Beta Agonists

Question 1

What are the short-acting beta-agonists used for asthma & COPD?

Answer 1

Albuterol
Terbutaline
Metaproterenol
Pirbuterol
Levalbuterol

Question 2

What are the long-acting beta-agonists used for asthma & COPD?

Answer 2

Fomoterol
Salmeterol
Indacaterol/Vilanterol
Olodaterol

Question 3

How beta agonists work?

Answer 3

They work on Gs protein receptors –> increase of AC –> increased cAMP –> bronchodilation

Question 4

Albuterol

Answer 4

• SABA
• Indications: asthma, acute bronchitis, COPD, bronchiolitis
• Adverse Effects: HA, dizziness, dry mouth, insomnia, cough
• Contraindications/Warnings: Paradoxical bronchospasms, deterioration of asthma, CV effects, immediate HS rxns

Question 5

Terbutaline

Answer 5

• SABA
• The only beta2 R agonist that is SubQ –> provides immediate axn w/ sustained delivery
• Contains sulfa and should not be used in pts w/ sulfa allergies
• Indications: Prophylactic trx of bronchospasm assoc w/ asthma, bronchitis, & emphysema in pts 12+
• Cautions: Not for tocolysis
• Adverse Effects: HA, nausea, tachycardia, palpitations

Question 6

Meteproterenol

Answer 6

Indications: bronchial asthma, reversible bronchospasm which may occur in assoc w/ COPD & bronchitis
Caution: can produce a significant CV effect in some pts, can produce paradoxical bronchospasm

Question 7

Pirbuterol

Answer 7

• Indications: Used in prevention & reversal of bronchospasms in pts 12+ w/ reversible bronchospasm including asthma. May be w/ or w/o concurrent theophylene/corticosteroid use.
• Caution: Can produce severe CV effects in some pts, as measured by pulse rate, BP, and/or sx. This allows for adequate monitoring.

Question 8

Levalbuterol

Answer 8

• SABA
• Indications: Trx or prevention of bronchospasm in pts 4+ with reversible obstructive dz
• Warnings: Paradoxical bronchospasms

Question 9

Fomoterol

Answer 9

• LABA
• Indications: trx of asthma in pts 5+ as an add-on to a long-term asthma control med, such as a corticosteroid. Maintenance trx in bronchoconstriction in pts w/ COPD.
• Warnings: Do NOT use without use of long-term asthma control med, such as inhaled corticosteroid. LABA’s have risk for increasing asthma related deaths and asthma-related hospital hospitalizations.

Question 10

Salmeterol

Answer 10

• LABA
• Trx of asthma in pts 4+
• Prevention of exercise-induced bronchospasms (EIB) in pts 4+
• Maintenance trx of bronchospasms assoc w/ COPD

Question 11

Indacaterol/Vilanterol

Answer 11

• LABA

- Trx breathing problems caused by COPD, including chronic bronchitis and emphysema

Question 12

Olodaterol

Answer 12

• LABA
• Used as long-term, once daily maintenance bronchodilator trx of airflow obstruction in pts w/ COPD, chronic bronchitis, & emphysema

Question 13

Suggested combination inhalers

Answer 13

• ICS + LABA
• Fluticasone + Salmeterol
• Mometasone + Formoterol
• Budesonide + Formoterol

Question 14

What to prescribe for mild intermittent asthma/breathing issues?

Answer 14

Short-acting beta2-agonist

Question 15

What to prescribe for mild persistent asthma/breathing issues?

Answer 15

SAB2-agonist & low dose of ICS

Question 16

What to prescribe for moderate persistent asthma/breathing issues?

Answer 16

SAB2-agonist, low dose ICS, & LABA

Question 17

What to prescribe for severe persistent asthma/breathing issues?

Answer 17

SAB2-agonist, high dose ICS, & LABA

Question 18

What to prescribe for very severe persistent asthma/breathing issues?

Answer 18

SAB2-agonist, high dose ICS, LABA, & OCS