Bronchodilators Flashcards
prednisone
oral corticosteroid
montelukast
leukotriene antagonist
zafirlukast
leukotriene antagonist
anti-IgE Ab
obalizumab
bronchospasm
IgE on mast cells
-release histamine and other mediators
blocking single one - not very helpful
corticosteroids - block lots
preformed mediators
histamine
TNF alpha
protease
heparin
immediate
vasodilation, edema
lipid mediators
minutes
leukotrienes, prostaglandins
mucus secretion
cytokines
interleukins, GM-CSF
hours
inflammatory cell proliferation
IgE proliferation
IL-4, IL-5
Th2 cell
aerosol delivery
lots swallowed
-bets drugs - poor GI absorption
spacer - larger particles deposited before inhales - allows only smaller -which go to small airways
1-5 micrometers - get to small airways
DOC for rapid relief of bronchospasm
beta-adrenergic agonist
beta agonist overuse
side effect intensify
seek help as soon as decline in efficacy of tx noticed
asthma tx
control inflammatory component
bronchodialtor - sympomatic use PRN
COPD tx
focus on reversible component
-bronchodilation
no hand lung coordination
nebulizer
SABA
albuterol
LABA
formoterol
salmeterol
emergency use
epinephrine - subQ
beta agonist MOA
beta2 receptor
stimulate adenylyl cyclase and increase cAMP
relax bronchial smooth m, inhibit mediators of mast cells
prevention of nighttime asthma attacks
salmeterol
prophylactic bronchodilation
slow onset - not for acute tx
most effective long term treatment persistent asthma
inhaled corticosteroids
recommendations - long acting beta2 agonist in combination with inhaled corticosteroid
beta agonist side effect
muscle tremor, cramps, tachyarrythmias, metabolic disturbanceq
long term use of LABA
may down-regulate beta-2 receptors
lose protective effect
stop use once asthma control achieved and maintain use of an asthma-controller - inhaled corticosteroid
anaphylactic rxn
epinephrine subQ
quaternary muscarinic receptor antagonist
ipratropium bromide
inhaled aerosol
poor GI absorption** - swallowed little effect
COPD tx
ipratropium
long acting muscarinic antagonist
tiotropium
theophylline
methylxanthine
- adenosine receptor antagonist
- PDE inhibitor
- hyperpolarize cell membranes
intranasal ipratropium
allergic rhinitis
postnasal drip syndrome
methylxanthines
theophylline
cause bronchodilation
used to be first line for asthma - not less prominent role in therapy because benefits modest with narrow therapy index
noctural asthma improvement
with slow release theophylline
but corticosteroids and salmeterol are probably better option
PDE4 inhibitor
roflumilast
-for COPD
increased cAMP levels and reduce inflammation
reduced exacerbations
side effects - nausea, diarrhea, psych, weight loss
only pt not responding other therapy
corticosteroid MOA
steroid receptor agonist
-to nucleus and +/- regulate gene transcription - takes time
inhibit lots of inflammatory mediators
aerosol steroids
safer
systemic corticosteroids
IV/oral - for severe asthma in hospital
prednisone/methylprednisone - IV then oral tapered off dose
corticosteroid side effects
HPA suppression bone resorption carb/lipids cataracts purpura dysphonia candidiasis
combined products
fluticasone / salmeterol
budesonide / formoterol
mometasone / formoterol
reversible component COPD
inflammation and bronchospasm
this is drug therapy
irreversible component COPD
alveolar destruction
COPD tx
inhaled ipratropium / tiotropium with beta2 agonist
monotherapy with inhaled corticosteroids - not approved for COPD
growth retardation
concern with high dose corticosteroids in children
triple therapy
for COPD
-tiotropium, LABA, corticosteroid
superior to 1 or 2 agents in relieving symptoms such as dyspnea and in improving lung function
cromolyin
anti-inflammatory
-inhibit antigen-induced bronchospasm
inhibits release of histamine from mast cells
not effective in tx of ongoing or acute bronchospasm - primarly used as prophylactic**
LTD4 receptor antagonist
motelukast
-oral prophylaxis for exercise induced asthma
alt tx for mild persistant asthma
