Agents for Respiratory Illness Flashcards
Describe the disease process of asthma
- Chronic inflammation of airways
- Contraction of bronchial smooth muscle
- Acute bronchospasm
- Increased secretion of mucus
What is the presentation of asthma?
SOB
Cough
Chest tightness
Wheezing (stridor)
Respiratory medications used in asthma target which area of the respiratory system?
The conducting zone
The conducting zone includes
Sympathetic and Parasympathetic innervation as well as mucus-secreting (goblet) and ciliated cells
Sympathetic innervation activates B2 receptors which will cause
bronchial dilation
Parasympathetic innervation activates muscarinic receptors which will cause
bronchial constriction
What class of drug does Albuterol belong?
Short-acting beta 2-agonist (SABA)
Albuterol will cause relaxation of bronchial and tracheal smooth muscle which will cause
-Relieves bronchospasm
- Reduces airway resistance
- Facilitates mucous drainage
- Increases vital capacity
What is the indication of albuterol?
Management of acute bronchospasm in asthma and other chronic obstructive airway disease
What are the side effects of albuterol?
- Sympathetic effects: tachy, hyperglycemia, hypokalemia
- Tremor
- Paradoxical bronchospasm
Metaproteronal (orciprenaline) is in what drug class?
Moderately selective beta 2 agonist
What short-acting B2 agonist is inferior to albuterol for management of acute asthma symptoms?
Levalbuterol
What are the two categories of Leukotriene Modifiers?
Leukotriene receptor agonists
5-lipoxygenase inhibitors
What are the properties of leukotrines?
- Chemoattractant for eosinophils and neutrophils
- Constrict bronchiolar smooth muscle
- Increase endothelial permeability
- Promote mucus secretion
What are the indications for leukotrine receptor antagonists (Montolucast and Zafirukast)?
- Asthma
- Allergic rhinitis
- exercise-induced bronchoconstriction (daily med proph.)
What are the contraindications of leukotrine receptor antagonists?
- phenylketonuria
- hepatic disease
What are the indications for theophylline?
- Used both orally or intravenously in the treatment of asthma, bronchospasm and COPD (rarely); also in infant apnea
- Alternate treatment for asthma, not first-line
What is the MOA of theophylline?
Structurally similar to caffeine
Sympathomimetic, increases HR, inotropy, BP
Relaxes smooth muscle
Anti-inflammatory and immunomodulatory effect
Why does theophyline have cardiac effects?
Also works as a nonselective adenosine receptor antagonist
What are the toxic side effects of theophyline?
Nausea
Diarrhea
Heart arrhythmias
CNS excitation
Seizures
What is another methylxanthine that has a similar MOA to theophyline but is not available in the U.S.?
Aminophylline
What is the indication for inhaled corticosteriods?
Acute and/or persistent asthma (mild to severe), COPD
What are the side effects of inhaled corticosteriods?
Cough (pretreat with inhaled bronchodilator)
Cataracts, thrush, hoarseness
HPA suppression
Growth suppression
Reduction in bone density
What are the inhaled corticosteriod drugs?
Budesonide
Beclomethasone
Fluticasone
Mometasone
What oral corticosteroids that can be used for asthma?
Methylprednisolone
Prednisolone
Prednisone
Can LABA’s be used as a monotherapy in asthma treatment?
NO, need to be used to complement ICS use, action is synergistic
Can LABA’s be used as a montherapy in COPD?
Yes
What is the only meaningful difference in LABA’s compared to SABA’s?
Duration of action, lasts approximately 12 hours (compared to 4-6 h)
Can LABA’s be used in an acute attach of asthma or COPD?
No, used in the maintenance of asthma and prevention of attacks, COPD maintenance
What drugs are LABA/ICS combination inhalers?
- Salmeterol/Fluticasone (Advair)
- Formoterol/Budesonide (Symbicort)
- Formoterol/Mometasone (Dulera)
What drugs are SABA/anti-cholinergic combination inhalers?
Albuterol/Ipratropium (combivent)
What is the management of an mild-to-moderate asthma exacerbation in the primary care setting?
SABA 4-10 puffs every 20min for 1 hour
Prednisolone IV if able
Controlled O2 (target saturations for adults 93-94% and for children 94-96%)
What is the disease process of COPD?
Chronic, irreversible obstruction of the airway (progressive disease)
Associated with a decrease in FEV1
What are the indications for ipratropium?
COPD management, specifically to block cholinergic (vagal) mediated bronchospasm and mucus production
What is the MOA for Ipratropium?
Anti-muscarinic activity on the bronchial smooth muscle that results in decreased contractility of smooth muscle
What are the side effects of Ipratropium?
Local and systemic anticholinergic effects
Xerostomia
Urinary retention
*Overall well tolerated
