Pulmonary Drugs

Question 1

Inhaled Beta Agonist

Answer 1

“-terol”

Use = COPD

SABA: albuterol (ProAir)
5 min onset
4-6 hr duration
PRN for shortness of breath

LABA: 12-24 hr duration
PRN or maintenance tx (1-2x daily)
can be used for asthma, but only when combined with ICS

MOA = agonize B2 receptors = bronchodilation

AE = generally well tolerated. Can cause tachycardia, tremor, hypokalemia (w/ thiazide diuretic)

Question 2

Inhaled Antimuscarinic

Answer 2

Use = COPD

SAMA: 15-20 minute onset
6-8 hr duration
PRN

LAMA: tiotropium (Spiriva)
12-24 hr duration
Maintenance tx 1-2x daily

MOA = primarily binds M3 in smooth muscle, antagonize ACh actions at these sites = bronchodilation.

AE = dry mouth; generally well tolerated

Question 3

Inhaled corticosteroids

Answer 3

fluticasone (Flovent)

Use = COPD; for exacerbations and severe disease states; Asthma

MOA = decreases inflammation to suppress immune system

AE = oral candidiasis, hoarse voice, osteoporosis, cataracts, increased blood glucose, mood changes, fluid retention.
Rinse mouth out after each use.

Question 4

Combined products

Answer 4

SAMA + SABA: albuteral/ipratropium (Combivent)
LABA + ICS: formoterol/budesonide (Symbicort)
LABA + LAMA + ICS: salmeterol/fluticason (Advair)

MOA = combining bronchodilators may increase effect with lower AE as compared to increasing dose of single drug.

Question 5

Leukotriene Modifiers

Answer 5

montelukast (Singulair)

Use = asthma

MOA = competitively antagonize leukotriene receptors

AE = well tolerated
Alternative for kids/adults

For asthma take 1x in evening; for allergies take in AM

Question 6

Immunomodulators Anti-IgE

Answer 6

omalizumab (Xolair)
subcut

Use = asthma

MOA = binds IgE antibody = prevents IgE binding to receptors on the mast cells and basophils –> limits activation and release of allergic response mediators

AE = injection site reaction
Rare AE = anaphylactic allergic reaction

Must be given in providers office.

Question 7

CFTR Modulators

Answer 7

tezacaftor/ivacaftor (Symdeco)
lumicaftor/ivacaftor (Orkambi)

Use = CF

MOA of ivacaftor = improves CFTR activity (channels open longer)
MOA of tezacaftor/lumacaftor = facilitates trafficking of CFTR to cell membrane

AE = HA, GI pain (N/V), respiratory pain, nasal congestion, nasopharyngitis, cough dyspnea

Question 8

Mucolytics

Answer 8

Hypertonic Saline
Dornase alfa (pulmozyme)

USE = CF

MOA = increases hydration of airway for mucus secretion –> increases mucociliary function; cleaves DNA = decreases mucous viscosity for improved airflow

AE = chest pain, cough, voice disorder, skin rash