Oxygenation Flashcards
Types of Bronchodilators
beta-2 agonists
anticholinergics
methylxanthines
types of anti-inflammatory drugs r/t oxygenation
glucocorticoids leukotriene modifiers mast cell stabilizers monoclonal antibodies phosphodiesterase inhibitors
beta-2 agonists MOA
act by relaxing bronchial smooth muscle which results in dilation.
SABA characteristics
onset is immediate
via nebulizer often
for acute asthma attacks
SABA prototype
Albuterol (Proventil HFA)
LABA characteristics
prevention, maintenance.
never used as a monotherapy. instead used with a glucocorticoid.
NOT PRN, but scheduled.
LABA prototype
Salmeterol
SE of beta-2 agonists
tachy, tremors, palpitations, angina
Anticholinergics r/t oxygenation
blocks the PNS
anticholinergics prototype
Ipratropium (atrovent). typically ordered with albuterol, additive effect.
Ipratropium characteristics
onset is in 30 secs, peaks in 3 mins, 1/2 of 6 hrs.
SE of ipratropium
dry mouth, irritation of pharynx. contraindicated in pt. with a peanut allergy and with glaucoma.
Methylxanthines characteristics
not really used anymore. hard to take. narrow safety margin. chemically related to caffeine
Methylxanthines prototype
theophylline
Theophylline characteristics
oral admin, therapeutic levels 10-20 mcg/mL, NO SMOKING. 1/2 life varies, 2-15 hrs. D-D interactions!
aminophylline (somophyllin) admin
slowwww IV administration.
glucocorticoids (r/t oxygenation)
suppress inflammation
glucocorticoid prototype
beclomethasone
inhaled glucocorticoids
used as a daily prevention
little to no systemic effects
may take 1-4 wks to reach full effects
SE: adrenal suppression, candidiasis, dysphonia
oral/IV glucocorticoids
acute bronchoconstriction
prednisone (oral)
methylpredisone (solumedrol)– IV
transition from oral to IV can be tricky! may have to take both for a little while.
Acute asthma and glucocorticoids
high dose solumedrol for several days with or without oral therapy at home.
Leukotrienes
important in the inflammatory response resulting in edema, inflammation and bronchoconstrictions.
Leukotriene modifiers prototype
Montelukast (singulair)
ex: zafirloblast (accolate), zileuton (zyflo)
Singulair (montelukast) characteristics
PO daily
used for prophylaxis of chronic asthma
NOT effective for acute attacks
maximal effects develop within 24 hrs of 1st dose
SE: neuropysch effects (depression and suicide)
Mast Cell Inhibitors MOA
inhibits mast cells from releasing histamine and other chemical mediators of inflammation. prevention by decreasing inflammation.
Mast cell inhibitors prototype
cromolyn (intal).
Cromolyn characteristics
rebound bronchospasm if stopped abruptly. admin by nebulizer. SE: cough and broncospasm
Monoclonal antibodies prototype
Omalizumab (Xolair)
Omalizumab characteristics
binds to IgE in the body
for severe persistent asthma
injected subq 2-4 weeks
Omalizumab SE
viral infections, URI, sinusitis, headache, injection site response. serious: Anaphylaxis
Phosphodiesterase type 4 inhibitor MOA
blocks action of an enzyme that breaksdown cAMP resulting in decreased release of inflammatory mediators
PDE4 inhibitor prototype
Roflomilast
PDE4 indications
severe COPD with chronic bronchitis
SE of PDE4 inhibitors
loss of appetite, weight loss.
Serious: psych effects– anxiety, depression, suicide
Preventers of Allergic Rhinitis
Antihistamines
Intranasal glucocorticoids
Mast Cell stabilizers
Relievers of Allergic Rhinitis
oral and nasal decongestants
Antihistamines characteristics
1st line therapy for mild/med seasonal allergies
most effective when taken prophylactically
antihistamine prototype 1st gen
diphenhydramine. will cause sedation
antihistamine prototype 2nd gen
loratadine (claritin). not as much sedation.
intranasal glucocorticoids characteristics
most effective for seasonal allergies
admined with a metered dose spray device
action and SE: limited to nasal passages
SE: burning/drying sensations, epistaxis
Intranasal glucocorticoids prototype
Fluticasone (Flonase)
decongestants
sympathomimetics. stimulate nervous system to relieve nasal congestion (alpha 1 agonist)
decongestant oral admin
slower onset of action
SE: HTN, CNS stimulation. should not be used in cardiac pts.
decongestant oral admin prototype
pseudoephedrine (sudafed). can make meth out of this. so use phenylephrine (Sudafed PE). not as effective
decongestant nasal admin
risk for rebound congestion. causes escalating congestion requiring more drug to get the same results. don’t take more than 3-5 days
intranasal decongestant prototype
oxymetazoline (afrin)
Antitussive types
Opioid: codeine
nonopioid: dextromethorphan (robutussin). most frequently used form
opioids used for coughs
1/10th of the level for pain mgmt
usually a combo drug
expectorants
increase bronchial secretions.
stimulate flow of secretions
prototype: guaifenesin
mucolytics
makes mucus more watery, more productive cough.
prototype: acetylcyestine (mucomyst)
also, 3% NS in a neb!
