Obstructive Pulmonary Pharm Flashcards
bronchodilators
-Beta2 agonists
-anticholinergics
-xanthine derivatives
-used to treat all respiratory diseases
-work by relaxing bronchial smooth muscle
anti-inflammatories
-leukotriene receptor antagonist
-inhaled glucocorticoids
-mast cell stabilizers
beta adrenergic agonist drugs
-short acting: albuterol (po/inhalant) and levalbuterol (inhalant)
-long acting- salmeterol and formoterol (both inhalants)
short vs long acting
-most inhaled B2 agonist are short acting
-SABA are rescue drugs-duration q 4-6 hrs
-long acting beta2 agonist: preventors
-duration: 12-24 hrs
beta adrenergic agonist: MOA
-mimic action of SNS-fight or flight
-relax and dilate the airways by stimulating the beta2 adrenergic receptors throughout the lungs
-bronchial dilation and increased airflow into and out of the lungs=goal
non selective beta adrenergic agonist
-non selective drugs (epinephrine) stimulate alpha receptors=vasoconstriction: decreased edema/swelling in mucous membranes, limits amount of secretions
-non-selective also stimulate beta1= CV effects
-CNS stimulation occurs- nervousness/tremors occur
beta adrenergic agonist indications
-prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions
beta adrenergic agonist contraindications
-uncontrolled HTN
-cardiac dysrhythmias
-high risk for stroke
-avoid use with MAOI’s and sympathomimetics bc of risk of HTN
beta adrenergic agonist adverse effects
-non selective have the most
-can reverse overdose with beta blockers
-insomnia
-restlessness
-anorexia
-cardiac stimulation
-hyperglycemia
-tremor
-vascular headache
selective beta agonist
-albuterol/proventil
-SABA
-MDI or nebulizer
-indications: treatment of asthma, bronchitis, and emphysema
-treatment of ACUTE episodes of wheezing, chest tightness, SOA
albuterol
-SABA
-use of more than one canister per month indicates inadequate control of asthma and need for initiating or intensifying anti inflammatory therapy
long acting beta 2 agonist
-salmeterol
-LABA
-given twice daily
-warning: has been associated with increased asthma-related deaths
-always given with an inhaled corticosteroid, not indicated for monotherapy
salmeterol indications
-worsening of COPD
-moderate-severe asthma
Anticholinergics
-still a type of bronchodilator-but work on acetylcholine receptors
-giving anticholinergic agents results in: turning off cholinergic response (PNS) and turning on SNS- thus increasing perfusion to heart, lungs, and brain
-KEY POINT: by blocking the effect of acetylcholine, we inhibit the normal physiological response
anticholinergic drug
ipratropium
ipratropium
MOA: blocks action of acetylcholiine-creates bronchodilation
-indications: used for PROPHYLAXIS and maintenance therapy
-often given in combination with albuterol
anticholinergic adverse effects
-urinary retention
-sedation, dizziness, confusion, hallucinations
-blurred vision, dry eyes
-tachycardia
-feeling hot, decreased sweating
-dry throat and mouth, constipation
-think DRYING effect
xanthine derivative drugs
-theophylline
-aminophylline
xanthine derivatives MOA/uses
-increasing levels of the cAMP enzyme by inhibiting phosphodiesterase
-used as a second line drug because of the high risk of toxicity and drug-drug interactions
-preventative treatment of asthma attacks and COPD exacerbation
xanthine derivatives AE and contraindications
-toxicity- N/V/D, insomnia, H/A, tachycardia, seizures, dysrhythmias, hyperthyroid, peptic ulcers
-interactions: caffeine may increase side effects and smoking can decrease absorption
-has a narrow therapeutic index- monitor serum levels and watch for toxicity
-lots of drug interactions
leukotriene receptor antagonist drugs (LTRA)
-montelukast
-zafirlukast
LTRAs MOA
-leukotrienes cause inflammation, bronchoconstriction, and mucus production
-prevent leukotrienes from attaching to receptors located on immune cells and within the lungs
LTRA’s route and uses
-PO
-oral prophylaxis and chronic treatment of asthma in adults and children
LTRAs adverse effects
-headache
-nausea
-dizziness
-insomnia
-diarrhea
-montelukast has few drug-drug interactions, but zafirlukast has several
inhaled corticosteroid drugs
-beclomethasone diprpionate
-budesonide
-fluticasone
inhaled corticosteroids MOA
reduce inflammation and enhance activity of beta agonists
inhaled corticosteroids use and route
-given via nebulizer or MDI
-can take several weeks of continuous therapy before full effect of the steroids realized
-NOT a rescue drug
-given for prevention of persistent asthma attacks and long term maintenance of severe COPD
-for asthma- teach to take on a regular schedule, and give the bronchodilator first to allow more thorough absorption of the steroids
inhaled corticosteroid adverse effects
-pharyngeal irritation
-coughing
-dry mouth
-oral fungal infections
-RINSE MOUTH after use
combinations: inhaled glucocorticoid and bronchodilator
-budesonide and formeterol
-fluticasone and salmeterol
-used for moderate-severe asthma
-NEVER for acute attacks
mast cell stabilizer drug
cromolyn
cromolyn MOA
stabilize membranes of mast cells and prevent release of broncho-constrictive inflammatory substances
-used for prevention of acute asthma attacks (15-20 mins prior to known triggers)
monoclonal antibody anti asthmatic drug
-omalizumab
omalizumab MOA
-monoclonal antibody which selectively binds to immunoglobulin IgE- limits the release of mediators of allergic response
omalizumab
-must be monitored closely for hypersensitivity reactions
-given via injection
-indicated for add on therapy for asthma
selective PDE4 inhibitor
-drug: rofumilast
-MOA: selectively inhibits PDE4 enzyme in the lung cells
-indicated for prevention of COPD exacerbations
-given orally
-SE: N/V/D, headache, muscle spasms, decreased appetite, uncontrollable tremors
