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326 pharm 1 > pulmonary mod 1 > Flashcards

pulmonary mod 1 Flashcards

1
Q

pulmonary med classes

A

bronchodilators

  • beta 2 agonists
  • anticholinergics
  • Xanthine derivatives

anti-inflammatories

  • leukotriene receptor antagonist (LTRAs)
  • inhaled glucocorticoids
  • mast cell stabilizers

others: omalizumb, roflumilast

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2
Q

which class and their effects

A

dilates bronchioles, relax bronchial smooth muscle

  • beta-2 agonists
  • inhaled anticholinergics
  • xanthine derivatives

decreases bronchial inflammation

  • glucocorticoids
  • mast cell stabilizer
  • LTRAs
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3
Q

beta-adrenergic agonists

A

short-acting (SABA) - q 4-6 hrs (asthma attack, acute, rescue)

  • albuterol (Proventil)
  • levalbuterol (Xopenex)

long-acting (LABA) - q 12 hrs (preventor) (all inhaled)

  • salmeterol (Servent)
  • formoterol (Foradil)
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4
Q

beta-adrenergic agonists subtypes

A

relax and dilate stim beta-2 adrenergic receptors in LUNGS

3 subtypes:

  1. non-select adrenergic drugs
    - still BOTH beta-1 and 2 receptors and alpha receptors (epinephrine)
  2. non-seletc beta-adrenergic
    - stim both beta-1 and 2 receptors (metaproterenol)
  3. selective beta-2 receptors
    - PREFERED FOR TX PULMONARY COND (ALBUTEROL)
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5
Q

NON-SELECTIVE BETA ADRENERGIC AGONISTS

epinephrine

A

stim alpha receptors = vasoconstriction

  • decreases edema/swelling, limits secretions
  • causes incr CNS stim, incr cardiovascular effects of beta-1 stim
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6
Q

beta-adrenergic agonists indications and contraindications

beta-blockers reverse effect

A

indications
- prevent/relieve bronchospasms/asthma/bronchitis

contraindications

  • uncontrolled HTN, cardiac dysrhythmias, high risk stroke
  • avoid with MAOIs, sympathomimetic bc risk HTM
  • diabetics need incr dose due inc BS
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7
Q

beta-adrenergic agonist ADVERSE EFFECTS

A

non-select have most
Beta-2 - HTN or hypotension
insomnia, restlessness, anorexia, cardiac stim, hyperglycemia, tremor, vascular headache

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8
Q

SELECTIVE beta agonist - SABA

albuterol (Proventil)
asthma

levalbuterol (Xopenex)

A

rescue drug
delivery - MDI or neb
1ST LINE FOR ACUTE ASTHMA ATTACK

indications- tx asthma, bronchitis, emphysema
- acute episodes wheezing, chest tightness, SOA, EIA (exercise-induced asthma)

Use of more than one canister per month indicates inadequate control of asthma & need for initiating or intensifying anti-inflammatory therapy

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9
Q

Long-acting Beta 2 agonist agent (LABA)

salmeterol (Servent)
formoterol (Foradil)

A

not for acute tx, it’s for mx 2x day inhale

  • *ass. with incr asthma-related deaths
  • black/afri amer most common

indications
- worsening COPD, mod-severe asthma

**ALWAYS as inhaled corticosteroid, NOT monotherapy

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10
Q

Anticholinergics

A

bronchodilator

  • work on acetylcholine receptors, not adrenergic receptors
  • Turning off cholinergic response (PNS) and turning on SNS
  • SNS dominates = increasing perfusion to heart, lungs, and brain
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11
Q

Anticholinergics

** ipratroprium (Atrovent)
combivent/Duoneb

A

MOA: Blocks action of acetylcholine= creates bronchodilation (by preventing bronchoconstriction)

Indications: Used for PROPHYLAXIS and maintenance therapy
NOT for rescue

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12
Q

adverse effects anticholinergics

A 
Dry as a bone
Hot as a hare
Blind as a bat
Red as a beet
Mad as a hatter
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13
Q

Xanthine Derivatives (Methylxanthines) - bronchodilator

theophylline (TheoDur/Theo-24)
aminophylline

second-line treatment

A

MOA: increasing levels of the cAMP enzyme by inhibiting phosphodiesterase
Stimulates CNS and CVD system

indications
- Preventative treatment of asthma attacks and COPD exacerbation

Side effects
Toxicity- N/V/D, insomnia, H/A, tachycardia, dysrhythmias, seizures (more common in elderly)

Contraindications: uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers

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14
Q

xanthine derivatives interactions

A

Interactions:
Caffeine - may ↑ side effects
Smoking → ↓ absorption

Has a narrow therapeutic index- monitor serum levels and watch for toxicity

Lots of drug interactions macrolide antibiotics, allopurinol, cimetidine, quinolones, flu vaccine, oral contraceptives

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15
Q

Anti-inflammatories

A

LTRAs

  • montelukast (Singulair)
  • zafirlukast (Accolade)

inhaled corticosteroids

  • beclomethasone diproprionate (Beclovent)
  • budesonide (Pulmicort Turbuhaler
  • fluticasone (Flovent)

COMBO: inhaled glucocorticoid and bronchodilator

  • budesonide & formoterol (Symbicort)
  • fluticasone and salmeterol (Advair)

mast cell stabilizers
- cromolyn (Intal)

Monoclonal Antibody Anti-asthmatic
- omalizumab (Xolair)

Selective PDE-4 Inhibitor
- roflumilast

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16
Q

Anti-inflammatories - Leukotriene receptor antagonist (LTRA)

montelukast (Singulair)
zafirlukast (Accolade)

A

Leukotrienes cause inflammation, bronchoconstriction, and mucus production

MOA: LTRAs prevent leukotrienes from attaching to receptors located on immune cells and within the lungs - prevents inflammation

Used for oral prophylaxis and chronic treatment of asthma in adults and children, allergies
*** NOT for acute asthma attacks

Adverse effects: headache, nausea, dizziness, insomnia, diarrhea

17
Q

Anti-inflammatories - Inhaled Corticosteroids

beclomethasone diproprionate (Beclovent)
budesonide (Pulmicort Turbuhaler)
fluticasone (Flovent)

neb or MDI

A

MOA: reduce inflammation and enhance activity of beta-agonists, bronchodilation

Given for prevention of persistent asthma attacks and long-term maintenance of severe COPD

Adverse effects: pharyngeal irritation, coughing, dry mouth, and oral fungal infections

rn considerations
- RINSE MOUTH AFTER USE
- teach to take on a regular schedule, not PRN & give  the bronchodilator first to allow more thorough absorption of the steroids 
- take sev weeks for effect
-
18
Q

Combinations: Inhaled glucocorticoid & bronchodilator

budesonide & formoterol (Symbicort)
fluticasone and salmeterol (Advair)

A

Used for moderate to severe asthma

KEY TEACHING: THESE ARE NEVER FOR ACUTE ATTACKS

19
Q

Anti-inflammatories - Mast cell stabilizer

cromolyn (Intal)

A

MOA: stabilize membranes of mast cells & prevent release of broncho-constrictive inflammatory substances

Used for prevention of acute asthma attacks
15-20 minutes prior to known triggers

20
Q

anti-inflammatories - Monoclonal Antibody Anti-asthmatic

omalizumab (Xolair)

Newest generation of anti-asthmatic

A

Indicated for add-on therapy for asthma

MOA: monoclonal antibody which selectively binds to immunoglobulin IgE - limits the release of mediators of allergic response

Given via injection

Must be monitored closely for hypersensitivity reactions (anaphylaxis big risk)

21
Q

anti-inflammatory - Selective PDE-4 Inhibitor

roflumilast

oral

A

MOA: selectively inhibits PDE4 enzyme in the lung cells

Potent anti-inflammatory effects within the lungs

Indicated for prevention of COPD exacerbations
**Not for acute/immediate action

SE: N/V/D, headache, muscle spasms, decreased appetite, uncontrollable tremors

22
Q

SUMMARY SLIDE: Two classes of agents to treat asthma

A

Quick-relief medications
RESCUE/ relievers
SABA
albuterol/Proventil

Long-term control medications PREVENTERS
Anticholinergics
Xanthine derivative 
Inhaled corticosteroids
Leukotriene modifiers
Mast cell stabilizers
LABA

326 pharm 1 (23 decks)

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