Antiasthmatics Flashcards
Albuterol Sulfate for inhalation brand names
Proventil, Ventolin, Proair
Albuterol Sulfate Indications/Dosages
Maintenance to prevent exacerbation of bronchospasms: 2 inh QID
Exercise-induced bronchospasm: 2 inh 15 min prior to exercise
Albuterol Sulfate Mechanism
stinulates adenyl cyclase, which catalyzes formation of cAMP from ATP, causing relaxation of bronchial, uterine, and vascular smooth muscle through stimulation of B2-adrenergic receptors
Albuterol Sulfate Metabolism and excretion
Metabolized in the liver
Excreted in urine and feces
Minimal systemic absorption
Albuterol Sulfate drug interactions
other sympathomimetics, tricyclic antidepressants, MAO-I’s: increase toxicity of medication
Non-potassium sparing diuretics: May worsen hypokalemia and/or ECG changes
Digoxin: may decrease serum digoxin levels
Albuterol Sulfate CI/Precautions
CI: patients with hypersensitivity
caution in patients with CV disorders, HTN, hyperthyroidism, DM, and nursing mothers/pregnancy
Proventil can cause paradoxical bronchospasms (life-threatening)
Albuterol Sulfate Pregnancy category
C
Albuterol Sulfate ADR’s
Nausea, vomiting, nervousness, headache, insomnia, tremor, dizziness, HTN, tachycardia, palpitations
Albuterol Sulfate Patient education
Do not take more frequently than recommended
Seek medical attention if taking more frequently or becomes ineffective
Avoid contact with eyes
Shake canister before inhalation
Inhalation technique
Clean mouthpiece weekly, let air dry
Beclomethasone brand name
QVAR
Beclomethasone indication/dosage
maintenance treatment of asthma, prophylactic therapy in patients >5y, reduce or eliminate need for systemic corticosteroids.
children 5-11: 40-80mcg BID
adults: 40-160mcg BID, max dose is 320mcg BID
Beclomethasone mechanism
bind to receptor proteins in cytoplasm of cells, form steroid-receptor comples, which enters the nucleus of the cell and reacts with DNA, then stimulates transcription of mRNA, which carry out anti-allergy and anti-inflammatory actions
decreases airway inflammation and improves asthma symptoms
Beclomethasone drug interactions
additive effects with systemic corticosteroids
Beclomethasone CI/precautions
CI: primary treatment of status asthmaticus
caution: transfer from systemic CS (death due to adrenal insufficiency)
do not use a bronchodilator, do not use for rapid relief of bronchospams
secondary fungal infections in mouth can occur
Beclomethasone pregnancy category
undefined, use with caution in pregnancy
Beclomethasone ADR’s
headache, URTI, and pharyngitis
thrush possible
Beclomethasone patient education
avoid contact with eyes not for immediate/rescue relief, should be used on a regular basis can take up to 4 weeks to see benefit use bronchodilator minutes before QVAR prime initially and after 10 days of nonuse store upside down, resting onc anister follow instructions for inhalation clean inhaler at least weekly
Budesonide brand name
Pulmicort
Budesonide indication/dosage
maintenance treatment of asthma and prophylactic therapy
Adults and Kids 6y+: initiate at 180mcg (children) or 360mg (adults) BID.
Max dose is double this for each group
Budesonide mechanism
binds to receptor proteins found in cytoplasm of sensitive cells (steroid-receptor complex), reacts with DNA and stimulates transcription of mRNA, creating enzymes that carry out antiallergy and anti-inflammatory activity
Budesonide drug interactions
ketoconazole may increase plasma levels
Budesonide CI/precautions
CI: primary treatment of status asthmaticus
caution: transferring from systemic CS to inhaled CS (adrenal insufficiency)
not a rapid-acting inhaler
secondary oral candidal infections can occur, wash mouth thoroughly after use
Budesonide ADRs
Turbohaler: headache, asthenia, pain, dyspepsia, nausea, oral candidiasis, arthralgia, cough, respiratory infection, rhinitis and sinusitis
Respules: respiratory infection, rhinitis, cough, otitis media, vomiting, diarrhea, abdominal pain and rash
Budesonide patient education
avoid contact with eyes
not a rescue inhaler
may take as long as 4 weeks to see benefits
use bronchodilators prior to ICS
do not mix respules with other solutions in nebulizer
rinse mouth without swallowing after each use
red mark appears when there are 20 or fewer doses left
Budesonide + Formoterol brand name
Symbicort
Budesonide + Formoterol indication/dosage
treatment of asthma in patients 12y+: 2 inhalations BID (either 80/4.5 or 160/4.5 inhalers)
COPD: 2 inhalations BID of 160/4.5 inhaler only
Budesonide + Formoterol mechanism
Budesonide: potent anti-inflammatory corticosteroid showing inhibitory activities against multiple cell types (mast, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (histamine, eicosanoids, leukotrienes, and cytokines)
Formoterol: stinulates adenyl cyclase to relax smooth muscle and inhibit release of mast cell mediators (histamine, leukotrienes, etc)
Budesonide + Formoterol drug interactions
additive effects with systemic CS
other sympathomimetics, TCAs, and MAO-I’s increase toxicity of Budesonide + Formoterol
B-blockers decrease effectiveness of formoterol
3A4 inhibitors may increase plasma levels (ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefaxodone, nelfinavir, saquinavir, ketoconazole, telithromycin)
Budesonide + Formoterol CI/precautions
CI: primary treatment of status asthmaticus
LABA’s increase risk of ASTHMA-RELATED DEATH.
caution: patients transferring from OCS to ICS
not a rapid-acting inhaler
secondary oral candidiasis
caution in patients with CV disorders, hypertension, hyperthyroidism, DM.
Budesonide + Formoterol pregnancy category
C
Budesonide pregnancy category
B
Budesonide + Formoterol ADRs
mild-moderate in severity
URTI, nasopharyngitis, headache, vomiting, sinusitis, bronchitis, oral candidiasis, nasal congestion
Budesonide + Formoterol patient education
avoid contact with eyes rinse mouth after use report decreased effectiveness of rescue inhalers not a rescue inhaler! may take up to 4 weeks to see benefit
