opd pharm Flashcards
bronchodilators
beta 2 agonists
anticholinergics
xanthine derivatives
antiinflammatories
LTRAs
inhaled glucocorticoids
mast cell stabilizers
bronchodilators
all resp disease
work by stimulating beta 2 adrenergic receptors in lungs relaxing bronchial smooth muscle - cause dilation of bronchi/bronchioles and increased airflow
mimic sns (fight or flight)
beta adrenergic agonists
long or short acting
-erol
asthma attack = short term only
short acting beta
albuterol (PO/inhaled)
levalbuterol (inhalant)
q4-6hr, rescue drugs
long acting beta
selmetrol
formoterol
all inhalant
q12 - 14hr, preventer
non selective adrenergic drugs
stimulate beta 1 and 2 and alpha (epinephrine)
alpha: vasoconstriction (decrease edema/swelling in mucous membranes, limit secretions)
beta 1: CV effects - increased BP and HR
more SE with non selective
CNS stim - nervousness/tremors
non selective beta adrenergic
stimulate beta 1 and 2
metaproterenol
selective beta 2
albuterol
preferred med to treat pulmonary conditions
beta adrenergic agonist: I
prevent or relieve bronchospasm related to asthma/bronchitis/other pulmonary conditions
and conditions outside the pulmonary system
CI: uncontrolled htn, cardiac dysrhythmias, high risk for stroke
beta adrenergic agonist: nc
can be given with beta blockers but may diminish effects (prefer inhaled and selective, may need higher dose of BB)
avoid MAOIs and sympathomimetics bc htn (ephedrine)
diabetics may need higher doses of insulin bc raises bp
beta adrenergic agonist: SE
non selective have most
beta 2 = htn or hypoT
can reverse overdose with beta blocker but watch for bronchospasm
short half life - effects go away quickly
insomnia, restlessness, anorexia, cardiac stim, hypergly, tremor, vascular HA
why inhaled
minimize systemic SE (htn and HR issues)
MDI: inhale slow and deeply
DPI: breath activated, easier to use, better for cognitive issues and younger pt
neb: hospital, acute exacerbation
albuterol
selective beta agonists
onset in minutes
inhale q4-6, rescue
MDI or neb, first line for acute asthma
I: asthma, bronchitis, emphysema; acute wheezing, chest tightness, SOA
>1 canister/mo = inadequate control of asthma, need to start or intensify anti inflam therapy, 200 pushes, regular scheduled daily use not recommended
also prevent EIA
salmeterol
long acting beta 2 agonist agent
not for acute treatments - maintenance drug
2x/day via DPI
associated with increased asthma related deaths (AA)
I: worsening asthma or COPD
always given with inhaled corticosteroid not given alone
anticholinergics
work on acetylcholine receptors
turn off pns and turns on sns (bronchodilates), increase perfusion to heart, lungs, brain
block acetylcholine and inhibit normal phys response - bronchoconstriction and increased mucus
ipratroprium
anticholinergic
prophylactic and maintenance (not rescue)
usually given in combo with albuterol
ipratroprium: SE
anticholinergic effects
sedation, dizzy, confusion, hallucinations, urinary retention, dry mouth and throat, constipation, feel hot, decreased sweating, tachy, blurred vision, dry eyes
dry as a bone, hot as a hare, blind as a bat, red as a beet, mad as a hatter
xanthine derivatives
theophylline and aminophylline
increase levels of cAMP enzyme by inhibiting phosphodiesterase - stimulate CNS and CVD system
second line bc high toxicity and drug interactions
prevent asthma attacks and COPD exacerbation (not rescue)
xanthine derivatives: SE
toxicity: n/v/d, insomnia, HA, tachy, dysrhythmias, seizures (more common in elderly)
xanthine derivatives: CI and interactions
CI: uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers
Interactions: caffeine may increase SE, smoking decreases abs; macrolide abx, allopurinol, cimetidine, quinolones, flu vax, oral contraceptives
narrow therapeutic index: monitor serum levels and watch for tox (reverse with activated charcoal)
leuokotriene receptor antagonists
montelukast (>12 mo) and zafirlukast (>5yr)
leukotrienes cause inflam, chroncostriction and mucus production
moa: prevent leukotrienes (released from mast cells) from attaching to receptors on immune cells in lungs and prevent inflam
given PO - chewable tablets and granules, improve in 1 wk
prophylaxis and chronic, and allergies, not rescue
leuokotriene receptor antagonists: SE
HA, n/d, dizzy, insomnia,
M: few drug drug interactions
Z: lots if I
inhaled corticosteroids meds
beclomethasone diproprionate
budesonide
fluticasone
inhaled corticosteroids
can be PO for COPD exacerbation and others unless getting worse
limit systemic SE - neb or MDI
moa: reduce inflam and enhance beta agonist (combo therapy)
can take several weeks before full effect if inhaled, PO instant
not rescue
asthma - take on regular schedule, give bronchodilator first to allow more abs of steroid
inhaled corticosteroids SE
pharyngeal irritation, cough, dry mouth, oral fungal infections - rinse mouth after
combos: inhaled glucocorticoid and bronchodilator
mod - severe asthma (not acute attack!)
budesonide and formoterol - minutes
fluticasone and salmeterol - longer
both have long half life
mast cell stabilizer
stabilize membranes of mast cells and prevent release of broncho constrictive inflam substances
used for prevention of attack 15 -20 min before known trigger, still not rescue
cromolyn
monoclonal antibody antiasthmatic
omalizumab
newest gen of antiasthmatic
add on therapy
moa: selectively binds to immunoglobulin IgE -> limit release mediators of allergic response
given via injection
monitor closely for hypersensitivity reactions (anaphylaxis big risk)
selective PDE 4 inhibitor
roflumilast
moa: inhibit PDE4 in lung cells - anti inflam
prevent COPD exacerbation - not acute
oral
good for chronic bronchitis w hx of lots of exacerbations
SE: n/v/d, HA, muscle spasms, decreased appetite, uncontrollable tremors
long term control meds
anticholinergics
xanthine derivative
inhaled corticosteroids
leukotriene modifiers
mast cell stabilizers
LABA
rescue meds
SABA
albuterol
