ํ๋ฃจํฐ์นด์ ํ๋กํผ์ค๋ค์ดํธ
ํ๋ฃจํฐ์นด์ ํ๋กํผ์ค๋ค์ดํธ๋ ์์ํ์์ ์ฃผ๋ก ํก์ ์ฉ ์์ด๋ก์กธ๋ก ์ฌ์ฉ๋๋ ๊ฐ๋ ฅํ ํฉ์ฑ **๊ธ๋ฃจ์ฝ์ฝ๋ฅดํฐ์ฝ์ด๋**์ ๋๋ค. * **์ฃผ์ ์ฉ๋**: **๊ณ ์์ด ์ฒ์**, **๊ฐ์ ๋ง์ฑ ๊ธฐ๊ด์ง ์งํ**, ๋ง์ **์ฌ๋ฐ์ฑ ๊ธฐ๋ ํ์(RAO)** ๋ฐ ์ผ์ฆ์ฑ ๊ธฐ๋ ์งํ(IAD)๊ณผ ๊ฐ์ ๋ง์ฑ ์ผ์ฆ์ฑ ๊ธฐ๋ ์งํ์ ๊ด๋ฆฌํ๋ ๋ฐ ๋งค์ฐ ํจ๊ณผ์ ์ ๋๋ค. ๋น๊ฐ ๋ถ๋ฌด์ ๋ ์๋ ๋ฅด๊ธฐ์ฑ ๋ง์ฑ ๋น๋ถ๋น๋์ผ์๋ ์ฌ์ฉ๋ ์ ์์ต๋๋ค. * **์์์ ์ฅ์ **: ์ ๋ ํก์ ๊ธฐ(MDI)์ ๋๋ฌผ ์ ์ฉ ์คํ์ด์๋ฅผ ํตํด ํธํก๊ธฐ ์ ๋ง์ ์ง์ ์ ๋ฌ๋๋ฏ๋ก, ๊ฒฝ๊ตฌ ๋๋ ์ฃผ์ฌํ ์คํ ๋ก์ด๋์ ๊ด๋ จ๋ ์ ์ ๋ถ์์ฉ์ ํฌ๊ฒ ์ค์ด๋ฉด์ ์ฐ์ํ ๊ตญ์ ํญ์ผ ํจ๊ณผ๋ฅผ ์ ๊ณตํฉ๋๋ค. * **ํจ๋ฅ**: ์ธ๊ฐ ๊ธ๋ฃจ์ฝ์ฝ๋ฅดํฐ์ฝ์ด๋ ์์ฉ์ฒด์ ๋ํ ๊ฒฐํฉ ์นํ๋ ฅ์ด ๋ฑ์ฌ๋ฉํ์์ 18๋ฐฐ์ ๋ฌํฉ๋๋ค.
์์ฉ ๊ธฐ์ : Fluticasone exerts its effects by binding to cytosolic **glucocorticoid receptors** in the respiratory mucosa. **Mechanism Pathway**: Receptor binding โ Translocation of the receptor-ligand complex to the nucleus โ Alteration of gene transcription โ **Inhibition of pro-inflammatory mediators** (such as cytokines, prostaglandins, and leukotrienes) โ Decreased airway inflammation, reduced mucosal edema, and lowered airway hyperreactivity. *Note: The drug is highly lipophilic, allowing for prolonged retention in lung tissue, and undergoes extensive first-pass metabolism, which limits systemic bioavailability if swallowed.*
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Treatment of feline 'asthma' ยท one puff of the 44 micrograms/puff MDI ยท Inhalation ยท q12h ยท Initially try this dose. Study showed 44, 110, and 220 mcg all significantly reduced eosinophils in airway lavage fluid.
- Feline asthma (signs occurring more than once per week) ยท one puff of 110 micrograms fluticasone MDI ยท Inhalation ยท q12h ยท Use a delivery device (e.g., AeroKat) with a spacer. Cats with more serious disease may require the 220 micrograms MDI. Breathe in and out 7-10 times with mask in place. Give prednisolone at 1-2 mg/kg PO twice daily for 5-7 days initially, then taper over 2-3 months.
- Inflammatory airway disease (IAD) in young racehorses ยท Weeks 1 and 2: 2200 micrograms (10 puffs) twice daily. Weeks 3 and 4: 2200 micrograms (10 puffs) once daily. ยท Inhalation ยท q12h then q24h ยท 4 weeks ยท Use a delivery device (e.g., Aeromask or Equine-haler). Recheck in 4 weeks to determine further treatment.
- Moderate recurrent airway obstruction (RAO/heaves) ยท Week 3: 2200 micrograms (10 puffs) twice daily. Week 4: 2200 micrograms (10 puffs) once daily. End of 4 weeks (if good response): 2200 micrograms (10 puffs) once every other day. ยท Inhalation ยท q12h, then q24h, then EOD ยท Maintenance ยท Begin stringent environmental control and systemic prednisone. Add fluticasone at week 3 with salmeterol 210 mcg (10 puffs).
- Prevention of exacerbations of RAO ยท 6 mg ยท Inhalation ยท q12h ยท Using the EquineHaler. Highly likely that a lower dose can be used.
- Adjunctive treatment of chronic tracheobronchial disease (excessive side effects from oral steroids) ยท 110 microgram or 220 microgram (1 puff) ยท Inhalation ยท q12h ยท Use a delivery device (e.g., AeroDawg). Ensure a tightly fitting face mask and count 7-10 respirations after actuating the MDI into the spacer.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to fluticasone
- Acute bronchospasm or status asthmaticus (not a rescue inhaler)
์ด์๋ฐ์
- Pharyngitis (reported in humans)
- Upper respiratory infections (reported in humans)
- Hypothalamic-pituitary-adrenal (HPA) axis suppression (rare with inhaled therapy, but possible with chronic high doses)
- Cushingoid effects (with chronic overdosage)
- Paradoxical bronchospasm (rare)
์ฝ๋ฌผ ์ํธ์์ฉ
- Ketoconazole ยท Inhibits CYP3A4 isoenzymes; theoretically could increase systemic fluticasone levels.
- Other CYP3A4 inhibitors ยท May decrease the metabolism of fluticasone, potentially increasing systemic exposure.
๋ชจ๋ํฐ๋ง
- Clinical efficacy (reduction in coughing, wheezing, or respiratory effort)
- Signs of HPA axis suppression or cushingoid changes (rare with inhaled therapy)
๊ณผ์ฉ๋
Acute overdoses of this medication are unlikely to require treatment. Chronic overdoses could result in significant **HPA axis suppression** and **cushingoid effects**.
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.