Pharmacology Flashcards
SABA include example drug, MOA, indications, and side effects
Albuterol
stimulation of the beta-2 adrenergic receptors ny relaxing smooth muscle
Acute bronchoconstriction
tachycardia, tremor, hyperglycemia, hypokalemia, hypomagnesemia
LABA include example drug, MOA, indications, and side effects
Formoterol
Salmeterol
direct long acting beta 2 seletive agonists; Lasts for 12 hours via MDI dry powder inhaler. Faster than salmeterol
used for management of respiratory disorders such as asthma, COPD. highly efficacious when combined w/ asthma controller medication inhaled corticosteroid.
not recommended as mono therapy may cause death
inhaled corticosteroids include example drug, MOA, indications, and side effects
Fluticasone
Budesonide
Inhibit phospholipase by preventing the release of arachadonic acid and inflammation
Daily use to reduce airway inflammation
side effects: Sneezing, itching, rhinorrhea, sore throat, nosebleed, and nasal congestion Trush, hoarse voice
Systemic corticosteroid include example drug, MOA, indications, and side effects
Inhibit effect of phospholipase A2, preventing the release of arachadonic acid and subsequent inflammation
Asthma exacerbation
not
Last resort permanent daily dosing for patients with severe asthma refractory to any other treatments
Usually prednisone or methylprednisolone in a 5-day burst; longer courses may require tapering dose to prevent HPA-axis suppression and adrenal crisis
Can be administered PO (common), IV (preferred in emergent situations), or IM (solumedrol- last longer)
leukotriene inhibitors include example drug, MOA, indications, and side effects
montelukast
Prevents the binding of leukotrienes and smooth muscle constriction, neutrophil/eosinophil migration and edema
Asthma + Exercise induced bronchospasms
LFT elevation, headache,dyspepsia, behavioral changes in children
Not to be used when immediate bronchodilation is required
mast cell stabilizer include example drug, MOA, indications, and side effects
Cromolyn
Prevents degranulation and release of histamine to prevent inflammation
Mild-persistant asthma, NOT acute
Cough, irritation,unpleasant taste
anticholinergics (inhaled) include example drug, MOA, indications, and side effects
Ipratropium (atrovent)
Block muscular constriction of airways from vagal nerve stimulation
Used in acute management of bronchospasm in asthma and chronic management delivered via inhalation
local anticholinergic effects, bitter taste
Long acting anticholinergics include example drug, MOA, indications, and side effects
Tiotropium (spiriva)
block vagal nerve mediated bronchoconstriction
Bronchodilators for maintenace treatment of bronchospasm associated w/ COPD Used in acute management of bronchospasm in asthma and chronic management
anticholinergic effects
PDE-4 inhibitor include example drug, MOA, indications, and side effects
Roflumilast
Reduces intracellular cAMP to decrease inflammation
COPD
weight loss, nausea, vomiting, headaches, diarrhea
cough suppressant include example drug, MOA, indications, and side effects
Guaifenesin- reduces the viscosity of secretions Mucous Cough secretions can settle in smaller airways
Benzonatate- Numbs stretch receptors to reduce cough Cough dizziness, numbness of mouth/throat
H1 receptor blocker include example drug, MOA, indications, and side effects
allergic rhinitis
Loratadine- 2nd generation antihistamine nonsedating. Metabolized by the hepatic cytochrome p450 system. recommended for individuals working in jobs where wakefulness is critical
Cetirizine (zyrtec)- 2nd generation antihistamine weak potential for producing sedation. allergies
Fexofenadine- 2nd generation non sedating (sedation less common don’t enter CNS specific for peripheral receptors) antihistamine recommended for individuals working in jobs where wakefulness is critical. for Sneezing, watery rhinorrhea, itchy eyes/nose
alpha adrenergic agonist include example drug, MOA, indications, and side effects
Pseudoephedrine (Sudafed)- can be used to produce meth
Oxymetazolone (afrin)- Don’t use for greater than 3 days rebound congestion and dependence occurs
constriction of arterioles in periphery
allergic rhinitis
tachycardia, tremors, dry mouth, dryneyes
Theophylline
bronchodilator
Chronic asthma
narrow theraputic window, seizures, fatal heart arrhythmias, interacts with CYP450
Numerous drug interactions (not listed)
Omalizumab
Anti-IgE antibody, binds with IGE to prevent it binding to mast/basophils
uncontrolled moderate to severe asthmatics
anaphylactic reaction, joint pains, fever, rash, increased risk secondary malignancies
Diphenhydramine-
1st generation. Inhibit anticholinergic increasing dry mouth, urinary retention, and causing sinus tachycardia. treat motion sickness and insomnia
1st generation. Inhibit anticholinergic increasing dry mouth, urinary retention, and causing sinus tachycardia. used to treat motion sickness and insomnia sedation and short duration. paroxical hyperactivity in young children, fatigue dizziness, lack of coordination, contact dermatitis, tremors particularly in elderly. Contraindicated in individuals working in jobs in which wakefulness is critical Decrease effectiveness of cholinesterase inhibitors in treatment of Alzheimer’s.
treating COPD
bronchodilator:
anticholinergic ipratropium bromide & SABA (short-acting beta agonist). 1st line (2-4 puffs 36-72 mcg every 6 hours). anticholinergic ipratropium bromide (preferred to SABA) due to:
-longer duration of action
-absence of sympathetic side effect
SABA (albuterol, metaproterenol- MDI or inhalation solution by nebulizer)
-less expensive
-more rapid onset greater pt satisfaction
-at max dose= action equivalent of ipratropium
but may cause: tachycardia, tremor, hypokalemia
LABA (formo-, salme-, indaca-, aformo-, vilan- + -terol) + LAMA (tiotrop-, aclidin-, umeclidin- + -ium)
(long-acting bronchodilators)
-achieve same or superior bronchodilation compared to ipratropium
+ similar improvement in health status
-symptomatic benefits (expensive but superior clinical efficacy in persons w/ advanced disease but no effect on long-term decline in lung function)
Combination: tiotropium and formoterol improve FEV1 and FVC more thatn corticosteroid/LABA (salmeterol and fluticasone)
Salmeterol alone lowers mortalitly and fewer cardiovascular events
corticosteroids:
reduction in frequency of COPD exacerbation
-increase in self-reported functional status but oral not recommended for long-term
-No effect on mortality or decline in lung function; but is when combined with LABA
theophylline:
- oral (bronchodilation, anti-inflammatory properties, extrapulmonary effects on diaphragm strength, myocardial contractility, and kidney function)
- for pts who do NOT achieve symptom control from anticholinergic, beta-2 agonist, & corticosteroid therapy
- Should not be given in an acute setting in the hospital
- improves hemoglobin saturation during sleep (used as first line for sleep-related breathing disorders)
- improves dyspnea, pulmonary function, exercise performance
- NARROW therapeutic window
phosphodiesterase 4 inhibitor
roflumilast
-reduce exacerbation frequency
-mod-severe COPD (FEV1 <50%) and chronic bronchitis and are taking LABA/inhaled corticosteroid
antibiotics:
doxycycline (every 12h), trimethoprim-sulfamethoxazole ( every 12 hours), a cephalosporin (eg, cefpodoxime or cefprozil every 12 hours), a macrolide (eg, azithromycin daily for 5 days), a fluoroquinolone (eg, ciprofloxacin every 12 hours), and amoxicillin-clavulanate (every 12 hours). Suggested duration of therapy is 3–7 days and depends on response to therapy; some studies suggest that 5 days is as effective as 7 days but with fewer adverse effects.
Azithromycin has been shown to have anti-inflammatory properties in the lung
