Exam 4- Week 12 Flashcards
Tiotropium (Spiriva)
Anticholinergic/ antimuscarinic.
Used to treat COPD not asthma.
Montelukast (Singulair)
Adverse effects: Patients and parents of pediatric patients should be informed of the potential for neuropsychiatric events, including agitation, aggression, anxiousness, dream abnormalities and hallucinations, depression, insomnia, irritability, restlessness, suicidal thinking and behavior (including suicide), and tremor.
Patient teaching: take as directed, educate on side effects, educate to monitor respiratory status with peak flow meter
Inhaled corticosteroids
Fluticasone (Flovent), budesonide (Pulmicort), beclomethasone dipropionate (QVAR)
Used in the long-term management of asthma
Mechanism of Action: In the treatment of asthma and allergic rhinitis, the primary actions of orally inhaled corticosteroids are anti-inflammatory. The inhaled adrenocorticosteroids inhibit the immunoglobulin E (IgE) and mast cell–mediated migration of inflammatory cells into the bronchial tissue (late-phase allergic reaction).
Patient teaching: Patients who are concurrently using an inhaled bronchodilator should administer the bronchodilator first and wait several minutes before using the inhaled corticosteroid. This procedure enhances the absorption of the steroid in the bronchial tree. Use verbal instructions as well as actual demonstration with a placebo inhaler to reinforce the written instructions. spacers can be prescribed to ensure the medication is deposited in the lungs, not the mouth. Inhaled steroids are not to be used as abortive asthma medications; they are for preventive therapy only. Rinse mouth to prevent thrush.
Adverse effects: oral candidiasis, xerostomia, hoarseness (5% to 50% of patients), tongue and mouth irritation, flushing, and dysgeusia (altered taste sensation).
Long-acting beta agonists
Relax airway smooth muscle by increasing cyclic AMP
•Used in the treatment of bronchospasm associated with asthma, bronchitis, and COP
Precautions: LABA should not be prescribed in AA population
Ex: salmeterol, formoterol
Albuterol
Short-acting beta agonist. Selective beta2 agonist with some minor beta1 activity.
It can increase heart rate by directly stimulating beta2 receptors in the heart and by stimulating beta2 receptors in vascular smooth muscle. The effect on cardiac beta2 receptors is of consequence only at high serum levels of albuterol because it has a low affinity for these receptors and there are fewer beta2 receptors than beta1 receptors in the heart. Stimulation of the beta 2 receptors in the vascular smooth muscle leads to vasodilation, a decrease in diastolic blood pressure, and therefore a reflex increase in heart rate. Albuterol causes beta2-receptor stimulation of skeletal muscle that leads to tremors. Albuterol has fewer cardiac and CNS effects than some of the other beta agonists and is, therefore, often the drug of choice for first-line therapy. Levalbuterol is similar to albuterol, where the (S)-isomer from racemic albuterol is removed, leaving the (R)-isomer, which has less adverse effects. Pirbuterol is a selective beta2 agonist that is structurally identical to albuterol, except for the substitution of a pyridine ring for the benzene ring in its chemical makeup.
Short-acting beta agonists
Relax airway smooth muscle by increasing cyclic AMP
•Used in the treatment of bronchospasm associated with asthma, bronchitis, and COPD
Use: When other asthma control agents are ineffective. Use for as short a duration as possible.
Ex: albuterol, levalbuterol
Anticholinergics/ Antimuscarinics
- Ipatropium (Atrovent), tiotropium (Spiriva)
- Used in maintenance therapy in patients with COPD, ESPECIALLY IF TAKING PROPRANOLOL
- Block muscarinic (anticholinergic) receptors; decrease the formation of cGMP – leads to decreased contractility of the smooth muscle of the lungs
- Tiotropium better absorbed from lung
- Side effects – headache, nervousness
Last Cell Stanblizers
•Cromolyn, nedocromil
•Alter function of chloride channels
–Inhibits cough, inhibits mast cell and eosinophil response to antigens
•Used for asthma prophylaxis
Xanthine Derivitives
•Theophylline, aminophylline
•Used in the treatment of asthma
•Believed to work by producing an increase in cAMP
–Leads to bronchial smooth muscle and pulmonary vessel relaxation
Side effects:
Intranasal corticosteroids
- Mometasone (Nasonex), fluticasone (Flonase)
- Drug of choice in the treatment of allergic rhinitis
- Interrupt inflammation by inhibiting the synthesis of mediators
- Rare systemic absorption
- Side effects – primarily drying or burning of nasal mucosa
