Drugs for Asthma Flashcards
Asthma
Chronic inflammatory disorder that Limits airflow
Allergen causes release of mediators:
histamine, leukotrienes, prostaglandins, interleukins
Mediators cause
bronchoconstriction, infiltration of inflammatory cells
Adviar is a combination of
(salmeterol) long acting bronchodialator plus (fluticasone) a glucose corticord
Metered Dose Inhalers
Use 1-2 puffs, wait 1 minute between puffs; requires lung-hand coordination; Approximately 10% of dose reaches lung; 80% swallowed and other 10% left in device or exhaled; spacers are available to increase amount delivered to lungs. Used 3-4 times per day.
Dry-Powder Inhalers (DPIs)-
Breath activated so approximately 20% of dose reaches lung.
Nebulizers
Deliver dose slowly (over several minutes) by machine allowing bronchi to gradually dilate and medication to gain deeper access to lungs; Patients who have become unresponsive to a beta2 agonist delivered via an inhaler often respond when the same drug is given by nebulizer.
Bronchodilators
Beta 2 adrenergic agonists; Promote bronchodilation; sympathomymetic
Levalbuterol (Xopenex)
Bronchodilator; inhaled short acting; effects begin immediately; rescue inhaler, take first then follow up w/ longer acting inhaler, put in breathing treatment
Serevent (salmeterol)
Bronchodilator; Delayed effects; Used for prolonged prophylaxis; Do not use to abort an ongoing acute asthamtic attack
Serevent (salmeterol) adverse effects
usually minimal with inhaled preparations; tachycardia, angina, tremors
Glucocorticoid
fluticasone (Flovent)
fluticasone (Flovent)
(glucocorticoid) Blocks synthesis and release of inflammatory mediators (histamine, prostaglandins, interleukins); Decreases hypersensitivity, mucus production; Used for prophylaxis, can be administerd orally or by inhalation
Glucocorticoids adverse effects for inhaled medication
oropharyngeal candidiasis- teach patients to gargle with water or saline after each administration
Glucocorticoids adverse effects for oral medication
no significant effects when used 10 days or less; prolonged use can cause adrenal suppression, fluid retention, hypertension, moon face, osteoporosis, hyperglycemia, peptic ulcer disease, suppression of growth in young.
Cromolyn (Intal) stablizes
membranes of mast cells, blocking release of histamine
Cromolyn (Intal) 1st line agent for
for prophylactic therapy of moderate asthma
Cromolyn (Intal) prevents
bronchospasm associated with exercise induced asthma
Methylxanthines
theophylline, aminophylline
Methylxanthines
Relaxes smooth muscle of bronchi; Oral- maintenance, IV- emergencies; Narrow therapeutic range (10-20 mcg/ml)
with Methylxanthines caffeine
increases intensity
drugs that reduce levels of Methylxanthines
phenobarbital, phenytoin, rifampin
drugs that increase levels of Methylxanthines
cimetidine, fluoroquinolone
with Methylxanthines you must
individualize dosages
with Methylxanthines do not give by
rapid injection-could lead to cardiac arrest
most asthma pts are on how many inhalers
3 different types
what goes before steroid
bronchodialator then wait 1-2 min
oropharyngeal candidiasis
to prevent teach pt to gargle glucocorticoids w/ water or saline after each administration
remember Methylxanthines are similar to
caffeine
watch Methylxanthines carefully because they can become
toxic; has a Narrow therapeutic range (10-20 mcg/ml)
give Methylxanthines
slowy
Methylxanthines have what other effect
a diuretic effect
Methylxanthines will make what worse
dysrythmias
Atropine derivative -
an anticholinergic
Atrovent-ipratropium
parasympatholytic so similar to Methylxanthines ; it is a Back-door bronchodilator
Atrovent-ipratropium effectiveness
Effective for allergen-induced & exercise-induced asthma; Less effective than beta 2 agonists (albuterol)
Leukotriene Modifiers
Anti-inflammatory; Used for maintenance of chronic asthma and allergies
Leukotriene Modifiers are given on a
continual basis
Leukotriene Modifiers adverse effects
headache and GI upset
Montelukast (Singulair)
can be given safely to children
