Asthma Drugs Flashcards
1
Q
Albuterol (Proventil)
A
- short acting beta2 adrenergic agonist
- relief of symptoms
- inhaler
- hit maximal effect at 30 min; lasts several hours
- adverse effects minimal due to low systemic absorption. may see tachycardia or muscle tremors in increased doses
2
Q
Salmeterol (Serevent)
A
- long acting beta2 adrenergic agonist
- long duration (12+ hours)
- not for acute attacks - 2 puffs daily - hits maximal effect at 2 weeks
- inhaler
- must be used with corticosteroids (long acting beta agonists should NOT be used without corticosteroids)
- adverse effects minimal due to low systemic absorption. may see tachycardia or muscle tremors in increased doses
3
Q
Epinephrine
A
- non-selective beta agonist
- drug of choice for anaphylaxis
- rapid action (given IV or IM)
- severe CV side effects
4
Q
Isoproterenol
A
- non-selective beta agonist
- very potent and fast acting: greater effect on breathing than epinephrine, so used if the patient is suffering mainly from bronchoconstriction
- inhaled
- cardiac arrhythmias
5
Q
Ipratropium Bromide
A
- muscarinic antagonist
- not acute; hits peak effect at 1-2 hours
- does not work for non-muscarinic bronchospasm
- inhaled, minimal side effects; may see drying of the mouth/upper airways - can alleviate with spacer
6
Q
Caffeine (coffee)
A
- methylxanthine
7
Q
Theobromine (cocoa)
A
- methylxanthine
8
Q
Theophylline (tea)
A
- methylxanthine
- narrow therapeutic range: 5-15 micrograms/mL
staying in this range is hard - oral (tablet) - not for acute bronchospasm
- mechanism of action:
1. phosphodiesterase inhibitor –> increases production of cAMP, which leads to bronchodilation
2. adenosine antagonist (adenosine = bronchoconstrictor) - side effects at therapeutic doses: headaches, nervousness, insomnia, nausea/vomiting, epigastric pain
- side effects at greater than therapeutic doses:
> 30 micrograms/mL –> hypokalemia, cardiac dysfunction
> 40 micrograms/mL –> seizures - metabolism: liver cytochrome P450 –> many drug interactions which increase theophylline in the blood
- drugs that may increase serum theophylline levels: erythromycin, oral contraceptives, zileuton
- drugs that may decrease serum theophylline levels: barbiturates, carbamazepine, cigarette smoke (chemicals, not nicotine)
- disease states that may result in increased serum concentrations: liver disease, febrile illnesses like pneumonia or influenza
–> reduce the dose 50% in children with fever - disease states that may result in decreased serum concentrations: CF
9
Q
Flunisolide (Flovent)
A
- anti-inflammatory agent
- corticosteroid
- inhaled
- mechanisms: controls eosinophils, reduce mucosal edema, potentiate beta-adrenergics, inhibit transcription of inflammatory agents
- side effects: minimal since inhaled; can see oropharyngeal candidiasis (solution = gargle and spit after inhaling)
- corticosteroids work on everyone
10
Q
Fluticasone (in Advair, a combination drug)
A
- anti-inflammatory agent
- corticosteroid
- inhaled
- mechanisms: controls eosinophils, reduce mucosal edema, potentiate beta-adrenergics, inhibit transcription of inflammatory agents
- side effects: minimal since inhaled; can see oropharyngeal candidiasis (solution = gargle and spit after inhaling)
- corticosteroids work on everyone
11
Q
Prednisone
A
- anti-inflammatory agent
- corticosteroid
- systemic
- mechanisms: controls eosinophils, reduce mucosal edema, potentiate beta-adrenergics, inhibit transcription of inflammatory agents
- side effects: HTN, diabetes, iatrogenic cushings (hyper secretion of adrenal steroids –> change in fat distribution from extremities to midsections), adrenal suppression (adrenal fatigue), peptic ulcers
- corticosteroids work on everyone
12
Q
Fluticasone and Salmeterol (Advair)
A
- Fluticasone = corticosteroid; Salmeterol = long acting beta2 adrenergic agonist
- inhaler with internal blister pack (no spacer needed)
- one puff twice a day
- dosing: mg Fluticasone/mg Salmeterol
500/50 = systemic corticosteroid effects with extended use
250/50 or 100/50 = more common, no systemic effects - must use long acting beta2 adrenergic agonist like Salmeterol with a corticosteroid
- corticosteroids work on everyone
13
Q
LTB4
A
- leukotriene
- attracts neutrophils
- plasma LT’s may be a marker for asthma in humans
- blood leukocytes from asthmatics release more
- urine LTE4 correlates with the severity of spontaneous bronchoconstrictive attacks
- 5-lipooxygenase activity is stimulated by antigen challenge of sensitized tissues
14
Q
LTC4, LTD4 (SRS-A)
A
- leukotriene
- SRS-A = slow reacting substance of anaphylaxis
- causes bronchoconstriction, hyperreactivity, mucosal edema, and mucus secretion
- plasma LT’s may be a marker for asthma in humans
- blood leukocytes from asthmatics release more
- urine LTE4 correlates with the severity of spontaneous bronchoconstrictive attacks
- 5-lipooxygenase activity is stimulated by antigen challenge of sensitized tissues
15
Q
Zileutin
A
- anti-LT
- inhibits 5-lipoxygenase
- oral –> systemic
- metabolism: liver cytochrome P450
- -> drug interactions: increase theophylline levels, decrease warfarin clearance (increased prothrombin time), increase carbamazepine effect
- side effects: abnormal liver function tests, tachycardia, alopecia, rash, fibromyalgia-like symptoms, churg-strauss syndrome (rebound eosinophilia which can be life-threatening)
- anti-LT are good for exercise and aspirin-induced asthma; used to decrease dose of inhaled corticosteroids
