Drugs for Asthma and COPD Flashcards
terbutaline
short acting beta 2 agonist (relax airway smooth muscle)
only beta 2 drug available by subcutaneous injection
Albuterol
short acting beta 2 agonist (relax airway smooth muscle)
first line of treatment
pirbuterol
- short acting beta 2 agonist (relax airway smooth muscle)
- prevention and reversal of bronchospasm
- can produce clinically significant cardiovascular effects in some patients
levalbuterol
short acting beta 2 agonist (relax airway smooth muscle)
treatment and prevention of bronchospasm
formoterol
- long acting beta 2 agonist (relax airway smooth muscle)
- high lipid solubility due to long half life
- patients >5 y/o as ADD ON to corticosteroid in asthma
- maintenance bronchoconstriction in COPD
salmeterol
- long acting beta 2 agonist (relax airway smooth muscle)
- high lipid solubility due to long half life
- prevention exercise-induced bronchospasm
- in patients >4 y/o
indacaterol and vilanterol
- long acting beta 2 agonist (relax airway smooth muscle)
- high lipid solubility due to long half life
- Tx breathing problems caused by COPD
olodaterol
- long acting beta 2 agonist (relax airway smooth muscle)
- high lipid solubility due to long half life
- long term, once daily maintenance bronchodilator
- COPD patients
ipratropium
- anticholinergic drug, M3 antagonist
- free of systemic atropine-like effects
- COPD drug
tiotropium
- anticholinergic drug, M3 antagonist
- slower dissociating, once daily maintenance Tx
- COPD drug
aclidinium
- anticholinergic drug, M3 antagonist
- long term maintenance Tx of bronchospasm
- COPD drug
What patients should be cautious using methylxanthine?
pts with peptic ulcer disease, seizure disorders, cardiac arrhythmias
MOA methylxanthines
derived from purine base, Xanthine; inhibit PDE (increase cAMP) causing smooth muscle relaxation and suppress response of airways to stimuli
theophylline
- methylxanthine (increase cAMP)
- treat asthma/COPD/chronic bronchitis
- take orally
- narrow therapeutic window
- CYP 450 metabolism
methylxanthine drugs
- theophylline
- theobromine
- caffeine
inhaled corticosteroids use/side effect
- added as daily maintenance
- side effect = oral pharyngeal candida
beclomethasone
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- pts 5+ y/o
- RISK of adrenal insufficiency
budesonide
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- pts 6+ y/o
- NOT GOOD WITH MILK ALLERGY
ciclesonide
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- pts 12+ y/o
flunisolide
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- may eliminate need for oral corticosteroids
- pts 6+ y/o
Fluticasone
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- NOT for acute bronchospasm
- pts 4+ y/o
- ORAL CANDIDA RISK
momentasone
- inhaled corticosteroid
- CONTRAINDICATED WITH MILK ALLERGY
- maintenance Tx asthma and prophylactic therapy
- pts 4+ y/o
triamcinolone
- inhaled corticosteroid
- maintenance Tx asthma and prophylactic therapy
- indicated in patients requiring systemic corticosteroids
- DEATHS d/t adrenal insufficiency have occurred
- contraindicated status asthmaticus
oral and parenteral corticosteroids
- combine with short acting-beta agonists for flareups
- oral steroids more likely to cause side effects than inhaled
prednisone
- oral and parenteral corticosteroids
- used as anti-inflam/immunosuppressive
- may lead to HPA axis suppression
leukotriene receptor antagonist MOA and use
- block cysteinyl leukotriene receptors (CystLT1)
- used for treatment and prevention of acute asthma attacks, taken ORALLY
zafirlukast
- leukotriene receptor antagonist
- CAN CAUSE LIVER INJURY
- prophylaxis and chronic Tx of adults and children 5+ y/o
montelukast
- leukotriene receptor antagonist
- inhibits actions of LTD4 at CysLT1 receptor w/o agonist
- treat allergies and prevent asthma attacks
- not used for reversal of bronchospasms in acute attacks
zileuton
- 5-lipoxygenase inhibitor
- thus inhibits leukotriene formation
- prophylaxis and chronic Tx of asthma
- NOT RECOMMENDED in active liver dz (hepatic enzymes >3x normal limit)
MOA monoclonal Ab drugs
- prevent activity of mast cells
- using anti- IgE Ab
Uses Omalizumab (3)
- for moderate to severe persistent asthma
- patients 6+ y/o with positive skin test or invitro reactivity to perennial aeroallergen
- chronic idiopathic urticaria
class omalizumab
monoclonal Ab
Risk omalizumab
- ANAPHYLAXIS
- should only be administered in a health care setting due to life threatening activity
