Asthma/COPD Flashcards
Epinephrine
Action: Adrenergic receptor agonist.
Uses: Anaphylaxis; bronchospasm; cardiac arrest.
Toxicity: Anxiety; arrhythmia; nausea; local necrosis.
Other: Produces mydriasis; preferentially binds beta-2 at low doses (decreased vascular resistance); binds beta-2 and alpha-1 at high doses (increased vascular resistance).
Isoproterenol
Action: Non-selective beta-adrenergic receptor agonist.
Uses: Bradycardia; heart block; bronchospasm; hypoperfusion states.
Toxicity: Blurred vision; tachycardia; hypotension.
Albuterol
Action: Short acting B2-agonist
Usage: Acute asthma (reliever)
Salmeterol
Action: Long-acting selective beta-2-adrenergic receptor agonist.
Uses: Asthma; exercise-induced bronchospasm; COPD.
Toxicity: Paradoxical bronchospasm and asthma-related death; tachycardia; arrhythmia.
Other: Contraindicated without concomitant long-term asthma control medication (available combined with fluticasone, i.e. Advair®).
Terbutaline
Action: Selective beta-2-adrenergic receptor agonist.
Uses: Bronchospasm; premature labor (tocolysis).
Toxicity: Tachycardia.
Fomoterol fumarate
Action: Long acting beta-2 agonist (salmeterol family)
Usage: Asthma controler (step 3), exercise induced asthma
Toxicities: general B2 agonist
Methylxanthines
Action: Antagonize adenosine receptors, inhibits phosphodiesterase upregulating cAMP. stimulate CNS/Heart, diureses and smooth muscle relaxation. Includes Theophylline (tea), Theobromine, Caffeine.
Usage: Acute asthma (IV, reliever). Asthma/COPD controller (oral)
Toxicity: small therapeudic windows, lots of drug interactions, cardiotoxicity & neurotoxicity. flu-like adverse reactions (naseau, anorexia, fever, tremors, arrhythmias, etc). Not used for asthma much anymore.
Other: includes aminophylline
Cromolyn
Action: Inhibits histamine release by stabilizing mast cells
Usage: Asthma that is histamine mediated. (controller)
Toxicities: local irritation, cough/sneezing/throat
Ipratropium
Action: Muscarinic antagonist. Selective for M3 (less M2 effects)
Uses: Asthma, COPD (inhaled); rhinorrhea (nasal).
Toxicity: Dry mouth; bronchoconstriction.
Other: Non-selective anti-cholinergic effects to lesser degree
Tiotropium (Spiriva®)
Action: M3 muscarinic antagonist.
Uses: COPD, asthma (off label)
Toxicity: Xerostomia; constipation, increased risk of cardiovascular events
Other: long acting inhaled powder
Beclomethasone diproprionate
Action: Prodrug. decrease inflammation and airway responsiveness.
Usage: Asthma (inhaled)
Toxicities: long term usage assoc. w/ systemic side-effects (decreased ACTH release)- hyperglycemia, muscle weakness, inappropriate fat depositiion, osteoporosis/fractures, bruising, euphoria/restlessness, AVOID ACUTE WITHDRAWAL- especially in oral corticosteroids
Budesonide
Action: inhaled glucocorticoid
Usage: Asthma controller, increases FEV1 w/ longterm use, COPD
Toxicities: paradoxical bronchospasm, immediate hypersensitivity, upper airway symptoms
Fluticasone
Action: Glucocorticoid (inhaled)
Usage: asthma (controller)
Toxicity: corticosteroid toxicities- see beclomethasone. Not indicated for acute asthma
Zileuton
Action: inhibits 5-Lipoxegenase, limiting LTB4 (and other leukotriene) production from arachadonic acid
Usage: Asthma- short acting taken 4x daily. Potential use in colitis, rheumatoid arthritis
Toxicity: Not for acute atacks, elevation of liver enzymes (monitor). Decreases elimination of propranalol (which shouldn’t be used in asthma pts anyways). Also increases side effects of theophyline if co-administered
Montelukast
Action: Selective and competitive leukotriene receptor LTD-4 antagonists (blocks D4, E4)
Usage: Once daily for Asthma
Toxicity: Doesn’t inhibit CYP2C9/CYP3A4 (main drug metabolizing enzymes) like zofirleukast
