Salmeterol +
Fluticasone
.
LABA &
Corticosteroid
Asthma
.
COPD
01
Mode of Action
Mode of Action
Salmeterol stimulates intracellular adenyl cyclase, the
enzyme that catalyses the conversion of ATP to
cyclic-3',5'-adenosine monophosphate (cAMP)
resulting in relaxation of bronchial smooth muscle
and inhibition of release of mediators of immediate
hypersensitivity from mast cells
Fluticasone is a corticosteroid that provides
significantly potent vasoconstrictive and
anti-inflammatory effects.
02
Adverse Effects
Common Side Effects
●
●
●
●
●
●
Cough producing mucus
Headache
Irritation of the throat
Runny nose
Sneezing
Stuffy nose
Significant Side Effects
●
●
●
●
●
●
●
●
Paradoxical Bronchospasm (rare but potentially fatal)
Adrenal suppression
Acute adrenal crisis (prolonged use)
Laryngeal spasms, irritation and swelling
Lower respiratory tract infections (e.g. pneumonia, bronchitis)
Oral candidiasis
Decreased bone mineral density
Elevated blood pressure and heart rate, QTc prolongation,
hypokalaemia (high doses)
Significant Side Effects
● Increased intraocular pressure, glaucoma, cataracts, central
serous chorioretinopathy
● Cushing’s syndrome, Cushingoid features
● Growth retardation in children
● Hypersensitivity reactions (e.g. urticaria, angioedema, rash,
hypotension, anaphylaxis)
● Cardiac arrhythmias, increased serum glucose levels, systemic
eosinophilic conditions
● Psychological or behavioral effects (e.g. psychomotor
hyperactivity, depression, aggression) in children
Other Side Effects
Respiratory, Thoracic and
Mediastinal
● Hoarseness or dysphonia
● Sinusitis
● Nasopharyngitis
Musculoskeletal and Connective
Tissue
● Muscle Cramps and
Spasms
● Arthralgia
● Myalgia
● Traumatic Fractures
Other Side Effects
Nervous System
Psychiatric
● Tremors
● Anxiety
● Sleep Disorders
Skin and Subcutaneous
Tissue
● Contusions
Cardiac
● Palpitations
● Angina pectoris
03
Drug
Advantages & Disadvantages
Salmeterol-Fluticasone
Treats difficulty of breathing, wheezing,
shortness of breath, coughing and chest
tightness
Not a short-acting medication
Relaxes the opening air passages in the lungs
More disadvantages discussed in ADR/E
Controls symptoms of lung diseases
03
Inhaler Device
Advantages & Disadvantages
Metered Dose Inhaler
Quick to use, no preparation
Needs good coordination, highly dependent on
technique
Small, convenient to carry
High oropharyngeal deposition (Risk of oral
thrush infection, sore throat, hoarse voice, etc.)
Space chambers can be attached to improve
medication delivery
It cannot be used by Px w/ less than 30L
inhalation rate
Cheaper than DPIs
Difficult to determine remaining doses
04
Prescribing Info
Asthma
●
●
●
●
●
●
For short-term treatment of asthma until symptoms are well
controlled with other medicines
Dosage depends on the severity of disease and is adjusted
according to patient response and tolerance
○ Sample dose: Salmeterol 25 mcg and fluticasone 250
mcg per metered dose
Administered through oral inhalation using a Metered Dose
Inhaler (MDI)
○ May also be administered as a Dry Powder Inhaler (DPI)
Dosage form
○ Inhalational aerosol
○ 2 inhalations 2x a day, doses should be at least 12
hours apart
Onset of action: 30-48 minutes
Recommended usage of spacer in patients who may have
difficulty in administration
COPD
●
●
●
●
●
For long-term treatment of and prevention of COPD
flare-ups and worsening
Dosage depends on the severity of disease
○ Sample dose: Salmeterol 50 mcg and fluticasone
250 mcg per dose or blister
Administered through oral inhalation using a Dry
Powder Inhaler (DPI)
Dosage form
○ Inhalational powder
○ 1 inhalation 2x a day, doses should be at least
12 hours apart
Onset of action: 2 hours
Contraindications
●
●
Treatment of status asthmaticus,
acute asthma, or severe COPD
Allergic reactions to milk
proteins, Salmeterol /
Fluticasone or other components
of the drug
Warning & Precaution
●
●
Rinse mouth with water without
swallowing after each use of the
inhaler to reduce the risk of Candida
albicans infection of the mouth and
pharynx
Salmeterol/Fluticasone is cleared by
hepatic metabolism. Monitor use in
patients with hepatic impairment
05
Demo
How to use a pMDI
pMDIs (Pressurized Metered Dose
Inhalers)
●
Common inhaler device for patients with
asthma or COPD
●
Drug is dissolved/suspended in a propellant
●
Pressing down on canister will bring down
the metering chamber → aerosol is
released (puff)
Parts of the pMDI
●
Plastic case
●
Mouthpiece cover (snaps on and off)
●
Mouthpiece
●
Base
○
●
The area where the nozzle (inside) is
located
Canister (contains the medicine)
Procedure on How to Use It
1.
Clean inside and out (esp. mouthpiece)
2.
Test if new or has not been used for at least a week
○
Remove the mouthpiece cap
○
Shake well
○
Face it away from you
○
Press on top of canister to release a puff in the air
○
Should release a fine mist
Procedure on How to Use It
3.
Shake well
4.
Hold upright, thumb under mouthpiece, index finger on top of canister
5.
Exhale completely
6.
Place mouthpiece in mouth (between teeth), lips around it
○
Do not bite down
7.
Start inhaling as slow as possible
8.
Press on canister to release 1 puff while still slowly inhaling (about 3-5
seconds)
Procedure on How to Use It
9.
Hold your breath , take device out of mouth and hold away from you
(removing finger from top of canister)
10.
CONTINUE HOLDING BREATH for as long as possible/comfortable (about
10 counts)
11.
If another puff is needed, repeat process AFTER 30 SECONDS
○
12.
Including shaking well as first step
Return mouthpiece cover once done using
Tips
●
●
Common Errors
Some may prefer to
practice in front of
mirror during first few
tries
Mist should NOT come
out from top of the
device or sides of your
mouth
○
Should redo
●
Not shaking before use
●
Inhaling too quickly or at wrong
time
●
Not holding breath long enough
○
Meant to allow better drug
deposition and encourage
sedimentation
Paano Gamitin
1.
Manigurado na malinis ang inhaler, sa loob at labas, lalong lalo na yung
mouthpiece (kung saan ididikit ang bibig)
2.
I-test muna kung bago ang inhaler o hindi nagamit sa loob ng isang lingo
○
I-shake ng mabuti
○
Hawakan na hindi nakatapat sayo
○
Pindutin ang ibabaw ng canister
○
Dapat may lumabas ng konting mist/basang hangin
Paano Gamitin
3.
Muli, i-shake ng mabuti
4.
Hawakan nang patayo
○
Yung inyong hinlalaki sa ilalamin ng mouthpiece, at yung hintuturo sa
ibabaw ng canister
5.
Huminga nang palabas (todo todo)
6.
Ilagay ang mouthpiece sa bibig, sa gitna ng ngipin
○
7.
Wag kagatin ang mouthpiece
Huminga ng mabagal paloob at pindutin ang ibabaw ng canister
hanggang may lumabas na hangin
Paano Gamitin
8.
Manatiling huminga ng mabagal hangga't kaya (mga 3-5 seconds na
hinga paloob)
9.
Pigilan ang paghinga at tanggalin ang canister mula sa iyong bibig
○
Tanggalin ang daliri mula sa ibabaw ng canister
10.
Manatiling nakapigil ang paghinga (hangga't kaya, mga 10 seconds)
11.
Kung kailangan ng isa pang puff, maghintay ng 30 seconds
○
Gawin ulit yung proseso
○
Wag kalimutan i-shake yung inhaler bago gamitin)
Mga Paalala
Madalas na
Pagkakamali
●
Dapat kalmado
●
Hindi shineshake bago gamitin
●
Sa unang beses na
gagamitin ang MDI,
maaaring mag practice
muna sa harapan ng
salamin
●
Masyadong mabilis o maaga na
paghinga paloob
●
Siguraduhin na ang
bugha ay hindi lalabas sa
itaas ng MDI or sa gilid
ng bibig. Pag ito ay
lumabas sa gilid, ulitin
○
●
Maling timing
Hindi matagal ang pagtigil ng
paghinga
○
Ito ay nakakatulong sa
pagkalat ng gamot sa baga
Thanks!
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Table of contents
01
02
03
Jupiter
Venus
Saturn
Jupiter is a gas giant and the
biggest planet in the Solar
System. It's the fourth-brightest
object in the night sky. It was
named after the Roman god of
the skies and lightning
Venus has a beautiful name and
is the second planet from the
Sun. It’s terribly hot and its
atmosphere is poisonous. It’s
the second-brightest natural
object in the night sky
Saturn is a gas giant and has
rings. It's composed mostly of
hydrogen and helium. It was
named after the Roman god of
wealth and agriculture. It’s the
sixth planet from the Sun
01
Name of the section
You can enter a subtitle here if you need it
Our team
Mercury is the closest planet to the Sun and the
smallest one in the entire Solar System. This planet's
name has nothing to do with the liquid metal, since
Mercury was named after the Roman messenger god.
Despite being closer to the Sun than Venus, its
temperatures aren't as terribly hot as that planet's. Its
surface is quite similar to that of Earth's Moon
Speaking of craters, many of them were named after
artists or authors who made significant contributions to
their respective fields. Mercury takes a little more than
58 days to complete its rotation, so try to imagine how
long days must be there! Since the temperatures are so
extreme, albeit not as extreme as in Venus, and the
solar radiation is so high, Mercury has been deemed to
be non-habitable for humans
“This is a quote, words full of wisdom that someone
important said and can make the reader get inspired.”
—Someone Famous
Maybe you need to divide the content
Jupiter and Mars
Venus and Mercury
Jupiter is a gas giant and the biggest planet in
the Solar System. It's the fourth-brightest
object in the night sky. It was named after the
Roman god of the skies and lightning
Venus has a beautiful name and is the second
planet from the Sun. It’s terribly hot, even
hotter than Mercury, and its atmosphere is
extremely poisonous
Despite being red, Mars is actually a cold
place. It's full of iron oxide dust
Mercury is the closest planet to the Sun and
the smallest one in the Solar System
You can use bullet points
●
Venus has a beautiful name and is the second planet from the
Sun. It’s terribly hot, even hotter than Mercury, and its
atmosphere is extremely poisonous. It’s the second-brightest
natural object in the night sky after the Moon
●
Earth is the third planet from the Sun and the only one that
harbors life in the Solar System. We all live on it!
●
Jupiter is a gas giant and the biggest planet in the Solar
System. It's the fourth-brightest object in the night sky. It was
named after the Roman god of the skies and lightning
●
Mercury is the smallest planet in the Solar System. It was
named after the Roman messenger god
●
Despite being red, Mars is actually a cold place. It's full of iron
oxide dust, which gives the planet its reddish cast
Infographics are always useful
Venus
Mercury is the smallest planet
in the Solar System
Mercury
Venus is the second planet
from the Sun
01
02
03
04
Mars
Despite being red, Mars is a
very cold place
Jupiter
Jupiter is the biggest planet in
the Solar System
A picture is worth a thousand words
Slide with longer text
Mercury is the closest planet to the Sun and the smallest
of them all. This planet's name has nothing to do with the
liquid metal, since Mercury was named after the Roman
messenger god. Despite being closer to the Sun than
Venus, its temperatures aren't as terribly hot as that
planet's. Its surface is quite similar to that of Earth's Moon,
which means there are a lot of craters and plains.
Speaking of craters, many of them were named after
artists or authors who made significant contributions to
their respective fields. Mercury takes a little more than 58
days to complete its rotation, so try to imagine how long
days must be there! Since the temperatures are so
extreme, albeit not as extreme as in Venus, and the solar
radiation is so high, Mercury has been deemed to be
non-habitable for humans
Mercury is the closest planet to the Sun and the smallest
of them all. This planet's name has nothing to do with the
liquid metal, since Mercury was named after the Roman
messenger god. Despite being closer to the Sun than
Venus, its temperatures aren't as terribly hot as that
planet's. Its surface is quite similar to that of Earth's Moon,
which means there are a lot of craters and plains.
Speaking of craters, many of them were named after
artists or authors who made significant contributions to
their respective fields. Mercury takes a little more than 58
days to complete its rotation, so try to imagine how long
days must be there! Since the temperatures are so
extreme, albeit not as extreme as in Venus, and the solar
radiation is so high, Mercury has been deemed to be
non-habitable for humans
You can use this graph
Mercury
Mercury is the smallest
planet of them all
Jupiter
Jupiter is the biggest
planet of them all
Follow the link in the graph to modify its data and then paste the new one
here. For more info, click here
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