Pulmonary Flashcards
What type of pharmaceutical medications target bronchial smooth muscle?
Beta agonists and anitcholinergics
What type of pharmaceutical medications target the inflammation in the lungs?
Inhaled corticosteroids, leukotriene antagonists, and IgE blockers
What type of medication reduces viscosity of mucus to aid in coughing up the mucus?
Mucolytics, aka expectorants
Most chronic medications are delivered through devices for direct pulmonary delivery. What are the exceptions?
Leukotriene inhibitors
Theophlyne
What is helpful about spacers?
More drug gets into the lungs and less gets into the gut (they also enable less emphasis on technique)
When should a nebulizer be used and what is the downside?
When the pt can’t handle an inhaler. They use larger particles that are less well absorbed requiring more drug.
MOA and duration for a “rescue inhaler”
Beta adrenergic agonists relax bronchial smooth muscle for 3-6 hours. Known as short-acting beta agonists (SABA)
What are the two most common SABAs?
Albuterol
Metaproterenol
What are the side effects of SABAs and the reason they shouldn’t be used regularly?
Tachycardia
HTN in large doses
Jitters (anxiety)
What are the two most commonly used long acting beta agonists?
Salmeterol (1st)
Formoterol
Are LABAs controllers or relievers?
FDA warns that is still only a long-acting reliever (half of relieving effects are still present 12 hours after inhalation).
MOA of inhaled Ipratropium?
(Anticholinergic) Blocks Ach in the lungs which relaxes bronchial smooth muscle
What is the long acting inhaled anticholinergic drug?
Tiotropium
What are the four inhaled corticosteroids?
Beclomethasone
Budesonide
Flunisolide
Fluticasone
What are the side effects of inhaled corticosteroids?
Thrush (prevent with mouth rinse)
Pneumonia in COPD pts
small effect on bone growth in pediatrics
What is important to remember about the differences between inhaled corticosteroids and their dosing?
Dose equivalence is important, but the drugs are all about equally effective.
How much of the inhalant gets to the lung on average?
1/3 (with really good technique 1/2)
Why don’t we see many Leukotriene Modifiers in use? What is the most likely one to see?
They are not as effective as inhaled steroids
Montelukast (Singulair)
Theophylline MOA?
Methylxanthine, mild stimulant, bronchodilator, mild anti inflammatory, diaphragmatic inotrope. Requires monitoring for toxicity especially in a number of factors.
What do you need to know about oral or injectable steroids?
It’s a “burst therapy” for exacerbations of asthma or COPD and may be a very last resort in chronic asthma.
What is Omalizumab, what is is used for, and what is the warning about it?
Recombinant monoclonal antibody to IgE for “very, very” refractory asthma. Requires 3 statements of medical necessity and may cause hypersensitivity reactions (anaphylaxis).
What is the preferred management of intermittent asthma (step 1)?
SABA PRN
What is the preferred management of relatively benign persistent asthma (step 2)?
Low-dose ICS
Step 3 (out of 6) of persistent asthma management prefers what treatment?
Low-dose ICS + LABA or Medium-dose ICS or Tiotropium (anticholinergic)
What is the primary therapeutic approach to COPD and what class of drugs does that include?
Bronchodilation, with beta-agonists plus anticholinergics
