obstructive pulmonary pharm Flashcards
long-term control medications to treat asthma
PREVENTERS
-anticholinergics
-xanthine derivative
-inhaled corticosteroids
-leukotriene modifiers
-mast cell stabilizers
-long-acting beta agonist (LABA)
quick-relief medications to treat asthma
RESCUE/RELIEF
-short-acting beta agonist (SABA)
-albuterol
bronchodilators and classes
relaxes bronchial smooth muscle + dilates bronchi
3 classes:
1. beta-adrenergic agonist
2. anti-cholinergics
3. xanthine derivatives
beta-adrenergic agonists meds
long or short acting
short: albuterol + levabuterol –> rescue (4-6hr)
long: salmeterol + formeterol –> preventer (12-24hr)
beta-adrenergic agonists: MOA
mimic SNS - fight or flight
relax/dilate airway by stimulating beta2 adrenergic receptors throughout lungs
*goal: bronchial dilation and increased airflow in and out of lungs
3 subtypes of beta adrenergic agonists
- non-selective adrenergic
- non-selective beta-adrenergic: stimulate beta1 and beta2 (metaproterenol)
- selective beta2 receptors: (albuterol) preferred for pulmonary conditions
non-selective beta-adrenergic agonist
epinephrine
*stimulate beta 1 (CV effects- increased HR, BP), beta 2, alpha receptors (vasoconstriction)
*decreases edema/swelling in mucous membranes, limits amt of secretions
*CNS stimulation –> nervousness, tremors
beta-adrenergic agonist: indications/contraindications
prevention or relief of asthma, bronchitis, other pulmonary conditions
*contraindications: uncontrolled HTN, cardiac dysrhythmias, high risk for stroke
beta-adrenergic agonist: nursing considerations
effects may be diminished with beta blockers
avoid use with MAOI’s and sympathomimetics (ephedrine, Sudafed) –> HTN
raises BS –> diabetics may need higher doses of meds (insulin)
beta-adrenergic agonist: side effects
non-selective have the most
beta2: HTN or hypotension
short half life
can reverse effects with beta blockers ***WATCH for bronchospasm
**insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache
MDI
metered dose inhaler - non breath activated
(+): portable, convenient
(-): pt coordination essential, high pharyngeal deposition, difficult to deliver high doses
DPI
dry powder inhaler - breath activated
(+): propellant not required, convenient, portable
(-): diff to deliver high doses, high pharyngeal deposition, cannot use with endotracheal or tracheotomy tubes
nebulizer
(+): pt coordination not required, high doses possible
(-): expensive, possible contamination, device prep required
selective beta-agonist: albuterol
RESCUE!! ASTHMA ATTACKS!!! acute episodes of wheezing, SOA, chest tightness
mostly asthma - also bronchitis, emphysema
SABA - onset in minutes
inhalation: q 4-6hr
delivery method: MDI or nebulizer
albuterol: teaching points
regularly scheduled daily use is NOT recommended
*use of more than 1 canister (200 actuations) per month indicates inadequate control of asthma and need for initiating or intensifying anti-inflammatory therapy
*take 15 min before exercise for exercise-induced asthma
salmeterol
LABA - MAINTENANCE/PREVENTION
2x/day - DPI
indications: worsening COPD, mod-severe asthma
salmeterol: teaching points
associated with increased asthma-related deaths (common in African Americans)
always given with an inhaled corticosteroid - not intended for use by itself
anticholinergics
bronchodilator - work on acetylcholine receptors
turns off cholinergic (PNS) and turns on SNS –> bronchodilation –> increases perfusion to heart, lungs, brain
*by blocking acetylcholine, we inhibit normal physiological response (mucous production and bronchoconstriction)
anticholinergic: ipratropium
blocks action of acetylcholine - creates bronchodilation
used for prophylaxis and maintenance
often given in combo with albuterol
side effects of anticholinergics
dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter
dry throat, dry mouth, dry eyes, constipation, hot, decreased sweating, blurred vision, tachycardia, sedation, dizziness, confusion, hallucinations
theophylline and aminophylline: class and MOA
bronchodilators - xanthine derivatives
MOA: increases levels of the cAMP enzyme by inhibiting phosphodiesterase - stimulates CNS and CVD system
theophylline and aminophylline: indication
preventive for asthma and COPD exacerbation
theophylline and aminophylline: contraindications
uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers
interactions: caffeine (increase SE’s), smoking (decrease absorption)
theophylline and aminophylline: side effects
toxicity - N/V/D, insomnia, headache, tachycardia, dysrhythmias, seizures (elders)
xanthine derivatives: theophylline and aminophylline: nursing considerations
second-line bc high risk of toxicity/drug interactions
*macrolide ATB, allopurinol, cimetidine, quinolones, flu vaccine, oral contraceptives
narrow therapeutic index - monitor serum levels
anti-inflammatories
LTRA’s, inhaled corticosteroids, mast cell stabalizers
leukotriene receptor antagonist
montelukast
zafirlukast
montelukast
zafirlukast
MOA
prevent leukotrienes from attaching to receptors located on immune cells and within lungs –> prevents inflammation
*leukotrienes cause: inflammation, bronchoconstriction, mucus production
montelukast
zafirlukast
nursing considerations
montelukast: > 12 months old
zafirlukast: > 5 years old
montelukast
zafirlukast
indications
oral prophylaxis and chronic treatment of asthma in adults and children + allergies
route: PO (chewable or granules)
montelukast
zafirlukast
side effects
headache, nausea, dizziness, insomnia, diarrhea
montelukast: few drug interactions
zarfirlukast: several drug interactions
inhaled corticosteroid
beclomethasone diproprionate
budesonide
fluticasone
inhaled corticosteroids: MOA
reduce inflammation and enhance activity of beta agonists
help with bronchodilation
inhaled corticosteroids: indications/considerations
may take several weeks to see effect
route: nebulizer or MDI
for prevention of persistent asthma attacks + long-term maintenance of severe COPD
inhaled corticosteroids: side effects
pharyngeal irritation, dry mouth, coughing, oral fungal infections
**RINSE MOUTH AFTER USE
teaching point for asthma w/ inhaled corticosteroids
take on a regular schedule, not as needed!
give bronchodilator first –> will allow more absorption of steroid
inhaled glucocorticoids and bronchodilators are used in combination for
moderate to severe asthma
long half lives + onset in minutes
*budesonide+formeterol
*fluticasone+salmeterol
mast cell stabilzer
cromolyn
cromolyn: MOA
stabilize membranes of mast cells and precent release of broncho-constrictive inflammatory substances
cromolyn: indication
prevention of acute asthma attacks
*take 15-20 min prior to known triggers
monoclonal antibody anti-asthmatic
omalizumab
*newest generation
omalizumab: MOA
monoclonal antibody which selectively binds to immunoglobulin IgE, which limits release of mediators of allergic response
(decreases hyper responsiveness)
omalizumab: indications/considerations
add on therapy for asthma
route: injection
*monitor closely for hypersensitivity rxn –> anaphylaxis big risk
selective PDE-4 inhibitor
roflumilast
roflumilast: MOA
selectively inhibits PDE4 enzyme in the lung cells –> decreases inflammation in lungs
roflumilast: indications
prevention of COPD exacerbations
route: oral
roflumilast: side effects
N/V/D, headaches, muscle spasms, decreased appetite, uncontrollable tremors
