Chapter 5 Respiratory drugs - bronchial disorders Flashcards
albuterol (ventolin, proventil)
metaproterenol (alupent)
terbutaline (brethaire)
formoterol (perforomist)
pirbuterol (maxair)
bitolterol (tornalate)
levalbuterol (xopenex)
arformoterol (Brovana)
adrenergic bronchodilators
- b2 adrenergic receptor agonist — bronchodilation
indication
* acute asthma sx
* prevent exertion-induced asthma
effects
* vasodilation
* tachycardia
* CNS stimulation
* above all — nonspecific agonists
* ** inhalation preparations fewer side effects **
interactions
* MAO inhibitors
* tricyclic antidepressants
* other sympathoimietcs
* all above can induce toxicity
* beta blockers — inhibit acftivity
bronchodilation less effective in hypoxic and acidotic patients
salmeterol (serevent)
adrenergic bronchodilators
- long acting B2 > b1
indication:
* chronic tx of asthma
* bronchospasm in adults
* NOT for acute exacerbations
effects
* nasopharyngitis (mild infection of the nose and throat that can produce symptoms such as a runny nose, sneezing, and coughing)
* headache/cough
BID dosing
epinephrine
ephedrine
adrenergic bronchodilators
- b2 receptors - bronchodilation, a1 - vasoconstriction, decreased secretions (epinephrine)
- a, b1, b2 (ephedrine)
indication
* emergently for severe bronchoconstriction + vasodilation (anaphylaxis)
effects
* tachycardia
* metabolic + GI abnormalities
* CNS stimulation
SUBQ works immediately (epinephrine)
IV for ephedrine
contraindications
* HTN
* hyperthyroidism
* CV insufficiency
* glaucoma
interactions
* MAO inhibitors, tricyclic antidepressants, other sympathomimietics
isoproterenol (isuprel)
adrenergic bronchodilator
- b1 and b2 agonist
indication:
* similar to epinephrine – severe emergent bronchoconstriction / vasodilation (anaphylaxis) — REQUIRES prescription
effects
* tachycardia
* metabolic and GI abnormalities
* CNS stimulation
inhalation/IV/sublingual
contraindication
* tachycardia
interactions
* MAOIs, tricyclic, sympathomimietics
WITHDRAWAL — may induce relfex bronchoconstriction
Ipratropium (atrovent)
aclidiniuim (tudorza)
umeclidinium (incruse)
tiotropium (spiriva)
reveflenacin (yupelri)
anticholinergic
- muscarinic antagonist
- reverses acetycholine induced bronchoconstriction
indication
* bronchospasm associated w/ COPD in adults
effects
* few systemic anticholinergic side effects b/c compounds cross into systemic circulation poorly
inhalation
contraindicatoin
* narrow angle glaucoma
* prostatic hypertrophy
additive effects w/ adrenergic agonists
marked in combination w/ albuterol
theophylline
methylxanthine
- unknown mech
- @ toxic levels — this can inhibit phosphodiesterase which is an enzyme that breaks down cAMP (2nd messenger that mediates adrenergic induced bronchodilation)
- methylxantines block adenosine receptors that may account for CNS and cardiac stimulation
- can also induce diuresis
indication
1) maintenance therapy in moderate-severe asthma
2) slow onset - not good for acute siutation
3) theophylline replaced by ipratropium bromide and/or sympathomimietic agents for non-asthmatic COPD
effects
* n/v
* headache
* insomnia
* tachycardia
* dizziness
* neuromuscular irritability
* seizure
* monitor serum levels!
contraindications
* pt w/ sz disorder
* CV disorder
* peptic ulcer disease
interactions
sympathomimetics – inc heart + CNS toxicity
* cimetidine, oral contraceptives, several antibiotics — inc half life of theophylline => inc toxicity
* dehydration with concurrent use of furosemide
doubling dose … is dangerous b/c it can cause seizures
TX OD with ipecac (syrup), activated charcoal, and cathartic (laxative)
aminophylline
methylxanthine
- unknown mech
- @ toxic levels — this can inhibit phosphodiesterase which is an enzyme that breaks down cAMP (2nd messenger that mediates adrenergic induced bronchodilation)
- methylxantines block adenosine receptors that may account for CNS and cardiac stimulation
- can also induce diuresis
indication
* IV loading dose for severe, acute bronchoconstriction (theophylline cannot be administered IV
effects
* n/v
* headache
* insomnia
* tachycardia
* dizziness
* neuromuscular irritability
* seizure
* monitor serum levels!
contraindications
* pt w/ sz disorder
* CV disorder
* peptic ulcer disease
interacations
sympathomimetics – inc heart + CNS toxicity
* cimetidine, oral contraceptives, several antibiotics — inc half life of theophylline => inc toxicity
* dehydration with concurrent use of furosemide
this drug is the water soluble salt of theophylline – 78% theophylline
Beclomethasone (beclovent)
budesonide (pulmicort)
fluticasone (flovent)
flunisolide (aerobid)
mometasone (twisthaler)
ciclesonide (zetonna)
triamcinolone (azmacort
corticosteroid
- decrease inflamation and edema in resp tract
- enhance activity of sympathomimetics in hypoxic and acidotic states
indication
* asthma which cannot be controlled by sympathomimetics (bronchodilators) alone
effects
* usually do not induce systemic toxicity
* action primarily in lungs
* inc risk of oral candida albicans infection (thrush)
inhalation - rapid inactivation in lungs
contraindications
* tx of status asthmaticus (medical emergency, an extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory failure.)
* pt w/ systemic fungal infections
inhalation agents must not be substituted for systemic steroids w/o first tapering systemic steorids (d/c as soon as possible)
cromolyn (intal)
inflammaotry cell stabilizer
- prevent release of inflammatory mediators (histamine for e.g) from mast cells, macrophages, neutrophils, and eosinophils
indication:
* prophylaxis of asthma attacks
* NOT USEFUL — ongoing attack
effect
* throat irriation
several weeks of therapy for effective prophylaxis — inhalation
MAY allow pts to reduce maintenace dose of brohodilators or corticosteriods
zafirlukast (accolate)
montelukast (singulair
lekuotriene receptor antagonists
- competitive antagonists of leukotriene D4/E4 receptors
- inhibits bronchoconstriction and inflammation
indication
* prophylaxis and chronic asthma
effects
* inc’d respiratory infection in OA
* headache, GI distress
contra
* not for reversal of bronchospasm in acute asthma attacks
interactions
* theophylline + erthromycin reduce zafirlukasts levels
* phenobarbital reduce monetlukast
zileuton (zyflo)
leukotriene receptor antagonist
inhibits 5-lipxygenase, enzyme for leukoriene synthesis (inflammation and allergic disease)
- prophylaxis and chronic asthma tx
effects
* headache
* Liver enzyme elevation
* GI
Contra
* not for reversal of bronchospasm in acute asthma attacks
interations
* inc serum tehophylline level
benralizumab (fasenra)
mepolizumab (nucala)
reslizumab (cinqair)
leukotriene receptor antagonist
- monoclonal antibody that binds interluekin-5 receptor on eosinophils + basophils (contribute to asthma) l/t NK cell mediated death
indication
* maintenance asthma therapy
* not for acute asthma exacerbations
effects
* hypersensitivity rxn to drug
very long serum half life (benra + mepo)
IV (resliz)
contraindications:
for benra and mepo — avoid patients with helminthic infection (eosinophils clear helminths) — parasitic worms
DO NOT WEAN STEROIDS TOO RAPIDLY AFTER STARTING THIS DRUG 1st two on this list
surfacant (exosurf, survanta)
miscellanoues
- infant respiratory distress syndrome – d/t lack of surfactant; crucial for decreasing surface tension in lungs, premit alveoli to open more readily
- administerd endotracheally to reduce incidence and severity of IRDS
- Toxicity — desaturation and bradycardia during administration and risk of pulmonary hemorrhage
n-acetylcysteine (mucomyst)
misc
mucolytic agent
* reduce viscoity of mucous by cleaving protein complexes
* indication - chronic bronchopulmonary disease
alpha, proteinase inhibitor (prolastin)
misc
- pt w/ alpha1 antitrypsin deficiency (condition that raises your risk for lung and other diseases. AAT is a protein made in your liver to help protect the lungs. If your body does not make enough AAT, your lungs are more easily damaged from smoking, pollution, or dust from the environment. This can lead to COPD) develop pan acinar emphysema d/t degradation of elastin by neutrophil-produced elastase (major inflammatory protease released by neutrophils and is present in the airways of patients with cystic fibrosis (CF), chronic obstructive pulmonary disease, non-CF bronchiectasis, and bronchopulmonary dysplasia)
- given this drug IV each week
- primary toxicity - fever
