ASTHMA Flashcards
asthma abnormality
insufficient expiration
drugs used in asthma symptom relief
symptom relief: beta2 agonists (fast/long-acting), ipratropium, theophylline (less often)
drugs used in asthma long term control
corticosteroids; cromolyn, nedocromil; leukotriene modifiers; anti-IgE antibody
adjunct drugs used in asthma
antibiotics; mucolytics; oxygen (sedatives ci’d)
asthma last resort drugs
general anesthesia; muscle relaxation; controlled respiration; bronchial lavage; ketamine
summary of asthma drugs
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short-acting beta2 agonists
albuterol, levalbuterol, pirbuterol, terbutaline, metaprotenerol - for acute episodes
long-acting beta2 agonists
salmeterol, formoterol - for prophylaxis, long term therapy
beta2 agonists adverse effects
selectivity is relative; beta2 - muscle tremor, diabetogenic; beta1 - tachy, arrhythmogenic; loss of responsiveness; high dose continuous use - hypokalemia;
beta2 agonists uses
NOT anti-inflammatory; can be for preventative i.e. b4 going to gym
beta2 agonists and theophylline moa
can have over-additive effect!
theophylline characteristics
methylxanthine, related: caffeine, theobromine
theophylline pk
oral, sustained release; iv; many drug interactions; low therapeutic margin
theophylline adverse effects
cns - nervousness, tremor; cv - catecholamine release, +inotropy/chronotropy; arrhythmogenic; GI - hyperacidity, nausea
theophylline toxicities
convulsions, coma
theophylline uses
controversial -> dec in US (seizure risk - last choice); considered safe/useful in Europe esp in emergencies; more used for intermittent claudication
theophylline molecular moa
induce histone deacetylase -> dec inflammatory gene expression -> promotes corticoid action (unrelated to phosphodiesterase) -> controller/preventer drug
anticholinergics
ipratropium, thiotropium
ipratropium characteristics
polar compound; mostly local effect when used as inhalant; ineffective in 30% of asthma pt’s
ipratropium adverse effects
rare w/usual doses; dry mouth; NO tremor, tachy, dyskrinia (thickening mucous)
ipratropium uses
esp COPD w/vagal components; asthma in kids/old; psychogenic exacerbations of asthma; combo with beta2 agonists
thiotropium characteristics
much longer half-life; limited absorption from bronchial mucosa into system; some selectivity for M1, M3 receptors; labeled for COPD (combo tx)