pulmonary mod 1 Flashcards
pulmonary med classes
bronchodilators
- beta 2 agonists
- anticholinergics
- Xanthine derivatives
anti-inflammatories
- leukotriene receptor antagonist (LTRAs)
- inhaled glucocorticoids
- mast cell stabilizers
others: omalizumb, roflumilast
which class and their effects
dilates bronchioles, relax bronchial smooth muscle
- beta-2 agonists
- inhaled anticholinergics
- xanthine derivatives
decreases bronchial inflammation
- glucocorticoids
- mast cell stabilizer
- LTRAs
beta-adrenergic agonists
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)
beta-adrenergic agonists subtypes
relax and dilate stim beta-2 adrenergic receptors in LUNGS
3 subtypes:
- non-select adrenergic drugs
- still BOTH beta-1 and 2 receptors and alpha receptors (epinephrine) - non-seletc beta-adrenergic
- stim both beta-1 and 2 receptors (metaproterenol) - selective beta-2 receptors
- PREFERED FOR TX PULMONARY COND (ALBUTEROL)
NON-SELECTIVE BETA ADRENERGIC AGONISTS
epinephrine
stim alpha receptors = vasoconstriction
- decreases edema/swelling, limits secretions
- causes incr CNS stim, incr cardiovascular effects of beta-1 stim
beta-adrenergic agonists indications and contraindications
beta-blockers reverse effect
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
beta-adrenergic agonist ADVERSE EFFECTS
non-select have most
Beta-2 - HTN or hypotension
insomnia, restlessness, anorexia, cardiac stim, hyperglycemia, tremor, vascular headache
SELECTIVE beta agonist - SABA
albuterol (Proventil)
asthma
levalbuterol (Xopenex)
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
Long-acting Beta 2 agonist agent (LABA)
salmeterol (Servent)
formoterol (Foradil)
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
Anticholinergics
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
Anticholinergics
** ipratroprium (Atrovent)
combivent/Duoneb
MOA: Blocks action of acetylcholine= creates bronchodilation (by preventing bronchoconstriction)
Indications: Used for PROPHYLAXIS and maintenance therapy
NOT for rescue
adverse effects anticholinergics
Dry as a bone Hot as a hare Blind as a bat Red as a beet Mad as a hatter
Xanthine Derivatives (Methylxanthines) - bronchodilator
theophylline (TheoDur/Theo-24)
aminophylline
second-line treatment
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
xanthine derivatives interactions
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
Anti-inflammatories
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
Anti-inflammatories - Leukotriene receptor antagonist (LTRA)
montelukast (Singulair)
zafirlukast (Accolade)
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
Anti-inflammatories - Inhaled Corticosteroids
beclomethasone diproprionate (Beclovent)
budesonide (Pulmicort Turbuhaler)
fluticasone (Flovent)
neb or MDI
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 -
Combinations: Inhaled glucocorticoid & bronchodilator
budesonide & formoterol (Symbicort)
fluticasone and salmeterol (Advair)
Used for moderate to severe asthma
KEY TEACHING: THESE ARE NEVER FOR ACUTE ATTACKS
Anti-inflammatories - Mast cell stabilizer
cromolyn (Intal)
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
anti-inflammatories - Monoclonal Antibody Anti-asthmatic
omalizumab (Xolair)
Newest generation of anti-asthmatic
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)
anti-inflammatory - Selective PDE-4 Inhibitor
roflumilast
oral
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
SUMMARY SLIDE: Two classes of agents to treat asthma
Quick-relief medications
RESCUE/ relievers
SABA
albuterol/Proventil
Long-term control medications PREVENTERS Anticholinergics Xanthine derivative Inhaled corticosteroids Leukotriene modifiers Mast cell stabilizers LABA
