Bronchodilators Flashcards
inhaled corticosteroids
budesonide
fluticasone
oral corticosteroids
prednisone
methyprednisolone
prednisolone
cromolyn compounds
cromolyn sodium
leukotriene inhibitors
montelukast
short acting beta 2 agonists
alburerol
long acting beta 2 agonists
formoterol
salmeterol
other beta agonists
Epi
racemic epi
muscarinic antagonits
ipratropium bromide
tiotropium
combivent
albuterol +ipratropium
methyxanthines
theophylline
anti IgE
omalizumab
decongestants
alpha-agonists-phyenlephrine
antitussives
opioids (codeine, dextromethorphan)
non opioids
expectorants
guaifenesin
mucolytics
n-actylcysteine
DNAase
> 10um
deposit in mouth and oropharynx
<.5um
inhaled then exhaled
1-5um
deposit in small airways
MDI
metered dose inhaler
delivers drug w/HFA, co-solvents, and/or surfactants
low cost
hand held coordination
spacer devices
attach to MDI improve ratio of inhaled to swallowed drug and reduce need for coordination
VHCs
valved holding chambers
have one way valves to prevent patient from exhaling into device, better for kids
nebulizers
severe asthma exacerbations w/poor inspiratory capacity or unable to coordinate
dry powder inhalers
require high air flow and can be irritating
beta 2 agonists
preferred therapy for bronchoconstriction
immediately effective for acute attacks
MOA beta agonists
stimulate AC and increase cAMP -> decrease Ca -> smooth mm relaxation and inhibit mast cells
albuterol
onset <15min
lasts 2-6hrs
levalbuterol
R isomer of racemic albuterol
Epi
nebulized solution in kids and infants
drug of choice for emergency Tx of anaphylactic rxns via SQ injection
causes bronchodilation and vasoconstiction
Salmerterol
long acting 12hours
not suitable for acute bronchospasm
prevention of nighttime asthma attacks
formoterol
long acting dry powder for maintence of asthma and COPD
NOT for acute attacks
arformoterol
COPD
long term use of LABA
may down regulate expression of beta 2 R and loss of drug effectiveness -> more death and hospitalizations
should be combined w/corticosterioid
oral administration of beta agonists side effects
skeletal mm tremor mm cramps cardiac tachyarrhythmias metabolic disturbances hypokalemia (especially with diuretics) hyperglycemia
indications for oral beta agonists
<5yrs who cannot use inhalers
severe asthma exacerbations may be unable to tolerant nebulizer or inhaler
most common adverse effect of beta agonists
skeletal mm tremors
CNS side effects of beta agonists
restlessness, apprehension, anxiety, tremors
CVS side effects of beta agonists
tachycardia, dsyrhymias, hyper or hypotension
drug interactions of beta agonists
potentiate cardiotoxcity of thyroid, digitals, and methylaxthines
ipratropium bromide and tiotropium
quaternary amine muscarinic agonists
COPD
little to no side effects b/c not well absorbed
ipratropioum
exclusively as aerosol
lasts for 6hrs
can be used intranasal or allergic rhinitis and chronic post nasal drip
combivent
albuterol + ipratropoum
treatment of choice for COPD patients
methylxanthines
adenosine R antagonists
inhibits cyclic nucleotide phosphodiesterases -> increase cAMP and cGMP
decrease Ca-> hyperpolerize cell membranes
effects of theophylline
bronchodialtion CNS stimulation (HA, nausea, vommiting, anxiety) cardiac stimulation modest peripheral vasodilation improved skeletal m contractility thiazide like diuresis
clinical theophylline
narrow therapeutic index
must use slow release formulas
should not be used unless blood levels can be regularly monitored
can be used for nocturnal asthma, but not first line
roflumilast
severe COPD
oral PDE4 inhibitor -> increase cAMP -> reduce inflammation
roflumilast side effects
nausea diarrhea psychiatric symptoms weight loss last resort
corticosteroids
asthmatics who require inhaled beta agonists 4+/wk
high dose corticosteroids
spacer device to reduce risk of adverse effects mandatory
dose can often be reduced over time
corticosteroids MOA
bind intracellular cortisol Rs -> TF inhibit production and release of: cytokines vasoactive and chemoattractive factors lipolytic and proteolytic enzymes decrease mobilization of leukocytes antiinflammatory
adverse effects of corticosteroids
oral candidasis and dysphonia (spacer) hypothalamic-pituitary-adrenal axis suppression bone resorption cataracts and skin thinning purpura growth retardation in children glucose intolerance weight gain HTN osteoporosis immunosupression mood disorders
cromolyn sodium
inhibits release of histamine
indirectly inhibits Ag-induced bronchospasm
suppress chemoattractants-> decrease Eos, neutrophils, and monocytes
does not directly relax smooth m
primary prophylactic
LTB4
neutrophil attractant
LTC4 and LTD4
bronchoconstriction
increased bronchial reactivity
mucosal edema
mucus hypersecretion
zafirlukast and montelukast
selective for LTD4 oral peak 1-3hrs useful for aspirin induced asthma dyspnea most common side effect
zarfirlukast
kids >12
liver damage
montelukast
6-12yrs
safe for long term use
zyflo
> 12yrs
omalizumab
anti-IgE
serious and life-threatening hypersensitivity rxns to drug can occur
expensive
allergic rhinits
topical corticosteroids-> nasal spray
croolyn sodium
antihistaimines
nasal decongestants
nadal decongestants
alpha agonists -> vasoconstrict
COPD
inhaled ipratropoum or tiotropoum w/beta agonists (combivent)
monotherpay w/corticosteroids not approved
triple therapy for COPD
tiotropium
formoterol/salmeterol
fluticasone or budesonide)
opioids
act at CNS suppress cough reflec
adverse effects of opioids
CNS- euphoria, depression of respiratory and vasomotor centers
GI- constipation, nausea, vomiting
GU- hesitancy or retention
opioid drug interaction
additive CNS depression w/sedative hypnotics, phenotiazines and tricyclic antidepressents
non-opioids
local anesthetics and demulcents act directly on nn endings in pharynx
