Pulmonary Medications Flashcards
Benefits of administering via inhalation (3)
1) TE enhanced by delivering directly to site of action
2) systemic effects are minimized
3) rapid onset of relief particularly in acute attacks
Two main pharmacologic classes for COPD and asthma
1) anti-inflammatory
2) bronchodilators
Preferred route for chronic treatment
1) inhalation - inhalers or nebulizers
2) exacerbations may require more potent oral therapies (short and long term side effects)
Four types of inhalation devices
- metered dose inhaler (mdi)
- respimats
- dry powder inhalers
- nebulizers
Metered dose inhalers definition
small hand held pressurized devices that deliver a measured dose of drug with each activation (puff)
Dosing of Metered dose inhalers
typically 1-2 puffs with an interval of at least 1 minute between puffs
Spacers are recommended because
they attach directly to the MDI too increase the delivery of the drug
- they increase the amount of the drug to the site of action (10-50%)
- some are fitted with an apparatus that makes a sound when inhalation is too rapid
- can prevent bronchospasm of sudden intake of drug
Respimats definition
- another form of inhaler that delivers the drug as a very fine mist
- requires actuation of the dose by the user; however, the device does NOT use propellants
delivery of respimats
delivers the actuation about 1-1.5 seconds vs. 1/10th of a second for MDI
- extremely small particle size ensures greater delivery of drug to the lungs
Dry-powder inhalers definition
deliver drugs in the form of a dry micronized powder directly to the lungs
how are Dry-powder inhalers activated
they are breath activated
- do not require as much coordination as MDIs or even respimats
how much do Dry-powder inhalers deliver
deliver about 10% more active drug to the lung tissue than an MDI without a spacer (these do not use spacers)
Nebulizers definition
a small machine used to convert a drug solution into a mist - finer droplets than inhalers
Nebulizers benefits and usage
- face mask or handheld mouthpiece can be used to deliver the nebulized medication
- requires NO coordination as nebulized medications are deliver with each breath
uses of nebulizers
used commonly in office or at home settings and can even be portable
- particularly useful in children and end-stage diseases
Anti-inflammatory drugs use
foundation of asthma and COPD therapy for long term control
anti-inflammatory drug classes for COPD or asthma
1) glucocorticoids
2) leukotriene modifiers
3) omalizumab
4) roflumilast
Glucocorticoids
- what are they used for?
- route?
aka steroids
- these are the most effective drugs for long term control of airway inflammation
- typical route of administration is inhaled but IV and oral may be used in severe disease/ exacerbations
Leukotriene modifiers uses
used as a secondary line therapy when glucocorticoids cannot be used or as add-on when therapy is inadequate (oral therapy)
Omalizumab
second line agent indicated ONLY FOR ALLERGY RELATED ASTHMA
- subQ injection
Roflumilast
ONLY USED IN COPD
- last line, add-on therapy
(oral)
Glucocorticoids indications
first line agent in asthma (also can use in COPD)
MOA Glucocorticoids
1) SUPPRESS INFLAMMATION AND REDUCE BRONCHIAL HYPERREACTIVITY
a) decreases synthesis and release of inflammatory mediators (leukotrienes, histamine, prostaglandins)
b) decreased infiltration and activity of inflammatory cells (eosinophils, leukotrienes)
c) decreased edema of the airway mucosa
Routes Glucocorticoids
1) inhalation- must be on a fixed schedule- NOT PRN (do not abort an ongoing attack)
2) oral- used in moderate to severe acute exacerbation- as brief of therapy as possible
Glucocorticoids ADR for ICS
1) dependent on route and duration of therapy
- inhaled = minor and much more rare - OP candidiasis (oral thrush) and hoarseness
- MAKE SURE YOU RINSE AFTER USE
Oral glucocorticoids indications
a lot!
but right now just ACUTE EXACERBATIONS OF REACTIVE AIRWAY DISEASES FOR SHORT COURSE (10 days or less)
ADR for chronic use of oral glucocorticosteroids
1) adrenal suppression
2) hyperglycemia
3) PUD - inhibition of gastroprotective prostaglandins
4) growth suppression/ bone loss
5) CV effects –> increased BP, fluid retention
6) CNS and psychiatric/ behavioral effects -psychosis
7) cushingoid features- truncal obesity, moon face, thinning of skin
8) infections- weakens IS
9) glaucoma/cataracts
Fluticasone indications
asthma maintenance and control
contraindications to fluticasone
HSN to milk proteins or lactose (not intolerances)
- diskus only
fluticasone routes
1) MDI- HFA
2) DPI- diskus
Beclomethasone indications
maintenance and prophylactic treatment of asthma in patients 5 and OLDER
Contraindications to beclomethasone
status asthmaticus or other acute asthma episodes requiring intensive measures
Beclomethasone routes
1) MDI
- QVAR- hand activated
- QVAR redihaler- breath acutuated
Budedsonide indications
asthma maintenance and contorl
Contraindications for budedsonide
severe HSN to milk proteins (flexhaler only)
primary treatment of status asthmaticus or other acute asthma episode requiring intensive measures
Routes budedsonides
1) FDI (flexhaler)
2) nebulized solution (respules)
Mometasone indications
asthma maintenance
contraindications for mometasone
HSN to milk proteins,
primary treatment of status asthmaticus
other acute episodes of asthma requiring intensive measures
Which age group is best for budedsonide?
Kids with asthma- this is the only ICS with a nebulized solution
