Lecture 4: Asthma and COPD Drugs Flashcards
Which 3 major drug classes are used as bronchodilators in the tx of asthma and COPD?
- β2-agonists
- Anti-cholinergic
- Methylxanthines
2 most common AE’s assocaited with β2-agonists?
Muscle tremor and palpitations
What is the only β2 drug available for SQ injection?
Who is it not recommended for?
Terbutaline
not for ppl w/ sulfur allergy
What are the indications for use of Terbutaline?
Tx or prophylaxis of bronchospasm assoc. with asthma, bronchitis and emphysema in pt’s >12 y/o
What is the black-box warning for Terbutaline?
Not recommended as a medication for tocolysis
Which β2-agonist for asthma is not recommended for pt’s with sulfa allergies?
Terbutaline
What are some of the more serious maternal AE’s associated with Terbutaline?
- Cardiac or cardiopulmonary arrhythmias
- Pulmonary edema
- MI
- Hypotension
- Tachycardia
Albuterol may have interactions with what 5 other drug classes?
- β-blockers (duh)
- Digoxin
- Diuretics
- MAO inhibitors
- Tricyclic antidepressants
Which life-threatening AE can occur after tx w/ Albuterol?
Paradoxical bronchospasm
What are 2 indications for the use of the β2-agonist Metaproterenol?
- Bronchodilator for bronchial asthma
- Reversible bronchospasm which may occur in assoc. w/ bronchitis and COPD
Which drug class should not be used concomitantly with Metaproterenol?
Beta-adrenergic aerosol bronchodilators due to additive effects
What are 2 cautions/warnings associated with the use of Metaproterenol?
- Can produce significant cardiovascular effect in some pt’s, as measured by pulse, BP, sx’s and/or ECG changes
- Can produce paradoxical bronchospasm (can be life threatening)
Which β2-agonist may be used with or without concurrent theophylline and/or corticosteroid therapy?
Pirbuterol
What are the indications for the use of the β2-agonist, Levalbuterol?
Tx or prevention of bronchospasm in pt’s > 4 y/o with reversible obstructive airway disease
What are the 4 long-acting β2-agonists?
- Fomoterol
- Salmeterol
- Indacaterol
- Olodaterol
What are the 3 indications for use of the LABA, Fomoterol?
- Add-on for tx of asthma in pt’s ≥5 y/o in combo w/ long-term asthma control med such as an inhaled corticosteroid
- Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥5 y/o
- Maintenance tx of bronchoconstriction in pt’s with COPD
What are cautions/warnings for the use of LABA’s in asthma and COPD?
- ↑ risk of asthma-related death and asthma-related hospitlizations
- MUST be used concomitantly with an inhaled corticosteroid for asthma (fomoterol and salmeterol)
What is the indication for the use of the LABA, Indacaterol?
Used to tx breathing problems caused by COPD, including chronic bronchitis and emphysema
What are the 3 indications for use of the LABA, Salmeterol?
- Add-on for tx of asthma in pt’s ≥4 y/o in combo w/ long-term asthma control med such as an inhaled corticosteroid
- Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥4 y/o
- Maintenance tx of bronchoconstriction in pt’s with COPD
What are the most common AE’s of the LABA, Indacaterol?
- Cough + oropharyngeal pain + nasopharyngitis
- HA and nausea
What is the indication for use of the LABA, Olodaterol?
Used as LONG-term, 1x/daily maintenance bronchodilator in pt’s with COPD, including chronic bronchitis and emphysema
Which anticholinergic drug is indicated for use as a bronchodilator for maintenance tx of bronchospasm associated with COPD, including chronic bronchitis and emphysema?
Ipratropium
Which anticholinergic drug is indicated for long-term, 1x/daily, maintenance tx of bronchospasm associated with COPD, and for reducing COPD exacerbations?
Tiotropium
Caution should be used when co-administering tiotropium or ipratropium with what drug classes, due to additive interactions?
Anticholinergic-containing drugs
What is the indication for use of the anticholinergic drug, Aclidinium?
LONG-term, maintenance tx of bronchospasm associated with COPD, including chronic bronchitis and emphysema
What are 3 major AE’s associated with the anticholingeric, Aclidinium?
- Paradoxical bronchospasm
- Worsening of narrow-angle glaucoma
- Worsening of urinary retention
What is a caution/warning related to the use of the anticholingeric, Aclidinium for COPD?
NOT for acute use or initial tx of bronchospasm