Obstructive Pulmonary Pharmacology (Exam 1b) Flashcards by Isaiah Smith

Class of medications that dilate the bronchioles

-Beta2-adrenergics

-Inhaled Anticholinergics

-Xanthine derivatives

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Class of medications that decrease bronchial inflammation

-Glucocorticoids

-Mast cell stabilizer

-LTRA’s

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Bronchodilators

Used to treat all respiratory disease

Work by relaxing bronchial smooth muscle (causing dilation)

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Beta-Adrenergic Agonists (Bronchodilator)

-Can be long or short acting

-Usually end in -erol (both short and long)

-Crucial to know if it short or long acting

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Short Acting Beta Adrenergic Agonists

-Albuterol (PO/Inhalant)

-Levalbuterol Inhalant

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Long Acting Beta-Adrenergic Agonists

-Salmeterol

-Formoterol

All long acting are in form of inhalant

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Short Active vs Long acting inhalation

-Most B2 agonist are short acting (SABA)

-SABA are Rescue drugs

-Duration = 4-6 H

-Long acting B2 agonist are preventer drugs

-Duration = 12-24 H

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Beta-adrenergic Agonist: MOA

Mimic action of SNS –> Flight or fight

Relax and dilate the ariways by stimulating the Beta 2 adrenergic receptors throughout the lungs

Causing bronchial dilation and increased airflow into and out of the lungs = goal

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Beta-adrenergic agonist: Indications

Prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions

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Beta-adrenergic agonist: NSG considerations

Can be given with beta blocker, but may diminish effects (give more)

Avoid use with MAOI and sympathomimetics (ephedrine/sudafed) increase risk of HTN

Diabetics may need higher doses of meds because raises blood sugar

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Beta-adrenergic agonist: contraindications

Uncontrolled HTN, cardiac dysrhythmias, high risk of stroke

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Beta-adrenergic agonist: Adverse effects

hyper or hypo tension

bronchospasm

insomnia
restlessness
anorexia
cardiac stimulation
HA

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Inhalers are given

minimize systemic side effects

Don’t see cardiac and htn problems as much because we are just aim at the beta 2 receptors in the lungs

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Inhaler PDF on canvas

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Selective Beta Agonist: Albuterol

-Short-acting beta2 agonist (SABA): onset is mins

-Inhalation Q4-6H

-Rescue drug

-Delivery method: MDI or nebulizer —> FIRST line of treatment for acute asthma attack

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Albuterol: Rescue Drug

Use of more than on canister per month indicates inadequate control of asthma and need for initiating or intensifying anti-inflammatory therapy

(200 actuations per canister)

Also used for prevention of EIA (Exercise induced asthma)

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Albuterol: Indications

Treatment of COPD umbrella

Acute episodes of wheezing, chest tightness, and SOA

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Salmeterol: class

LAB2A

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Salmeterol: Indications

Not for acute treatments –> it is a maintenance drug

Worsening of COPD

Moderate - Severe asthma

Always given with an inhaled corticosteroid, no indicated for monotherapy

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Key Point: Salmeterol

Always given with an inhaled corticosteroid, not indicated for monotherapy

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Salmeterol: Warning

Has been associated with increased asthma-related deaths (more common in black AA’s)

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Anticholinergics

Still type of bronchodilators —> instead of working on beta receptors this works on acetylcholine receptors

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Giving Anti-Cholinergic agents results in

-Turning off cholinergic response (PNS) and turning on SNS

-SNS dominates = Bronchodilation (Thus increasing perfusion to heart, lungs, and brain)

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Anticholinergic: KEY point

-By blocking the effects of acetylcholine (anticholinergic drugs), we INHIBIT the normal physiological response

-Less Bronchoconstriction and less mucus production

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ipratropium: class

Anticholinergics

ipratropium: MOA

Blocks action of acetylcholine = creates bronchodilation (by preventing bronchoconstriction)

ipratropium: Indications

Used for PROPHYLAXIS and maintenance (not rescue drug) Given in combination with albuterol

ipratropium: Adverse Effects

Dry as bone Hot as a hare Blind as a bat Red as a beet Mad as a hatter Urinary retention - DRY everything - Sedation/confusion - Blurred vision - Tachycardia - Feeling hot and decrease sweating

Xanthine Derivatives (Bronchodilators)

theophylline aminophylline

Xanthine Derivatives: MOA

Increasing levels of the cAMP enzyme by inhibiting phosphodiesterase (Stimulates CNS and CVD system) Used a second line treatment because of the high risk of toxicity and drug-drug interactions

Xanthine Derivatives: Indicaitons

Preventative treatment of asthma attacks and COPD exacerbation

Xanthine Derivatives: SE

-Toxicity --> N/V/D, insomnia, tachy, seizures (Elderly)

Xanthine Derivatives: Contraindications

Uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers

Xanthine Derivatives: Interactions

Caffeine may increase SE (Theophylline) Smoking may decrease absorption

Xanthine Derivatives: NSG condsiderations

Has narrow TPI --> monitor serum level and watch for toxicity. If becoming toxic you can use activated charcoal Lots of drug interactions

Anti-Inflammatories COPD drugs

LTRA's Inhaled corticosteroids Mast cell stabilizers

Leukotriene receptor antagonist (LTRA) drugs

montelukast zafirlukast

Leukotriene Receptor antagonist: MOA

LTRA's prevent leukotrienes from attaching to receptors located on immune cells and within the lungs --> prevents inflammation

LTRA: Indication

Used for oral prophylaxis and chronic treatment of asthma in adults and children Not used in asthma attacks

LTRA: Adverse effects

Headache, nausea, dizziness, insomnia, and diarrhea

Which LTRA has more drug-drug interactions

Zafirlukast has more drug-drug interactions vs Montelukast

LTRA's and kids

-Montelukast can be given to kids over twelve months but zafirlukast can only be given to kids over 5 yrs

Inhaled Corticosteroids

beclomethasone budesonide fluticasone

Inhaled corticosteroids: MOA

-Reduces inflammation and enhance activity of beta agonists (also help with bronchodilation)

Inhaled corticosteroids: Consideration

PO corticosteroids work immediately and can be used in emergent situations. Inhaled can take several weeks of continuous therapy before full effect of the steroids are realized

Are inhaled corticosteroids a rescue drug?

NO They are given for prevention of persistent asthma attacks and long term maintenance of severe COPD For asthma - teach to take on regular schedule, not PRN and give the bronchodilator first to allow more thorough absorption of the steroid

Inhaled Corticosteroids: Adverse Effects

Pharyngeal irritation, cough, dry mouth and oral fungal infections RINSE MOUTH AFTER USE

Combinations of inhaled glucocorticoid and bronchodilator

budesonide and formoterol fluticasone and salmeterol Used for moderate to severe asthma

Combination of Inhaled GCS and Bronchodilator: Key teaching

Are never for acute attacks Give bronchodilator first so better absorption for steriods

Mast cell stabilizer

cromolyn

cromolyn all

Stabilize membranes of mast cells and prevents release of broncho-constrictive inflammatory substances used 15-20 min prior to know trigger. (not rescue)

monoclonal antibody anti-asthmatic

omalizumab

Newest generation of anti asthmatic indicated for add on therapy (never byself) given via injection

omalizumab: MOA

Monoclonal antibody which selectively bind to immunoglobulin IgE --> limits the release of mediators of allergic response

omalizumab: big risk

Must be monitored closely for hypersensitivity reactions (anaphylaxis is big risk)

Selective PDE-4 inhibitor

roflumilast

roflumilast: MOA

Selectively inhibits PDE4 enzyme in the lung cells Potent anit-inflammatory effects within the lungs

roflumilast: indications

for prevention of COPD exacerbations (not for acute/immediate action)

roflumilast: SE

N/V/D -Decrease appetite -Uncontrollable tremors and muscle spasms

Long term Control Medications

1. Anticholinergics 2. Xanthine derivative 3. Inhaled corticosteroids 4. Leukotriene modifiers 5. Mast cell stabilizers 6. LABA

Quick-releif medications: Rescuse

1. SABA Albuterol / Levalbuterol