Module 10: Respiratory Flashcards
What is first line therapy for maintenance of COPD?
LABA (Formoterol) or LAMA (Triotropium) as monotherapy or in combination (LABA/LAMA).
ICS (Fluticasone proprianate) + LABA (Formoterol) for patients with more frequent exacerbations.
What is first line therapy for treatment of COPD exacerbation?
SAMA (Ipratroprium) + SABA (Albuterol) + systemic corticosteroid (prednisone for 5 days) + abx if needed (typically amoxicillin or doxycycline).
What is first line therapy for treatment of Asthma?
Very mild:
PRN LABA for adults, SABA for kids
Mild Persistent Asthma:
Low-dose inhaled corticosteroid (ICS) + as-needed LABA or SABA
Moderate to Severe Persistent:
Low/medium dose ICS + SABA or LABA
Severe Asthma:
High dose ICS + LABA or SABA
What is first line pharmacologic therapy for allergic rhinitis?
- Intranasal Corticosteroids (INCS) such as fluticasone propionate, budensoide.
- Second generation Oral Antihistamines such as cetrizine, loratadine.
Ipratroprium
Inhaled Short-acting anticholinergic (SAMA)
MOA = Blocks muscarinic receptors in bronchial smooth muscle, preventing acetylcholine binding = decreased cGMP = bronchodilation
Acute exacerbation of COPD in combo with a SABA.
Caution in renal and hepatic
Caution in lactation
Caution < 12yr
Caution elderly (increased r/o anticholinergic effects)
Tiotropium
Long-acting acetylcholine antagonist (LAMA)
MOA = Selectively and reversibly inhibiting M3 receptors in smooth muscle of airways for up to 24 hrs.
Long-term maintenance of bronchospasm d/t COPD as monotherapy or in combo with LABA
Caution in end-stage renal
Caution in hepatic
Caution in lactation
Caution in < 12 yr
Caution elderly (increased r/o anticholinergic effects)
Albuterol
Short-acting beta2-adrenergic agonist (SABA)
MOA = binds to beta2-adrenergic receptors in airway smooth muscle = activation of cAMP = decreased intracellular Ca2+ = relaxes smooth muscle airways.
Tx of bronchospasm in acute asthma or COPD
Caution in severe renal
Caution in hepatic
Caution in lactation
Caution in < 4 yr
Caution in elderly with CVD = increased r/o arrhythmias
Formoterol
Long-acting beta2-adrenergic agonist (LABA)
MOA = Produces accumulation of cAMP = relaxation of smooth muscle
Maintenance tx to prevent bronchospasm in COPD and asthma
Caution in severe renal
Caution in hepatic
Caution in lactation
Caution < 5yr
Caution in elderly with CVD = increased r/o arrhythmias
Fluticasone Propionate
Inhaled Corticosteroid
MOA = Local anti-inflammatory and immune modulator
Maintenance of asthma as prophylactic therapy and maintenance of COPD in pt’s with more frequent exacerbations.
Caution in hepatic
Caution in pregnancy
Contraindicated < 4yr
Caution in elderly d/t increased r/o osteoporosis and #’s with long-term use
Prednisone
Oral Corticosteroid
MOA = Suppresses inflammation and the normal immune response
Chronic inflammation
Allergic inflammation
Hematolgic
Neoplastic
Autoimmune
Acute exacerbation of COPD (short course)
Dose adjust in severe renal
Dose adjust in severe hepatic
Caution in pregnancy and lactation
Caution in elderly (sedation, hyperglycemia and osteoperosis)
Diphenydramine
Oral Histamine 1 Receptor Antagoinst (first generation)
MOA = Antagonizes effects of histamine at H1-receptor sites. Significant CNS depressant and anticholinergic effects.
Anaphylaxis
Seasonal and perennial allergic rhinitis
Allergic dermatoses
Caution in severe renal
Caution in hepatic
Caution in pregnancy and lactation
Caution in elderly d/t anticholinergic effects, sedation
Cetirizine
Oral Histamine 1 Receptor Antagonist (second gen)
MOA = Antagonizes effects of histamine at H1-receptor sites. Minimal anticholinergic and sedation.
Seasonal and perennial allergic rhinitis
Chronic urticaria
Caution in sever renal
Caution in hepatic
Caution in pregnancy and lactation
Contraindicated <2 yrs
Caution in elderly d/t possible anticholinergic effects
