Bronchodilators Flashcards
Where are beta 2 adrenergic receptors located?
lungs, uterus, select arterioles, liver, and skeletal muscle
Therapeutic use of short-acting beta 2 agonist (SABA) Albuterol?
QUICK RELIEF agent for ASTHMA → acute bronchospasm and for prevention of exercise-induced bronchospasm.
Example of a SABA?
Albuterol (Proventil HFA, Ventolin HFA, ProAir)
MOA of Albuterol?
Stimulates beta 2 adrenergic receptors in the smooth msl of the bronchi and bronchioles → bronchodilation
Adverse effects of albuterol?
Nervousness, restlessness, tremor, CP, insomnia, arrhythmias, HTN, hypokalemia, paradoxical bronchospasm
Route for albuterol?
oral- long acting (long-term control)
inhaled- short acting
Contraindications for albuterol?
hypersensitivity
Precautions for albuterol?
Be cautious if you have cardiac disease, HTN, hyperthyroidism, diabetes, excess inhaler use may lead to tolerance and paradoxical bronchospasm.
Drug interactions with albuterol?
Beta adrenergic blockers; MAOIs, tricyclics, and caffeine products can increase HR; Theophylline; some cold products (Naproxen or Ibuprofen)
How do we evaluate the effectiveness of the albuterol?
peak expiratory flow rate (PEF), symptom frequency, and SABA use
T/F. Albuterol is the only rescue inhaler to be used during asthma attacks
True
For an acute asthma attack what are the next two medications that should be administered?
Ipratropium (Atrovent) and Methyl prednisolone (Solu-Medrol)
Onset of action for Ipratropium?
short acting; 1-3 minutes
Route of administration for Ipratropium?
inhalant and intranasal
Therapeutic uses of Ipratropium (Atrovent)?
- MAINTENANCE therapy of reversible airway obstruction d/t COPD
- off label use for asthma exacerbations with albuterol
MOA of Ipratropium (Atrovent)?
Anticholinergic agent; muscarinic antagonist; blocks the muscarinic receptors in the bronchi to block the action of Ach
Adverse effects of IpratropIum (Atrovent)? Hint: anticholinergic
dry mouth, Irritation of pharynx, Increased intraocular pressure
Ipratropium (Atrovent) contraindications?
hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide.
Precautions for Ipratropium? (PUG)
use cautiously in patients with prostatic hyperplasia, glaucoma, or urinary retention
Therapeutic use for a long-acting beta 2 agonist (LABA)? Salmeterol
- Long-term control of asthma but not the 1st choice.
- Asthma and bronchospasms (as concomitant therapy with an inhaled corticosteroid).
- Exercise induced asthma
LABA prototype?
Salmeterol (Serevent diskus)
MOA of Salmeterol?
stimulates adenyl cyclase resulting in increased intracellular cyclic AMP level at the beta 2 receptors which in turn triggers bronchial smooth muscles relaxation.
T/F. long acting agents like Salmeterol are not to be used alone but prescribed in combination with an inhaled glucocorticoid
True
How often is Salmeterol dosed?
Q12h
Adverse effects of Salmeterol?
HA, asthma related death when used alone
What class of agent is Theophylline (Elixophyllin, Theo-24)?
Xanthine; Methylxanthines; bronchodilator
MOA of Theophylline?
relaxes smooth msls of the bronchi
Therapeutic use of Theophylline?
second line agent for long-term control of chronic asthma or COPD
Adverse effects of TheoPhylliNe?
ANXIETY, tachycardia, N/V, HA, palpitations, tremors, anorexia, seizures, arrhythmias
Precautions to take with Theophylline? Hint: toxicity
cautious use in patients with cardiac arrhythmias, heart failure, liver or kidney dysfunction
Drug interactions with Theophylline?
multiple (caffeine). “CRANKY drug”
Route of administration-Theophylline?
oral or IV
Example of long-acting muscarinic antagonist?
Tiotropium (Spiriva) inhalation
MOA of Spiriva?
causes bronchial dilation by selectively and reversibly inhibiting acetylcholine at type 3 muscarinic receptors
Therapeutic use of Tiotropium (Spiriva)? Hint: anticholinergic, LAMA
MAINTENANCE therapy of bronchoconstriction associated with COPD
Adverse effects of Tiotropium (Spiriva)?
dry mouth, glaucoma, and angioedema
Spiriva drug class?
Anticholinergic, antimuscarinic, and bronchodilator
Patient education for Tiotropium (spiriva)? Hint: anticholinergic
Notify provider of angioedema or glaucoma
What is the most common combination of drugs for COPD?
SABA and short acting anticholinergic
What is the black box warning for LABA and corticosteroid combination?
can possibly increase asthma severity/asthma related deaths
What are the goals for asthma tx?
reducing impairment and reducing risk
What are the goals for COPD tx?
reduce sx and reduce risk and mortality
What type of medications are used to manage stable COPD?
LABA, LAMA, ICS, and PDE4 inhibitors
What medications are used to mange COPD exacerbations?
SABA, SAMA, systemic glucocorticoids, antibodies, and supplemental oxygen
