Pulm & Heme Drugs Flashcards
Albuterol Class
SABA
Terbutaline Class
SABA
Salmeterol Class
LABA
Chromolyn sodium Class
mast cell stabilizer
Omalizumab Class
immunodilator
Zafirlukast Class
leukotriene modifier (LTRA)
Montelukast Class
leukotriene modifier (LTRA)
Zileuton Class
leukotriene modifier (LTRA)
Prednisone Class
oral glucocorticoid
Beclomethasone Class
inhaled glucocorticoid (ICS)
Budesonide Class
inhaled glucocorticoid (ICS)
Fluticasone Class
inhaled glucocorticoid (ICS)
Ipratropium Class
Short-acting anticholinergic
Tiotropium Class
Long-acting anticholinergic
Nicotine patch, lozenge, gum, inhaler, spray Class
nicotine replacement
Varenicline Class
nicotine partial agonist
Buproprion Class
antidepressant
Diltiazem Class
calcium channel blocker
Verapamil Class
calcium channel blocker
Epoprostenol Class
prostacyclin analog
Bosentan Class
endothelin receptor antagonist
Sildenafil Class
phosphodiesterase inhibitor
Roflumilast Class
phosphodiesterase inhibitor
Unfractionated heparin (UFH) Class
antithrombin agent
Low molecular weight heparin (LMWH) Class
antithrombin agent
Fondaparinux Class
antithrombin agent
Warfarin Class
oral anticoagulant
Pirfenidone Class
drugs in IPF
Nintenadib Class
drugs in IPF
Albuterol, terbutaline, Salmeterol mechanism
bronchodilator
Chromolyn sodium mechanism
prevents the release of histamine, etc, from mast cells
Omalizumab mechanism
IgE binding in circulation
Zafirlukast, Montelukast mechanism
leukotreine D4 (LTD4) receptor antangonist
Zileuton mechanism
inhibits 5-lipoxygenase
Prednisone, Beclomethasone, Busesonide, Fluticasone mechanism
upregulate expression of anti-inflammatory genes & genes that increase gluconeogenesis, downregulates proinflammatory genes
Ipratropium, Tiotropium mechanism
blocks muscarinic acetylcholine receptors in lung smooth muscle, allowing bronchi to stay open
Nicotine patch, lozenge, gum, inhaler, spray mechanism
delivers nicotine so pt. does not have to smoke
Varenicline mechanism
oral partial agonist of alpha4beta2 subunit of nicotinic ACh receptor, stimulates receptor (decreases withdrawal), and blocks nicotine from binding (reduces reward)
Buproprion mechanism
non-competitive nicotinic antagonist, increased dopamine transmission in brain
Diltiazem, Verapamil mechanism
block L-type calcium channel receptors in smooth muscle, resulting in vasodilation
Epoprostenol mechanism
mimics prostacylin in the prostacyclin pathway, stimulares adenylate cyclase, causing increased cAMP and vasodilation, antiproliferation, and antiplatelet aggregation
Bosentan mechanism
blocks endothelin A & B receptors on smooth muscles, cardiac myocytes, and endothelial cells (B only), preventing sustained vasoconstriction and proliferation of vascular smooth muscle cells
Sildenafil mechanism
Inhibits PDE-5, thus inhibiting deactivation of cGMP in NO pathway, causes vasodilation and antiproliferation
Roflumilast mechanism
oral PDE-4 inhibitor, decreases airway inflammation and promotes airway smooth muscle relaxation
Unfractionated heparin (UFH) mechanism
complexes with antithrombin to inactivate thrombin
Low molecular weight heparin (LMWH), Fondaparinux mechanism
complexes with antithrombin to inactivate factor Xa
Warfarin mechanism
inhibits vit. K dependent gamma-carboxylation of factors II, VII, IX, and X
Pirfenidone mechanism
inhibits release of proinflammatory cytokines, attentuates fibroblast proliferation, inhibits release of TGF-beta, and inhibits collagen synthesis
Nintenadib mechanism
growth factor/angiokinase inhibitor at the vascular endothelial growth factor, fibroblast growth factor, and platelet derived growth factor receptors
Albuterol, Terbutaline indications
Step 1 asthma (intermittent); used in emergency situations to reduce/eliminate SOB, coughing, and wheezing, Symptom relief and increase FEV1 for COPD, acute COPD exacerbation
Salmeterol indications
Used in combination with ICS in persistent asthma, steps 3-6, Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)
Chromolyn sodium indications
Used to prevent wheezing, SOB, and trouble breathing caused by asthma
Omalizumab indications
Used in cases of allergic asthma triggers, particularly in steps 5 & 6 persistent asthma
Zafirlukast, Montelukast, Zileuton indications
Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4
Prednisone indications
Used as both emergency and long-term controller situations for asthma
Beclomethasone, Budesonide, Flucasone indications
Used in combination with LABA, LTRA, or theophylline for persistent asthma, steps 2-6; Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)
Ipratropium indications
Symptom relief and increases FEV1 for COPD (slower than SABA), acute COPD exacerbation
Tiotropium indications
Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)
Nicotine patch, lozenge, gum, inhaler, spray indications
Smoking cessation
Varenicline indications
Smoking cessation – can quit smoking 1 week after initiating therapy
Buproprion indications
Smoking cessation – reduces severity of nicotine cravings and withdrawal symptoms
Diltiazem, verapamil indications
PAH for patients who are highly vasoreactive (robust acute responder)
Epoprostenol indications
Improves hemodynamics, functional capacity, and survival in patients with pulmonary artery hypertension, high and lower risk patients
Bosentan indications
Improve hemodynamics and functional capacity in PAH patients
Sildenafil indications
Improves hemodynamics and functional capacity in patients with pulmonary artery hypertension, high and lower risk patients
Roflumilast indications
Improves FEV1 and decreases exacerbation rate in COPD
Unfractionated heparin (UFH) indications
Initial therapy for DVT
Low molecular weight heparin (LMWH) indications
Initial therapy for DVT, but reduces VTE and bleeding compared to UFH, for PE in unstable pts. and those w/high bleeding risk, VTE prevention (also Heparin)
Fondaparinux indications
initial therapy for DVT, equal to LMWH, PE in hemodynamically stable pts
Warfarin indications
prevention of recurrent DVT and PE
Pirfenidone indications
slows the course of disease progression in IPF
Nintenadib indications
may have efficacy in IPF
Albuterol, terbutaline side effects
Tachycardia, palpitations, tremor, hypokalemia
Salmeterol side effects
Tachycardia, palpitations, tremor, hypokalemia, increased risk of COPD exasperation, asthma death?
Chromolyn sodium side effects
Sore throat, bad taste, stomach pain, cough, stuffy nose, itching or burning in nasal passages, sneezing, headache
Omalizumab side effects
possible anaphylaxis (rare)
Zafirlukast side effects
Cough or hoarseness, fever, chills, lower back or side pain, pain, pain or difficult urination
Montelukast side effects
GI disturbances, headaches, hypersensitivity reactions, sleep disorders, bleeding tendency
Zileuton side effects
Sinusitis, nausea, pharyngolaryngeal pain
Prednisone side effects
Adrenal suppression, growth suppression, osteoporosis, muscle weakness, hypertension, weight gain, diabetes, cataracts, Cushing’s syndrome, dermal thinning
Beclomethasone, budesonide, Fluticasone side effects
Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?
Ipratropium, tiotropium side effects
dry mouth
Nicotine patch, lozenge, gum, inhaler, spray side effects
Headache, nausea and GI problems, difficulty getting to sleep (with patch especially), may not be safe in pregnancy
Varenicline side effects
nausea, headache, insomnia, abnormal dreams; depression, suicidal thoughts and actions; small increased risk of adverse events in pts with cardiovascular disease
Buproprion side effects
insomnia, headache, changes in behavior: hostility, agitation, depressed mood and suicidal thought
Diltiazem side effects
Dizziness, headache, flushing, weakness, bradycardia, GI sx, coughing
Verapamil side effects
Don’t take verapamil with beta blockers due to risk of severe bradycardia
Epoprostenol, Sildenafil side effects
Headache, dizziness, flushing, nasal congestion; jaw pain, delivery system problems; cautious use in hypotensive pts, intrinsic lung disease, elevated LA pressure. ALWAYS WEAN to avoid withdrawal
Bosentan side effects
Teratogenic, peripheral edema, anemia
Roflumilast side effects
diarrhea, weightloss
Unfractionated heparin (UFH) side effects
bleeding
Low molecular weight heparin (LMWH), Fondaparinux side effects
Caution in specific populations, such as pregnant women, elderly, obese, renal disease
Warfarin side effects
interaction with diet, genetics, multiple drugs. Teratogenic
Albuterol, Terbutaline notes
Oral has more side effects than inhaled. For COPD, albuterol is used with ipratropium
Salmeterol used with what in COPD?
used with a steroid for COPD, use only with another controller (such as ICS)
Chromolyn sodium no longer available as?
no longer available as inhalation (replaced by LTRAs)
Omalizumab, Montelukast associated with
possibly associated with Churg-Strauss (allergic granulomatosis)
Prednisone oral unless
oral preferred to IV for pts w/o altered mental status
Beclomethasone, Budesonide, Flucasone not used where?
Used with what for COPD?
not used in ED, sometimes used with LABA from COPD
Ipratropium used with what for COPD
for COPD, sometimes used with albuterol
Nicotine patch, lozenge, gum, inhaler, spray quit rate
6mo quit rate: 25%
Varenicline quit rate
6mo quit rate: 24%
Buproprion quit rate
6mo quit rate: 33%
Epoprostenol administered
IV only
Bosentan is old or new?
newer drug
Sildenafil administered
Oral, IV
roflumilast is oral
Roflumilast has not been studied in combination with
ICS
Unfractionated heparin (UFH):
administeration and window?
reverses with?
crosses the placenta?
IV, narrow therapeutic window, reversible with protamine, does not cross placenta
Low molecular weight heparin (LMWH):
administration
subcutaneous injection