Oxygenation Flashcards
How long between puffs
Bronchodilator: 1 min
Glucocorticoid: 5 min
An inhaler with a spacer delivers [more or less] drug to the lungs
more
Categories of bronchodilators
- Beta2 Agonists
- ## Anticholinergics
Beta2 Adrenergic Agonists ending
-terol
Fastest acting bronchodilators
sympathomimetics: beta2 adrenergic agonists
SABA prototype and when used
albuterol (Proventil HFA) used for asthma attack with immediate onset
LABA prototype and when used
Salmeterol (Servent Diskus) never used as monotherapy, on a fixed schedule, used for prevention
SE of Beta2 Adrenergic Agonists
tachycardia, tremors, palpitations, angina, tolerance (typically not SE with occasional use)
Anticholinergics mechanism of action
blocking parasympathetic nervous system
Anticholinergic prototype
Ipratropium (atrovent)
SE of anticholinergics like Ipratropium (Atrovent)
dry mouth, irritation of pharynx
Contraindications for anticholinergics like Ipratropium (Atrovent)
peanut allergy, glaucoma
Theophylline drug class
Methyxanthines
Are methylxanthines like theophylline used in standard therapy?
Nope, it’s a hard drug to take and there are better options.
Anti-inflammatory drug categories (respiratory)
- glucocorticoids
- leukotriene modifiers
- mast cell stabilizers
- monoclonal antibodies
- phosphodiesterase inhibitors
glucocorticoid prototype
Beclomethasone (QVAR, Beclovent, Beconase, Vancenase, Vanceril)
Inhaled glucocorticoids SE
adrenal suppression, candidiasis, dyphonia
Managing candidiasis in inhaled glucocorticoids
take it last, rinse mouth
Oral/IV options for glucocorticoids
Solumedrol (IV) and prednisone (oral) used for acute bronchoconstriction, but not a rescue!
Leukotriene modifiers
Montelukast (Singulair)
Leukotriene (montelukast-singulair) teaching points
prevention, not effective for acute attacks, PO daily, neuropsych effects (depression/suicide)
Mast cell stabilizer prototype
cromolyn (intal)
Monoclonal antibody prototype
Omalizumab (Xolair) for severe, persistent, allergic asthma not controlled by high dose steroids
Omalizumab (Xolair) SE
viral infections, URI, sinusitis, headache, injection site response, anaphylaxis
Omalizumab (Xolair) route
subcut
Phosphodiasterase type 4 (PDE4) Inhibitor
Roflumilast
PDE4 mechanism of action
blocks PDE4 enzyme that breaks down cAMP resulting in decreased release of inflammatory mediators
1st gen antihistamine
diphenhydramine (Benadryl)
sedation, anticholinergic
2nd gen antihistamine
loratadine (clairitin)
intranasal glucocorticoids
flonase SE usualy in nasal passages. keep spray off septum and throat
sympathomimetic decongestants
alpha 1 agonist: pseudoephedrine (Sudafed)
Contraindications/SE of sympathomimetics
Cardiac patients. SE HTN, insomnia
Intranasal sympathomimetics
Oxymetazoline (Afrin)
Teaching for Afrin (oxymetazoline)
rebound congestion risk if used longer than 3-5 days. Can stop cold turkey, one nostril, or tapering in intranasal glucocorticoids
Opoid antitussive
codeine
Nonopoid antitussive
dextromethorphan (Robitussin) but can give euphoria if used in high doses
Is stopping a cough always beneficial?
No. Getting the junk out is a good thing. Reserve for sleep or if interrupting daily life.
Expectorants
stimulate flow of secretions: guaifenesin (Mucinex)
Mucolytics
make mucus more watery and cough more productive: acetylcysteine (Mucomyst) or hypertonic saline
