pulm moa Flashcards
Goal of therapy asthma and bronchitis
dec airways resistance by increasing diameter of bronchi and decrease mucous secretion
Early phase response asthma
inflammatory mediators such as leukotrienes, histamine, and prostaglandin D2s are released
late phase response asthma
fibrin and collagen are deposited in tissue
Mast cells- release
histamine and leukotrienes
Eosinophils-
release enzymes when foreign cells are encountered
Leukotrienes- cause
bronchoconstriction
IL4 and IL5 are
cytokines that signal molecules between cells
line of trmt for asthma
- saba
- ics
- laba
Albuterol moa
B2 agonist in airway smooth muscle causing muscle relaxation and bronchodilation
levalbuterol moa
B2 agonist in airway smooth muscle causing muscle relaxation and bronchodilation
saba cautionary
paradoxical bronchospasm, hx CV disorders
Primatene Mist moa
Same as EPI- activates B1, B2, and A1 causing bronchodilation, inc HR, and vasoconstriction
Ipratropium
Ipratorpium + albuterol
moa
Competitive antagonists for ACh at muscarinic receptors- inhibit ACh from constricting the bronchial airways
Ipratropium
Ipratorpium + albuterol se
dec sludge
Contraindications
Ipratropium
Ipratorpium + albuterol
soy and peanuts
Cautionary
Ipratropium
Ipratorpium + albuterol
paradoxical bronchospasm, hx of CV disorders, worsening of urinary retention
Short term asthma: Systemic corticosteroids moa
Inhibits release of antiinflammatory mediators- reduces synthesis of Phospholipase A2 so arachidonic acid can’t be made which causes lipoxygenase and cyclooxygenase to not be able to be made. This all causes leukotrienes and PG to be reduced. This means that inflammation is reduced and bronchodilation occurs over time
Short term asthma: Systemic corticosteroids se
glucose metabolism and fluid retention
diff btwn systemic and inhaled corticosteroids
theyre not systemic… they bypass 1st pass effect
se inhaled corticosteroids
candida albicans thrush
Contraindication inhaled corticosteroids
acute asthma attack
Caution inhaled corticosteroids
NOT a bronchodilator… not used for instant relief
inhaled corticosteroids moa
Inhibits release of antiinflammatory mediators- reduces synthesis of Phospholipase A2 so arachidonic acid can’t be made which causes lipoxygenase and cyclooxygenase to not be able to be made. This all causes leukotrienes and PG to be reduced. This means that inflammation is reduced and bronchodilation occurs over time
Salmeterol
MOA: B2 agonist in airway smooth muscle causing muscle relaxation and bronchodilation
Same as SABA, but longer duration (12 hrs vs 4-6)
Formoterol
MOA: B2 agonist in airway smooth muscle causing muscle relaxation and bronchodilation
Same as SABA, but longer duration (12 hrs vs 4-6)
Contraindication long term asthma LABA
asthma trmt with LABA alone
NEVER use____ alone in asthma… it’s a BBW… increased risk of asthma related death
LABA
Contraindications Long term asthma meds: Inhaled corticosteroids + LABA
acute asthma attacks
Fluticasone/salmeterol moa
MOA: dec inflammation and bronchodilation
Postmarketing SE for Mometasone/formoterol and Budesonide/formoterol:
angina pectoris, cardiac arrhythmias, and QT prolongation
Long term asthma meds: Inhaled corticosteroids + LABA
cautions
candida albicans infection, not bronchodilator
Fluticasone/vilanterol
moa
MOA: dec inflammation and bronchodilation
BBW: removed in 2017
Long term asthma meds: Inhaled corticosteroids + LABA
Mometasone/formoterol moa
MOA: dec inflammation and bronchodilation
Montelukast moa
antagonizes leukotriene receptors which prevent airway edema, smooth muscle contractions, and help secretions of thick mucus
Budesonide/formoterol
moa
MOA: dec inflammation and bronchodilation
Zafirlukast moa
antagonizes leukotriene receptors which prevent airway edema, smooth muscle contractions, and help secretions of thick mucus
Contraindications Montelukast and Zafirlukast
not used to acute asthma attacks
Theophylline moa
causes bronchodilation either by…
Adenosine receptor antagonist OR inhibiting phosphodiesterase (PDE 3 and PED4)
Zileuton moa
inhibits lipoxygenase which converts arachidonic acid to leukotrienes thus inhibiting leukotriene formation
Aminophylline moa
causes bronchodilation either by…
Adenosine receptor antagonist OR inhibiting phosphodiesterase (PDE 3 and PED4)
Zileuton se
elevates liver enzymes
Structurally similar to caffeine
Theophylline and aminophylline
se Theophylline and aminophylline
CNS side effects such as HA, insomnia, irritability, restlessness, seizures, tachycardia, difficulty urinating in males (bc its like caffeine)
Long term asthma meds: Methylxanthines
contra
not for acute asthma attacks
Narrow therapeutic index!
Long term asthma meds: Methylxanthines
There are inhibitors and inducers (remember inhibitors dec Cl and inc F)
Theophylline
Cromolyn sodium
moa
mast cell stabilizer- prevents release of histamine, leukotrienes, and cytokines
ContraindicationsCromolyn sodium
acute asthma attack
Omalizumab moa
blocks binding of IgE to mast cells, basophils, and other cells associate with allergic response
Omalizumab bbw
anaphylaxis, bronchospasm, hypotension, syncope, urticaria, angioedema of the tongue or throat… can occur yrs after taking the medication
Indacaterol moa
MOA: works on B2 to relax bronchial smooth muscle
laba 2 cautions
can produce paradoxical bronchospasms and cv effects such as inc hr or bp
Aclidinium moa
MOA: Competitive antagonists for ACh at muscarinic receptors- inhibit ACh from constricting the bronchial airways
Arformoterol moa
MOA: works on B2 to relax bronchial smooth muscle
Reslizumab
IL5 receptor antagonists- reduces eosinophils
Olodaterol moa
MOA: works on B2 to relax bronchial smooth muscle
Mepolizumab
IL5 receptor antagonists- reduces eosinophils
Dupilumab
IL 4 receptor antagonist- inhibits release of proinflammatory cytokines, chemokines, and IgE
Benralizumab
IL5 receptor antagonists- reduces eosinophils
BBW Reslizumab:
anaphylaxis
Glycopyrrolate
MOA: Competitive antagonists for ACh at muscarinic receptors- inhibit ACh from constricting the bronchial airways
Aclidinium/formoterol
moa
MOA: block ACh which leads to bronchodilation; longer acting bronchodilation
Umeclidinium/ vilanterol
moa
MOA: block ACh which leads to bronchodilation; longer acting bronchodilation
Glycopyrrolate/formoterol
moa
MOA: block ACh which leads to bronchodilation; longer acting bronchodilation
Umeclidinium
MOA: Competitive antagonists for ACh at muscarinic receptors- inhibit ACh from constricting the bronchial airways
COPD: anticholinergic + LABA
contra
Contraindications: contraindicated in asthma pts without use of long term asthma control medication
Tiotropium
MOA: Competitive antagonists for ACh at muscarinic receptors- inhibit ACh from constricting the bronchial airways
Glycopyrrolate/Indacterol
moa
MOA: block ACh which leads to bronchodilation; longer acting bronchodilation
COPD: anticholinergic + LABA
cautions
Cautions: paroxysmal bronchospasms, LABA can cause significant CV effects (inc hr and bp)
COPD: anticholinergic + LABA
bbw
in risk asthma related death
Tiotropium/olodaterol
moa
MOA: block ACh which leads to bronchodilation; longer acting bronchodilation
Roflumilast moa
MOA: Selective inhibitors of phosphodiesterase type 4, an enzyme that metabolizes cAMP; leads to relaxation of bronchial smooth muscles
Roflumilast se
SE= mental health issues
Roflumilast contra
moderate to severe liver impairment
Mast cells
store histamine; highest conc. In nose and eye
where are Basophils located
blood and deeper tissue
Histamine acts on
H1 receptor
histamine causes
Causes vasodilation, sneezing, itching, edema, contraindication of bronchial smooth muscle
In the drink Lean or Purple Drank
Commonly combined with codeine cough syrup
Promethazine
Most OTC sleep aids are ___ generation antihistamines
1st
Lipophilic and easily cross the BBB
1st generation antihistamines
SE 1st generation antihistamines
SE= sedation and CNS depression, VERY anticholinergic so they dec sludge, can cause paradoxical CNS stimulation in kids
Fexofenadine moa
selective for H1 receptors;
Diphenhydramine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Cetirizine moa
selective for H1 receptors;
Bromopheniramine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Chloropheniramine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Loratadine moa
selective for H1 receptors;
Levocetirizine moa
selective for H1 receptors;
Clemastine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Desloratadine moa
selective for H1 receptors;
Doxylamine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Dimenhydrinate moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Azelastine moa
MOA: competes with histamine for H1 receptor sites
Hydroxyzine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
Olopatadine moa
MOA: competes with histamine for H1 receptor sites
Cyproheptadine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
cough assoc with underlying inflammatory process
productuve
cough stimulated by irritant or inflammation; can damage respiratory structures
nonprod
Meclizine moa
MOA: nonselective for histamine at the H1 receptor in the GI tract, BV, and resp tract; block vasodilator action of histamine
mucinex moa
MOA: inc resp tract fluid and reduces viscosity
Lipophobic and does NOT cross the BBB; CNS penetration is minimal to none
2nd generation antihistamines
2nd generation antihistamines se
SE= non sedating and non anticholinergic properties
Guaifenesin moa
MOA: inc resp tract fluid and reduces viscosity
Dextromethorphan moa
MOA: acts on cough receptor in medulla; interrupts cough impulse transmission
Contraindications dxm
MAOI- can lead to serotonin syndrome
Currently a drug of abuse: robotripping
Drinking excessive amts of _____ and overdose
Dextromethorphan
Tessalon perles/ Benzonatate
moa
MOA: non narcotic antitussive- anesthetizes receptors in resp passages and lungs
Codeine/Guaifenesin
moa
MOA: narcotic analgesic that acts in the medulla to inc urge to cough
Codeine/Guaifenesin/ PSE
moa
MOA: narcotic analgesic that acts in the medulla to inc urge to cough
hydrocodone/chlorpheniramine
moa
MOA: narcotic analgesic that acts in the medulla to inc urge to cough
bbw Codeine Cough suppressants/ antitussives
BBW: respiratory depression and death have occurred in kids; ultra rapid metabolizers of codeine dt CYP2D6
hydrocodone/homatropine
moa
MOA: narcotic analgesic that acts in the medulla to inc urge to cough