Pulm Drugs Flashcards
Examples of short acting beta agonists
Albuterol (Ventolin, ProAir, Proventil)
Levalbuterol (Xopenex)
onset and Duration of short acting beta agonists
~5 minutes
3-4 hours
Examples of long acting beta agonists
Salmeterol (Serevent)
Onset and Duration of long acting beta agonists
15-20 minutes, >12 hours
Formulation os beta 2 agonist
- inhaler
2. solution for nebulizer
beta 2 agonist MOA
stimulates beta 2 receptors in bronchial smooth muscle –> relaxation of bronchial smooth muscle –> larger diameter airway
side effects of long term use of beta 2 agonists
- tachycardia
- anxiety
- tremor
Indications of beta 2 agonists
Relief of bronchospasm in asthma, COPD, anaphylaxis
Indications for beta 2 agonists in asthma
- prevention of exercise induced asthma
- rescue for acute bronchospasm
- long acting beta agonist for prevention in combo w/ inhaled steroid
beta 2 agonist contraindications
caution with conditions in which tachycardia is undesirable (severe CAD, aortic stenosis)
Beta 2 agonists side effects
tachycardia! palpitations! tremor! headache dizziness nausea (back to back treatments) hypokalemia hyperglycemia
when do you need to something in addition to SABA
using SABA more than 8 days a month or more than 2 times a week
medication given after SABA
daily inhaled corticosteroid
Inhaled corticosteroid examples
Budesonide (Pulmicort)
Mometasone (Asmanex)
Fluticasone (flovent, Arnuity Ellipta)
Inhaled corticosteroid MOA
decreases inflammation, decreases eosinophils
Inhaled corticosteroid route of administration
- aerosol
- dry power
- liquid for nebulizer
Inhaled corticosteroid Indications
asthma (long term control)
COPD
off label for Eosinophilic esophagitis
Inhaled corticosteroid Contraindications
No major CIs
Inhaled corticosteroid side effects
- oral candidiasis
- dysphonia/hoarseness
- sore throat
- dry mouth
- high doses –> osteoporosis, cataracts, same as systemic steroids
Inhaled anticholinergics examples
- Ipratropium (Atrovent Nasal Inhibitor)
- Ipratropium+albuterol/Combivent - Tiotropium/Spiriva
- Umeclidinium
Inhaled anticholinergics MOA
block muscarinic receptors –> bronchodilation and reduced nasal secretions
Inhaled anticholinergics Indications
COPD
treatment of acute asthma flare associated with respiratory infection (not first line)
Bronchitis
Ipratropium route of administration
inhaled
Ipratropium onset and duration of action
30-90 minutes, ~6 hours
Tiotropium dosing
once daily
Inhaled anticholinergics side effects
- nosebleeds
- nasal irritation
- sore throat
- can worsen angle closure glaucoma
- can worsen urinary retention
Inhaled anticholinergics cautions
glaucoma
urinary retention
(very drying)
Leukotriene Receptor Antagonists Indications
- prevention of persistent asthma (not first line)
- exercise induced bronchospasm
- allergic rhinitis
Leukotriene Receptor Antagonists CI
- acute liver disease or any impaired liver function
2. not used for acute asthma
Leukotriene Receptor Antagonists MOA
blocks inflammatory response –> reduces bronchoconstriction, decreases inflammation
Leukotriene Receptor Antagonists Examples
Montelukast (Singulair)
dosing for Montelukast
once a day
Leukotriene Receptor Antagonists S/E
headache
gastritis/GI upset
Rare but serious: Churg-Strauss syndrome
Methylxanthine Examples
Theophylline
Methylxanthine MOA
relax smooth muscle in bronchial airways and relax pulmonary blood vessels
Methylxanthine Indications
like 10th line for asthma and COPD
Methylxanthine CIs
- active or symptomatic coronary heart disease
- smokers
- geriatric patients
Methylxanthine S/E
- N/V
- headache
- insomnia
- tremor
- seizure
- restlessness
- irregular heartbeat
- palpitations
- tachycardia
Disadvantage of theophylline
narrow therapeutic index
need ongoing serum levels every 6-12 months
Mast Cell Stabilizers indications
- conditions with allergy component (asthma, rhinitis, conjunctivitis)
- systemic mastocytosis
- adjunct therapy (NOT acute therapy)
Mast Cell Stabilizers CI
none
Mast Cell Stabilizers MOA
prevents degranulation of mast cells which blocks release of proinflammatory factors
Mast Cell Stabilizers Example
Cromolyn sodium (Nasal Crom)
Mast Cell Stabilizers S/E
generally well tolerated
cough from throat irritation
nasal irritation
When would you consider Mast Cell Stabilizers for asthma pt
if not getting good control with regular progression and you think there is an allergy component
Considerations with Mast Cell Stabilizers
- do not provide bronchodilation so not useful in acute asthma attack or allergy symptoms that have already started
- delivered topically. low oral bioavailability
Monoclonal Antibodies indications
add on maintenance treatment of patients with severe asthma with an eosinophilic phenotype
Intranasal steroids examples
- Fluticasone (Flonase/Veramyst)
2. Mometasone (Nasonex)
disadvantage of intranasal steroids
sometimes takes weeks to get benefits, requires continuous dosing to see response
Intranasal steroids indications
- allergic rhinitis
2. nasal congestion
