COPD drugs Flashcards
Describe Albuterol (SABA/LABA?, classification, pharmacology, indications, MOA, pharmacokinetics, cautious usage, adverse reactions/side effects)
SABA
Classification: Bronchodilator
Pharmacologic: Adrenergic
Indications: Treatment of bronchospasm in asthma or COPD
Mechanism of action: Binds to b2-adrenergic receptors in airway smooth muscle →activation of adenyl cyclase and increased cAMP → decreases calcium –> decreased contraction of smooth muscles of the airway → bronchodilation
Pharmacokinetics:
- Half-life: Inhalation: 3.8 hr.
- Onset: Inhalation: 5–15 min
Use cautiously in:
- Cardiac disease
- Hypertension
Adverse reactions/side effects:
- Chest pain
- Palpitations
- Nervousness
- Restlessness
- Tremor
- Paradoxical bronchospasm
What should you describe in Albuterol assessment and patient teaching?
Assessment:
- Assess lung sounds, pulse, and BP before administration and during peak of medication
- Observe for paradoxical bronchospasm, withhold medication, and notify HCP
Patient teaching:
- Instruct to take as directed
- Take missed dose as soon as remembered, and spacing remaining doses at regular intervals
- Do not double doses or increase dose or frequency of doses
- Contact HCP if shortness of breath is not relieved
- Notify HCP if there is no response to the usual dose or if contents of one canister are used in less than 2 wks. → Need to re-evaluate treatment regiment
Describe Salmeterol (SABA/LABA?, classification, pharmacology, indications, MOA, pharmacokinetics, cautious usage, adverse reactions/side effects)
LABA
Classification: Bronchodilator
Pharmacologic: Adrenergic
Indications: Maintenance treatment to prevent bronchospasm in COPD including chronic bronchitis and emphysema
Mechanism of action: Produces accumulation of cAMP → decreased Calcium → decreased muscle contraction → bronchodilation.
Pharmacokinetics:
- Half-life: Inhalation: 3-4 hours
- Onset: Inhalation: 10-25 minutes
Use cautiously in: Cardiac disease
Adverse reactions/side effects:
- Palpitations
- Tachycardia
- Headache
What should you describe in Salmeterol assessment and patient teaching?
Assessment → same as for SABAs…
- Assess lung sounds, pulse, and BP before administration and during peak of medication
- Observe for paradoxical bronchospasm, withhold medication, and notify HCP
Patient Teaching:
- Remind patients/families that LABA’s aren’t for acute symptoms
- LABAs should be used with inhaled corticosteroids & is not a substitute for these meds
- Reinforce the importance of regular follow up care
Describe Ipratropium (SAMA/LAMA?, classification, pharmacology, indications, MOA, pharmacokinetics, cautious usage, adverse reactions/side effects)
SAMA
Classification: Bronchodilator
Pharmacologic: Anticholinergic
Indications: Maintenance therapy of reversible airway obstruction due to COPD, including chronic bronchitis and emphysema.
Mechanism of action: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cGMP → dilation.
Pharmacokinetics:
- Half-life: Inhalation: 2 hours
- Onset: Inhalation: 1-3 min
Use cautiously in: Prostate hyperplasia or urinary retention -> increase risk of acute urinary retention. Conflicting results
Adverse reactions/side effects:
- Hypotension
- Palpitations
- Bronchospasm
- Cough
What should you describe in Ipratropium implementation, assessment, and patient teaching?
Implementation:
- When Ipratropium is administered concurrently with other inhalation medications, administer adrenergic dilators first, followed by ipratropium, then steroids.
Assessment :
- Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult HCP about alternative medication if severe bronchospasm is present
- If paradoxical bronchospasm (wheezing) occurs, withhold medication
Patient Teaching:
- SAMAs are not for schedule medication and are used for acute symptoms
- Reinforce the importance of regular follow up care
Describe Tiotopium (SAMA/LAMA?, classification, pharmacology, indications, MOA, pharmacokinetics, cautious usage, adverse reactions/side effects)
LAMA
Classification: Bronchodilator
Pharmacologic: Anticholinergic
Indications: Long-term maintenance treatment of bronchospasm due to COPD. Reduce exacerbations in patients with COPD
Mechanism of action: Acts as anticholinergic by selectively and reversibly inhibiting M3 receptors in smooth muscle of airways
Pharmacokinetics:
- Half-life: Inhalation: 5-6 days
- Onset: Inhalation: Rapid
Use cautiously in: Prostate hyperplasia or urinary retention. -> increase risk of acute urinary retention. Conflicting results
Adverse reactions/side effects:
- Tachycardia
- Dry mouth
What should you describe in Tiotopium implementation, assessment, and patient teaching?
Implementation:
- When Tiotropium is administered concurrently with other inhalation medications, administer adrenergic dilators first, followed by triotropium, then steroids.
Assessment :
- Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult HCP about alternative medication if severe bronchospasm is present.
- If paradoxical bronchospasm (wheezing) occurs, withhold medication.
Patient Teaching:
- Remind patients/families that LAMA’s aren’t for acute symptoms
- Reinforce the importance of regular follow up care
Describe Budesonide/Formoterol Combination (classification, pharmacology, indications, MOA, pharmacokinetics, cautious usage, adverse reactions/side effects)
Inhaled Corticosteroid (ICS)
Classification: Anti-inflammatory (steroidal) and bronchodilator
Pharmacologic: Corticosteroids and LABA
Indications: Maintenance treatment of COPD
Mechanism of action:
- Budesonide: Potent, locally acting anti-inflammatory
- Formoterol: A Beta2-adrenergic agonist
Pharmacokinetics:
- Half-life: Inhalation: 10-15 hr
- Onset: Inhalation: Within 5 minutes.
Use cautiously in: Systemic corticosteroid therapy. Should not be abruptly discontinued when inhaled therapy is started or withdrawal can occur
Adverse reactions/side effects:
- Tachycardia
- Hypertension
What should you describe in Budesonide/Formoterol Combination assessment? (there is no teaching category as the prof made a mistake)
Assessment:
- Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult HCP about alternative medication if severe bronchospasm is present.
- If paradoxical bronchospasm (wheezing) occurs, withhold medication
