want to at least touch on them to understand what they do. So again, we're going to go back to what asthma is all about - that episodic bronchoconstriction and inflammation. With these medications, we're really talking about Theophylline.

We're talking about primarily being a bronchodilator so taking care of that opening of the airway but Mata Lucas chromalin homilizumab predn methylpred um all of these are really meant to reduce inflammation. So let's take a look at a couple of them and maybe some details about them.

So Theophylline, there's also aminophilin which is kind of a combination but the big thing to kind of take away is that we're working about the bronchodilation so this is the opening up of that Airway it relaxes the smooth muscles and opens the airway. So if you look at the offaline and aminophilin you see o-p-i-n-o-p-i-n so one way to remind you that it's the bronchodilator side more than the anti-inflammatory side.

I have a little coffee cup here because it's chemically a methazanthine so it is chemically similar to caffeine so if you want to think about what it's like to have too many cups of coffee you have the idea of what it is to have toxicity from Theophylline and I'll get to the um narrow therapeutic window in the next slide.

It does have a lot of drug interactions and this is why it's really fallen out of favor. I still have it, it's just something that we just don't use very often but you do want to check for potential interactions with those other drugs and the blood tests are going to be kind of part of this.

So when we look at a narrow therapeutic window I thought of a castle in how they had those Arrow slits and the narrow therapeutic window is between 10 and 20 micrograms per milliliter and so if you think of the T within this Arrow slit and I intentionally picked the T to combine the T from Theophylline, the T from therapeutic, the T from 10, and the T from 20. So the four T's and this narrow therapeutic window are maybe a good way to remember Theophyllin has this 10 to 20.

Uh Montelukast, I change the colors a little bit because when you think of Singulair it's kind of like that Claritin clear where you've got this picture of blue skies and green grass. This is for asthma and COPD that's refractory to other medications. It's just not - the other medicines are just not doing it.

It's a leukotriene inhibitor but you know what does that mean? Well leukotriene inhibitor is going to come from the mast cells and really it's going to be part of that kind of cascade of the um asthmatic response. And so when we look at adverse effects I put Neuropsychiatric event because this is exactly what's on the documents but really I think that you're going to see something like suicidal ideation or something like that but Neuropsychiatric events is obviously a real concern especially since we're talking about a medication that's often used with children.

Um lfts are probably a consideration with liver and then uh you really don't use this alone um you really use this as something to add to an asthma um treatment regimen but you don't use it alone and it's not called Singulair because you don't use it alone. It's called singular because it's once daily dosing and if you look at zapher look is what I think was the first one that came out - that one was four times a day so when you come out with one that you only take once a day, it's gonna kind of knock the other one off the market and I think that's exactly what happened. But look at the Lucas ending to remind you about the leukotrienes inhibitor as something that's going to improve asthma.

Okay, this is cromelin which is uh Intel um we use this for asthma and COPD and it's what's called a mast cells. This is crumbling and it's again for asthma COPD. It's a mast cell stabilizer. Think about the M for Mast and I've got a couple of pictures of ships here and the idea is that you're kind of going through the storm here until we stabilize the Mast and we get this nice Placid kind of view of a sailboat.

The idea is that to stabilize the mast cell is to stop releasing all of those things that are going to cause the asthmatic and allergic reactions. In terms of adverse effect, you get kind of a dry mouth, real irritation of the throat, and kind of a cough with it. So where you were rinsing your mouth out with inhaled steroids to avoid thrush, in this case, you're maybe gargling or rinsing your mouth out a little bit to avoid the irritation and to avoid that cough.

Uh contraindications really rare rare shortly shortness of breath or something like that um I often use IV steroids so this is not necessarily an oddball as much as it is that it's just much more rare. So something like asthma would benefit from methyl pred if you did have an asthma attack. It is a steroid anti-inflammatory and it's tough to say in terms of side effects because you're talking about using it for a couple of days probably where you know maybe agitation changing mood maybe a little bit of weight gain but again we're talking much shorter term steroid use.

Infections always kind of an issue um you know we suppressing the immune system anytime we're giving a steroid and then this is used in combination so Albuterol and petropium remembering that albuterol is that beta 2 Agonist it's a bronchodilator and ipritropium is the anticholinergic that really relaxes those lungs.

Okay uh omole is umab zolair uh this is kind of a Last Resort for many people who have allergic asthma or chronic hives where you don't know why they have hives and then nasal polyps. It's an ige blocker so it binds that ige antibody on mast cells and basophils and stops kind of the Cascade if you would flu-like symptoms might be one of the adverse effects but the real thing to worry about is that anaphylaxis can occur in the first dose and Beyond.

And this kind of makes sense because of the way that the anaphylaxis Cascade goes but again just recognizing that anaphylaxis could happen and so making sure that the patient is aware that okay we're gonna watch you while we give it to you but we're also going to ask you to watch yourself as you kind of move on.

And then last thing if this is a subcutaneous dosage so a little bit different than all the inhalers we've been talking about again this is for informational purposes only so it is not medical advice if you have medical condition consult a medical professional listening to the memorizing pharmacology podcast.

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