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EBL Oral Presentation - Asthma By: Arun Khurana, Zunnair Alam, Wing Chan, Rachel O’Neill, Elizabeth Warnock. Academic Advisor : Karen Hassell Topics to be covered in this presentation • Adrenoreceptor Agonists • Drugs used in treatment of asthma – Salbutamol – Salmeterol – Terbutaline Sulphate – Ephedrine Hydrochloride – Orciprenaline Sulphate • States of drugs and pKa values • Socio-economic impacts of asthma Adrenoreceptor agonists • 5 million people in the UK are currently receiving treatment for asthma 1.1 million children 4.3 million adults • Adrenergic receptor agonists are a class of drugs used to treat asthma and other pulmonary diseases. Adrenoreceptor agonists • These drugs act on the adrenogenic receptors causing smooth muscles to relax, which results in dilation of bronchial passages. • Beta-2 adrenergic agonists are most often administered by inhaling from a pressurizedmetered dose inhaler. Salbutamol Metabolism: Hepatic Half-Life: 1.6 hours Excretion: Renal Formula: C13H21NO3 = 239.311 •Salbutamol was the first selective Β2-receptor agonist to be marketed — in 1968. It was first sold by Allen & Hanburys under the brand name Ventolin. •Salbutamol is specifically indicated by Acute asthma. •The selectivity of Salbutamol depends on the dose given. Inhalation of drugs aids selectivity as it delivers small but effective doses to the airways thus helping in minimizing systemic exposure. After inhalation, the onset of drug action takes an intermediate amount of time ( bronchodilation is produced for about 6 hours ) . Salbutamol • It is marketed by GlaxoSmithKline as Ventolin, Aerolin or Ventorlin. • The most common side effects : fine tremor nervousness headache muscle cramps dry mouth palpitation. Salmeterol (Severent ) C25H37NO4 •Salmeterol helps to treat and manage Bronchospams, Nocturnal asthma, Chronic Asthma and Chronic obstructing pulmonary disease (COPD). It is known as a “LABA”. •Salmeterol works by attaching itself to particular beta 2 receptors. Specific secondary binding sites on the beta 2 receptors are targeted by Salmeterol molecules. As a result of this bronchial muscle is relaxed, bronchodilatation is promoted Salmeterol (Severent ) • The dosage of Salmeterol depends on which problem it is being used to treat. In the form of Inhalers it can treat: • Asthma- 50 micrograms (1 blister/2 puffs) twice daily. COPD- 50 micrograms (1 blister/2 Puffs) twice daily. • Salmeterol in all forms costs £29.26. Terbutaline Sulphate Form: white to greyish-white crystalline powder. MW:(C12H19NO3)2,H2SO4 =548.6 M.p.:246° to 248° • Terbutaline sulfate is a synthetic sympathomimetic amine • Uses-Terbutaline sulfate is used as a relatively short-acting bronchodilator in the symptomatic treatment of bronchial asthma and of reversible bronchospasm that may occur in association with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. Subcutaneous terbutaline is about as effective as an equal subcutaneous dose of epinephrine in improving pulmonary function. Terbutaline Sulphate • Dose: 500micrograms (1 inhalation), up to 4 times daily.The inhaled form of terbutaline starts working within 15 minutes and can last up to 6 hours. • Methods: By mouth, subcutaneous or slow intravenous injection, continuous intravenous infusion, inhalation of powder (Turbohaler®) and inhalation of nebulised solution. Ephedrine Hydrochloride •Melting Point: 216oC-222oC •Molecular formula: C10H15NO,HCl =201.7 •It exists as colourless crystals or a white crystalline powder. Ephedrine hydrochloride helps to relieve the symptoms caused by asthma. It helps to relax the smooth muscles present in the lungs, this is turn allows the bronchial discharge to flow out from the bronchial tubes to generate more cough. Dosage: This medication should be taken 3 times a day, by mouth. It may take a few hours before the full benefit of the drug takes effect. Ephedrine Hydrochloride Athletes all over the world use ephedrine chloride not only to boost energy levels, but to help lower their weight by the reduction of body fat. Ephedrine noticeably stimulates the central nervous system, increasing the heart rate and has an overall heat producing effect on most tissues in the body. Orciprenaline Sulphate Form: A white crystalline powder MW: 2(C11H17NO3).H2SO4 = 520.29 Melting point: about 205°C When treating asthma it is given by mouth in a dose of 20mg four times daily. It also comes in the form of an inhaler or in severe cases of bronchiospasm it can be administered directly as an intramuscular injection. Orciprenaline suphate, being only partially selective, affects receptors elsewhere in the body and can cause undesirable side-effects such as arrhythmias, tachycardias and anxiety attacks. A report published by the MHRA in November 2009 decided that orciprenaline sulphate (Alupent®) should no longer be used in the treatment of asthma. Orciprenaline Sulphate • Orciprenaline sulphate is a sympathomimetic agent with partially selective β -adrenoceptor stimulant activity. It is used as a bronchodilator in the treatment of reversible airways obstruction (asthma) and in some patients with chronic obstructive pulmonary disease. On inhalation, the onset of action is usually within 30 minutes and can last from 1 to 5 hours. Drug Comparisons Drug State pKa Terbutaline Sulphate A white to greyish-white crystalline powder 8.7, 10.0, 11.0 Orciprenaline Sulphate A white crystalline powder 9.0, 10.1, 11.4 Salbutamol A white powder 9.3, 10.3 Ephedrine Hydrochloride Colourless crystals or a 9.6 white crystalline powder Salmeterol A white to off-white powder 9.9 The economic impact of asthma Direct costs • Hospital costs • Costs of home care • Alternative medicine • Nursing home costs • Ambulance callouts Indirect costs • Time spent by others caring for sick relatives • Physical resources – e.g. the number of missing days lost or the number of premature deaths • Short-term absence due to sickness • Long-term absence such as early retirement The economic impact of asthma • The value of a lost school day measured as a reduction in the earning resulting from how the disease affects the returns on education. The time lost from work for parents who have to care for their sick children should also be counted. • Costs of unpaid input When a person is suffering from an illness, the household atmosphere maybe affected as the sick member of the household is unable to contribute to the financial stability, leading to placement of added pressure on the remaining family members. The social impact of asthma • There were 1,200 deaths from asthma in the UK in 2006. On average, 3 people per day or 1 person every 7 hours. • The effects of asthma on children and adolescent’s social lives are very profound, as they interfere with children’s ability to play, participate in school activities form friendships and relationships. Studies show that one in three 7 year old children who suffered from asthmatic symptoms had missed more than 50 days' schooling as a direct result of asthma. School absence can lead to psychological problems as a result of the child feeling different, inferior or being overprotected. These problems can in turn exacerbate the symptoms of asthma. The social impact of asthma • Some adults find their asthma is made worse by dust or fumes at work. This is known as work-aggravated asthma. For this type of asthma, employees should talk to their employer as soon as possible about relocating so that they are no longer exposed to the sensitizer that's causing their asthma. Thank you for listening to our presentation. We hope you found it informative. Please feel free to ask any questions.