Pulmonary Drugs Flashcards
1
Q
Albuterol: Class/Type
A
Short-acting beta-2 agonist (SABA)
2
Q
Albuterol: Mechanism
A
Bronchodilators
3
Q
Albuterol: Indication
A
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
4
Q
Albuterol: Side Effects/Toxicity
A
Tachycardia, palpitations, tremor, hypokalemia
5
Q
Albuterol: Notes
A
Oral administration has more side effects than inhaled. For COPD, albuterol is sometimes used with ipratropium
6
Q
Terbutaline: Class/Type
A
Short-acting beta-2 agonist (SABA)
7
Q
Terbutaline: Mechanism
A
Bronchodilators
8
Q
Terbutaline: Indication
A
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
9
Q
Terbutaline: Side Effects/Toxicity
A
Tachycardia, palpitations, tremor, hypokalemia
10
Q
Terbutaline: Notes
A
Oral administration has more side effects than inhaled. For COPD, albuterol is sometimes used with ipratropium
11
Q
Salmeterol: Class/Type
A
Long-acting beta-2 agonist (LABA)
12
Q
Salmeterol: Mechanism
A
Bronchodilators
13
Q
Salmeterol: Indication
A
Used in combination with ICS in persistent asthma, steps 3-6. Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)
14
Q
Salmeterol: Side Effects/Toxicity
A
Tachycardia, palpitations, tremor, hypokalemia. Increased risk of severe COPD exacerbation and asthma death.
15
Q
Salmeterol: Notes
A
Sometimes used with glucocorticoid for COPD. FDA recommends only use in combination with other controller meds (such as ICS)
16
Q
Chromolyn sodium: Class/Type
A
Mast cell stabilizer
17
Q
Chromolyn sodium: Mechanism
A
Prevents the release of mediators that would normally attract inflammatory cells and stabilizes the inflammatory cells
18
Q
Chromolyn sodium: Indication
A
Used to prevent wheezing, SOB, and trouble breathing caused by asthma
19
Q
Chromolyn sodium: Side Effects/Toxicity
A
Sore throat, bad taste, stomach pain, cough, stuffy nose, itching or burning in nasal passages, sneezing, headache
20
Q
Chromolyn sodium: Notes
A
No longer available for oral inhalation treatment (replaced by LTRAs)
21
Q
Omalizumab: Class/Type
A
Immunodilator
22
Q
Omalizumab: Mechanism
A
IgE binding in circulation
23
Q
Omalizumab: Indication
A
Used in cases of allergic asthma triggers, particularly in steps 5 & 6 persistent asthma
24
Q
Omalizumab: Side Effects/Toxicity
A
Possible anaphylaxis (rare)
25
Omalizumab: Notes
Possibly associated with Churg-Strauss syndrome (autoimmune disease)
26
Zafirlukast: Class/Type
Leukotriene modifiers (LTRA)
27
Zafirlukast: Mechanism
Leukotriene D4 (LTD4) receptor antagonists
28
Zafirlukast: Indication
Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4
29
Zafirlukast: Side Effects/Toxicity
Cough or hoarseness, fever, chills, lower back or side pain, pain, pain or difficult urination
30
Montelukast: Class/Type
Leukotriene modifiers (LTRA)
31
Montelukast: Mechanism
Leukotriene D4 (LTD4) receptor antagonists
32
Montelukast: Indication
Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4
33
Montelukast: Side Effects/Toxicity
GI disturbances, headaches, hypersensitivity reactions, sleep disorders, bleeding tendency
34
Montelukast: Notes
Possibly associated with Churg-Strauss syndrome (autoimmune disease)
35
Zileuton: Class/Type
Leukotriene modifiers (LTRA)
36
Zileuton: Mechanism
Inhibits 5-lipoxygenase
37
Zileuton: Indication
Alternate treatment in cases of persistent asthma, steps 2 and in combination with ICS in steps 3 & 4
38
Zileuton: Side Effects/Toxicity
Sinusitis, nausea, pharyngolaryngeal pain
39
Prednisone: Class/Type
Oral glucocorticoid (systemic)
40
Prednisone: Mechanism
Upregulate expression of anti-inflammatory genes and genes that increase gluconeogenesis and downregulate proinflammatory genes
41
Prednisone: Indication
Used as both emergency and long-term controller situations for asthma
42
Prednisone: Side Effects/Toxicity
Adrenal suppression, growth suppression, osteoporosis, muscle weakness, hypertension, weight gain, diabetes, cataracts, Cushing’s syndrome, dermal thinning
43
Prednisone: Notes
Oral is preferred to IV for patients without altered mental status
44
Beclomethasone: Class/Type
Inhaled glucocorticoid (ICS)
45
Beclomethasone: Mechanism
Upregulate expression of anti-inflammatory genes and genes that increase gluconeogenesis and downregulate proinflammatory genes
46
Beclomethasone: Indication
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)
47
Beclomethasone: Side Effects/Toxicity
Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?
48
Beclomethasone: Notes
Not used in the ED. Sometimes used with LABA for COPD
49
Budesonide: Class/Type
Inhaled glucocorticoid (ICS)
50
Budesonide: Indication
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)
51
Budesonide: Side Effects/Toxicity
Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?
52
Budesonide: Notes
Not used in the ED. Sometimes used with LABA for COPD
53
Fluticasone: Class/Type
Inhaled glucocorticoid (ICS)
54
Fluticasone: Indication
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)
55
Fluticasone: Side Effects/Toxicity
Oropharyngeal thrush, cataracts, osteoporosis, increased risk of pneumonia in COPD patients?
56
Fluticasone: Notes
Not used in the ED. Sometimes used with LABA for COPD
57
Ipratropium: Class/Type
Short-acting anticholinergic
58
Ipratropium: Mechanism
Blocks muscarinic acetylcholine receptors in the smooth muscle of the bronchi of the lungs, allowing the bronchi to stay open
59
Ipratropium: Indication
Symptom relief and increases FEV1 for COPD (slower than SABA), acute COPD exacerbation
60
Ipratropium: Side Effects/Toxicity
Dry mouth
61
Ipratropium: Notes
For COPD, sometimes used with albuterol
62
Tiotropium: Class/Type
Long-acting anticholinergic
63
Tiotropium: Mechanism
Blocks muscarinic acetylcholine receptors in the smooth muscle of the bronchi of the lungs, allowing the bronchi to stay open
64
Tiotropium: Indication
Controller medication for COPD (decreases symptoms and acute exacerbation rate, increases FEV1)
65
Tiotropium: Side Effects/Toxicity
Dry mouth
66
Nicotine patch, lozenge, gum, inhaler, spray: Class/Type
Nicotine replacement
67
Nicotine patch, lozenge, gum, inhaler, spray: Mechanism
Delivers nicotine so that the patient does not have to smoke to get it
68
Nicotine patch, lozenge, gum, inhaler, spray: Indication
Smoking cessation
69
Nicotine patch, lozenge, gum, inhaler, spray: Side Effects/Toxicity
Headache, nausea and GI problems, difficulty getting to sleep (with patch especially). May not be safe in pregnancy
70
Nicotine patch, lozenge, gum, inhaler, spray: Notes
6-month abstinence rate of 25%
71
Varenicline: Class/Type
Nicotine partial agonist
72
Varenicline: Mechanism
Orally-available partial agonist at the alpha4beta2 subunit of the nicotinic acetylcholine receptor stimulates nicotinic receptor (reduces withdrawal) and blocks nicotine from binding (reduces reward)
73
Varenicline: Indication
Smoking cessation – can quit smoking 1 week after initiating therapy
74
Varenicline: Side Effects/Toxicity
Nausea, headache, insomnia, abnormal dreams. Depression, suicidal thoughts and actions. “Small increased risk of cardiovascular adverse events in patients with cardiovascular disease”
75
Varenicline: Notes
6-month abstinence rate of 24%
76
Buproprion: Class/Type
Antidepressant
77
Buproprion: Mechanism
Non-competitive nicotinic antagonist. Increased dopamine transmission in the brain
78
Buproprion: Indication
Smoking cessation – reduces severity of nicotine cravings and withdrawal symptoms
79
Buproprion: Side Effects/Toxicity
Insomnia and headache. Changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts
80
Buproprion: Notes
6-month abstinence rate of 33%
81
Diltiazem: Class/Type
Calcium channel blockers
82
Diltiazem: Mechanism
Block L-type calcium channel receptors in vascular smooth muscle, resulting in vasodilatation
83
Diltiazem: Indication
PAH for patients who are highly vasoreactive (robust acute responder)
84
Diltiazem: Side Effects/Toxicity
Dizziness, headache, flushing, weakness, bradycardia, GI sx, coughing
85
Verapamil: Class/Type
Calcium channel blockers
86
Verapamil: Mechanism
Block L-type calcium channel receptors in vascular smooth muscle, resulting in vasodilatation
87
Verapamil: Indication
PAH for patients who are highly vasoreactive (robust acute responder)
88
Verapamil: Side Effects/Toxicity
Don’t take verapamil with beta blockers due to risk of severe bradycardia
89
Epoprostenol: Class/Type
Prostacyclin analogue
90
Epoprostenol: Mechanism
Mimics the properties of prostacyclin in the prostacyclin pathway via stimulation of adenylate cyclase à increased cAMP to result in vasodilatation, antiproliferation, and anti-platelet aggregation
91
Epoprostenol: Indication
Improves hemodynamics, functional capacity, and survival in patients with pulmonary artery hypertension, high and lower risk patients
92
Epoprostenol: Side Effects/Toxicity
Headache, dizziness, flushing, nasal congestion.Jaw pain, delivery system problems. Cautious use in hypotensive patients, intrinsic lung disease, elevated LA pressure. Always wean gradually to avoid abrupt medication withdrawal
93
Epoprostenol: Notes
IV
94
Bosentan: Class/Type
Endothelin receptor antagonists
95
Bosentan: Mechanism
Block endothelin A and B receptors on smooth muscle cells, cardiac myocytes, and endothelial cells (B only), preventing sustained vasoconstriction and proliferation of vascular smooth muscle cells
96
Bosentan: Indication
Improve hemodynamics and functional capacity in PAH patients
97
Bosentan: Side Effects/Toxicity
Teratogenic, peripheral edema, anemia
98
Bosentan: Notes
Newer drug
99
Sildenafil: Class/Type
Phosphodiesterase inhibitor
100
Sildenafil: Mechanism
Inhibits PDE-5, therefore inhibiting the deactivating of cGMP in the NO pathway and causing vasodilation and antiproliferation
101
Sildenafil: Indication
Improves hemodynamics and functional capacity in patients with pulmonary artery hypertension, high and lower risk patients
102
Sildenafil: Side Effects/Toxicity
Headache, dizziness, flushing, nasal congestion. Cautious use in hypotensive patients, intrinsic lung disease, elevated LA pressure. Always wean gradually to avoid abrupt medication withdrawal
103
Sildenafil: Notes
Oral, IV
104
Roflumilast: Class/Type
Phosphodiesterase inhibitor
105
Roflumilast: Mechanism
Oral PDE-4 inhibitor that decreased airway inflammation and promotes airway smooth muscle relaxation
106
Roflumilast: Indication
Improves FEV1 and decreases exacerbation rate in COPD
107
Roflumilast: Side Effects/Toxicity
Diarrhea, weight loss
108
Roflumilast: Notes
Has not been studied in combination with ICS
109
Unfractionated heparin (UFH): Class/Type
Antithrombin agents
110
Unfractionated heparin (UFH): Mechanism
Complexes with antithrombin to inactivate thrombin
111
Unfractionated heparin (UFH): Indication
Initial therapy fro DVT
112
Unfractionated heparin (UFH): Side Effects/Toxicity
Bleeding
113
Unfractionated heparin (UFH): Notes
IV, narrow therapeutic window, reversible with protamine, does not cross placenta
114
Low molecular weight heparin (LMWH): Class/Type
Antithrombin agents
115
Low molecular weight heparin (LMWH): Mechanism
Complexes with antithrombin to inactivate factor Xa
116
Low molecular weight heparin (LMWH): Indication
Initial therapy for DVT, but reduces VTE and bleeding compared to UFH. Tx for PE in unstable patients and those with high risk of bleeding. VTE prevention (also heparin)
117
Low molecular weight heparin (LMWH): Side Effects/Toxicity
Caution in specific populations, such as pregnant women, elderly, obese, renal disease
118
Low molecular weight heparin (LMWH): Notes
Subcutaneous injection
119
Fondaparinux: Class/Type
Antithrombin agents
120
Fondaparinux: Mechanism
Complexes with antithrombin to inactivate factor Xa
121
Fondaparinux: Indication
Initial therapy for DVT, with equal efficacy to LMWH. TX for PE in hemodynamically stable patients
122
Fondaparinux: Side Effects/Toxicity
Caution in specific populations, such as pregnant women, elderly, obese, renal disease
123
Fondaparinux: Notes
Subcutaneous injection
124
Warfarin: Class/Type
Oral anticoagulant
125
Warfarin: Mechanism
Inhibits vitamin K depended gamma-carboxylation of factors II, VII, IX, and X
126
Warfarin: Indication
Prevention of recurrent DVT and PE
127
Warfarin: Side Effects/Toxicity
Interactions with genetics, diet, multiple drugs. Teratogenic
128
Pirfenidone: Class/Type
Drugs in IPF
129
Pirfenidone: Mechanism
Inhibits release of pro-inflammatory cytokines, attenuates fibroblast proliferation, inhibits release of TGF-beta, and inhibits collagen synthesis
130
Pirfenidone: Indication
Shown to slow the course of disease progression in IPF
131
Nintenadib: Class/Type
Drugs in IPF
132
Nintenadib: Mechanism
Growth factor/angiokinase inhibitor at the vascular endothelial growth factor, fibroblast growth factor, and platelet derived growth factor receptors
133
Nintenadib: Indication
May have efficacy in IPF
