Obstructive Pulmonary Pharmacology (Exam 1b) Flashcards
Class of medications that dilate the bronchioles
-Beta2-adrenergics
-Inhaled Anticholinergics
-Xanthine derivatives
Class of medications that decrease bronchial inflammation
-Glucocorticoids
-Mast cell stabilizer
-LTRA’s
Bronchodilators
Used to treat all respiratory disease
Work by relaxing bronchial smooth muscle (causing dilation)
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
Short Acting Beta Adrenergic Agonists
-Albuterol (PO/Inhalant)
-Levalbuterol Inhalant
Long Acting Beta-Adrenergic Agonists
-Salmeterol
-Formoterol
All long acting are in form of inhalant
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
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
Beta-adrenergic agonist: Indications
Prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions
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
Beta-adrenergic agonist: contraindications
Uncontrolled HTN, cardiac dysrhythmias, high risk of stroke
Beta-adrenergic agonist: Adverse effects
hyper or hypo tension
bronchospasm
insomnia
restlessness
anorexia
cardiac stimulation
HA
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
Inhaler PDF on canvas
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
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)
Albuterol: Indications
Treatment of COPD umbrella
Acute episodes of wheezing, chest tightness, and SOA
Salmeterol: class
LAB2A
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
Key Point: Salmeterol
Always given with an inhaled corticosteroid, not indicated for monotherapy
Salmeterol: Warning
Has been associated with increased asthma-related deaths (more common in black AA’s)
Anticholinergics
Still type of bronchodilators —> instead of working on beta receptors this works on acetylcholine receptors
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)
Anticholinergic: KEY point
-By blocking the effects of acetylcholine (anticholinergic drugs), we INHIBIT the normal physiological response
-Less Bronchoconstriction and less mucus production
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
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
- Anticholinergics
- Xanthine derivative
- Inhaled corticosteroids
- Leukotriene modifiers
- Mast cell stabilizers
- LABA
Quick-releif medications: Rescuse
- SABA Albuterol / Levalbuterol
