Audio Transcript Auto-generated
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Okay let's finish these last three slides.
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Strong guys, we're gonna talk about our glucocorticoids are steroids.
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So they're a hormone they're produced by the adrenal cortex which is um because
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anti inflammatory and immunosuppressive uh to go
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over to the mechanism of action here.
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They remember their very little phillips. Steroids are very little phillips.
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So they go through the fossil lipid membrane into the
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cell and they can work on the nucleus um bye
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increasing the transcription of anti inflammatory cytokines and they work
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at the top of the um anti inflammatory cascade,
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preventing the cleavage of our academic acid off of the fossil lipid.
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Um To start the inflammatory cascade suppresses
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the inflammatory genes in the nucleus.
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So inhale corticosteroids are first line for patients with asthma.
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We're gonna have basically all our asthma patients on inhaled cortical steroids.
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Um chronic use of inhaled cortical steroids. You gonna use these every day.
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Um The benefit of inhaled steroids is that
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we're not going to have those systemic effects.
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We're not gonna have the bone um
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bones during skin, eyes as much when we're doing it, inhale it.
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It's going to stay more locally in the lungs.
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The side effect that you do need to worry about is
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going to be that the oral thrush the decrease healing in
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the mouth to make sure that you rent your mouthpiece out
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or you rinse your mouth out with water after every use.
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Um
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This is a good way to avoid the use of oral
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steroids because people who don't to take oral steroids long term.
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They get that
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blown up face, they can have osteoporosis. They could have cataracts.
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They can have um their sugars go up.
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All those side effects of steroids um And severe cases will give oral steroids if you
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have your asthma exacerbation will give you some
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oral steroids or an injection of steroids.
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Um They they are subject to the cytochrome P 4 50 system.
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So to talk about which ones we have on this list here we have dx about the
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zone which is our oral deodorant which you have to use a lot and are familiar with.
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We have floating zone which is flow vant.
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We have bec lo meta zone which is um Asma necks
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um twist taylor which comes in a bunch of different doses
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and then we can use them in combination with long acting beta agonists.
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We don't want to use long acting beta
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alone in asthma. We can use them alone in COPD. We cannot use them alone in asthma.
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So we're gonna have dual era which is more medicine and flew in for Motorola
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and then we can have um Advair which is flu flu
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season and sell mineral.
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And then Symbicort which is our new one
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um that we're seeing on the gina guidelines for
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for both the treatment of an asthma attack and
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that will last that long term for prevention.
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So Symbicort is the new one on the treatment guidelines that we're seeing.
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So inhale quarter gross.
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They always promote that uh oral candidates or candidates.
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So we want to make sure that we rinse our
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mouth out with water gargle and spit after each us.
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Um They can cause glaucoma cataracts, osteoporosis.
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But again that's more for if you're taking them orally.
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Um And it's going to cause decreased healing.
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What does that mean by decreased healing increases susceptibility to U. T. I. S.
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To rhinitis
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to um your infections to viruses.
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Conjunctivitis, gastroenteritis. So you're basically taking these orally.
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You're subject to your body not fighting off anything on its own.
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So our loco tryin antagonists, they're gonna work on the lipo oxygenates pathway.
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Um They're gonna inhibit the synthesis of leuco trans. So ours I flow is a
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five like lipo oxygen ace inhibitor.
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So it's gonna inhibit the enzyme that's going to create physical science.
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So it's going to stop the creation of local clients.
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They may have singular, singular and accolade, those are
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protein receptor antagonist.
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So they're going to work at the actual local train receptor.
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So they're not going to stop the making of liquid nutrients but
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they're going to stop the local nutrients from binding to the receptor.
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These are very common drugs.
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Monta Lucas is one of the fastest moving drugs comes in 10 mg comes in four
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or five mg and chewable tablets for kids um adverse effects of these in the Z.
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Flow. You can have a paddle toxicity can mess with the liver
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and a single layer. You can have that church Strauss syndrome.
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Um Which is a vascular disease causing worsening of asthma is very rare.
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Um But also you can have that black box warning which is
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um messing with your brain chemicals so it can cause hallucinations,
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depression, suicidal thoughts.
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All these weird things they don't know why.
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Um But they are seeing it post post market.
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Um So they had to add that black box warning.
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Um
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The efficacy is variable as I said I don't feel like
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it worked for me but it does work for some people.
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Obviously it got brought to market
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may work for some individuals versus others,
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definitely not as effective as steroids but also let's um
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it doesn't have as many side effects.
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Um And then we have our monoclonal antibodies that are going to bind with R. I. G.
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So that it cannot
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activate the mast cell to release its cytokines. Zola is what's caused.
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It's an injection every 2 to 4 weeks. It binds the I. G. A. Mass.
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So that it doesn't bind with the mass receptor. A mast cell receptor.
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Um Let's see here
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prevents mast cells
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prevents activation of the mast cells because what happens when we activate
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the mast cells it releases are cytokines which starts our reaction.
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The problem with these is you're susceptible to infection.
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Um Any of the ones that end in mob
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think susceptible to infection um can also cause hypersensitivity.
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So anaphylaxis is major with these.
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All of these mobs are gonna cause these same side effects. Um
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You can be at risk for clotting.
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Um And they have other side effects like alopecia dermatitis.
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These are no light drugs. They do have lots of side are major.
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This is from moderate to severe only so not for the treatment of mild asthma.
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This is from moderate to severe when nothing else is working. We're going to add it.
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This is not in place out.
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The steroids is in addition um when we're
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not when we're not controlled with the steroids.
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Okay then our last last last one I promise we're done guys. Um It's crumlin
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so cuomo and goes in the nebulizer.
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It's gonna stabilize mast cells so that they don't produce or they
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don't degradation and release their contents which are their side all kinds.
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Um This is good for mast cell diseases and
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can help with asthma like a little bit. It's not that effective.
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It doesn't have very many side effects either though.
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So it's worth a shot if things aren't working and you want to try it.
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It can work in some patients and it doesn't really have too many side effects. Um
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It's an aerosol that in a soluble salt so we're gonna put it in the nebulizer.
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Let's see what else
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mild on the side effect profile.
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Can you be used in patients two years and up. So that's good. Um
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Yeah that's about it.
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We did that
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All right guys,
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there's asthma and COPD that wraps up our
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inflammatory suite here and we get to go into
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antibiotics. My favorite.
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Alright guys, we'll see you in class on thursday so we can start and
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I will see you then.
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Have a great week by.