Pulmonary Pharm Flashcards by Jacob Lucas

What are the 3 subclasses of bronchodilators

Beta 2 Agonists

Anticholinergics

Xanthine derivatives

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3 subclasses of anti-inflammatories

leukortriene receptor antagonist (LTRAs)

inhlaed glucocoritcoids

mast cell stabilizers

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2 Other medication classes

omalizumab

roflumilast

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Classes for COPD treatment that dilate bronchioles

beta 2-adrenergics

inhaled anticholinergics

xanthine derivatives

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Classes for COPD treatment that decrease bronchial inflammation

glucocorticoids

mast cell stabilizer

LTRAs

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MOA of bronchodilators

work by relaxing bronchial smooth muscle

Causes dilation of bronchi/bronchioles

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3 classes of bronchodilators

Beta-Adrenergic Agonists

Anti-cholinergics

Xanthine derivatives

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2 beta-adrenergic agonists Short Acting drugs

Albuterol (Proventil) PO/Inhalant

Levalbuterol (Xopenex) Inhalant

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2 beta-Adrenergic Agonist Long Acting drugs

Salmetrol (Servent)

Formoterol (Foradil)

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What type of beta-adrenergic agonist should be used in an asthmatic attack

Short Acting

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What is the timing of short acting beta agonists

inhaled q 4-6 hrs

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what is the timing of long acting beta agonists

inhaled q 12 hours

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What type of beta agonists are resuce drugs

short acting

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what are long acting beta agonists used for

prevention

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what is the duration of long acting beta agonists

12-24 hrs

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MOA of beta-adrenergic agonist

mic action of SNS flight or flight

Relax and dilate the airways by stimulating the beta2-adrenergic receptors throughout the lungs

Bronchial dilation & increased airflow into and out of the lungs=goal

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what are the 3 subtypes of beta-adrenergic agonist

Non-selective adrenergic drugs– stimulate both beta-1 AND beta-2 receptors AND alpha receptors (epinephrine)

Non-selective beta-adrenergic– stimulate both beta-1 AND beta-2 receptors (metaproterenol)

Selective beta-2 receptors (albuterol) preferred medication to treat pulmonary conditions

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MOA of non-selective drugs

stimulate alpha receptors= vasoconstriction
Decreases edema/swelling in mucous membranes, limits amount of secretions

stimulate beta1= cardiovascular effects
What effects would these be?

CNS stimulation also occurs nervousness/tremors occur

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Indications for beta adrenergic agonists

prevention or relief of bronchospasm related to asthma/bronchitis/other pulmonary conditions

Will see them used for conditions outside the pulmonary system

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Contraindications for beta adrenergic agonist

uncontrolled hypertension, cardiac dysrhythmias, high risk for stroke

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beta-adrenergic agonist should not be given with what other drugs

MAOIs and sympathomimetics (ephedrine/sudafed) bc risk of hypertension

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What may diabetics need with beta-adrenergic agonist

Diabetics may need higher doses of meds because raises blood sugar

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What can beta- 2 drugs cause

hypertension or hypotension

7 Adverse effects of beta-adrenergic agonist

Insomnia
Restlessness
Anorexia
Cardiac stimulation 
Hyperglycemia
Tremor 
Vascular headache

What can reverse an overdose of beta agonist

beta blockers but beware of bronchospasm

T/F Non-selective have the most | adverse effects

TRUE

T/F Most beta-2s have very short half life

TRUE

2 types of inhalers

MDI - Metered dose inhaler DPI - dry powder inhaler

Why are meds given through inhalation?

Minimizes the systemic side effects

which inhaler is not breath activated

MDI

which inhaler is breath activated

DPI

Which inhaler is better for patients with cognitive problems or children

DPI

Albuterol/Probentil onset

minutes

T/F Albuterol is considered a rescue drug

True

What is the delievery method of Albuterol/Proventil

MDI or nebulizer

Albuteraol is a first line treatment for what

acute asthma attack

indications for albuterol/Proventil

Treatment of: Asthma, bronchitis, and emphysema Treatment of: ACUTE episodes of wheezing, chest tightness, SOA

Considerations for albuterol

Use of more than one canister per month indicates inadequate control of asthma & need for initiating or intensifying anti-inflammatory therapy 200 ACTUATIONS per canister Regularly scheduled daily use is NOT recommended * Also for PREVENTION of EIA (exercise induced asthma)

T/F salmeterol is used as a maintenance drug

TRUE

how many times daily is LABA given

twice daily (inhalation)

What is the warning with LABA - salmeterol

has been associated with increased asthma-related deaths More common in Black/African Americans

indications of salmeterol

Worsening of COPD Moderate-severe asthma Key Point: ALWAYS given with an inhaled corticosteroid, not indicated for monotherapy

Functioning of anticholinergics

Giving ANTI-cholinergic agents results in Turning off cholinergic response (PNS) and turning on SNS SNS dominates = bronchodilation Thus increasing perfusion to heart, lungs, and brain

Key point of anticholinergics Function

So, by BLOCKING the effect of acetylcholine (anticholinergic drugs), we INHIBIT the normal physiological response Bronchoconstriction and increased mucus production

MOA of anticholinergics

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

indications of anticholinergics

Used for PROPHYLAXIS and maintenance therapy | NOT for rescue

anticholinergics is often in combination with what

albuterol

anticholinergic drug

ipratroprium (Atrovent)

Adverse effects of antichlinergic

``` Dry Hot Blind Red Mad ```

2 Xanthine Derivative drugs

throphylline (TheoDur/Theo-24) aminophylline

MOA of Xanthine Derivatives

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

What is xanthine derivatives used for

Preventative treatment of asthma attacks and COPD exacerbation second-line treatment because of the high risk of toxicity and drug-drug interactions

S/E of xanthine derivatives

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

contraindications of xanthine derivatives

uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroid, peptic ulcers

interactions with xanthine derivatives

Caffeine - may ↑ side effects Smoking → ↓ absorption

Cautions of xanthine derivatives

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