Pulmonary Pharm Flashcards
which meds dilate the bronchioles?
–Beta-2 adrenergics
–inhaled anticholinergics
–Xanthine derivatives
which meds decrease bronchial inflammation?
–glucocorticoids
–mast cell stabilizers
–LTRAs
examples of Beta-2 adrenergic agonist meds
–albuterol
–levalbuterol
–salmetrol
–formoterol
short acting beta-2 adrenergic agonists
–albuterol
–levalbuterol
long acting beta-2 adrenergic agonists
–salmetrol
–formoterol
how often should short acting beta agonist meds be taken?
every 4-6 hours
how often should long acting beta agonist meds be taken?
every 12 hours
which are considered rescue drugs?
short acting
which are considered preventer drugs?
long acting
MOA of beta-adrenergic agonists
relax and dilate the airways by stimulating the beta-2 adrenergic receptors throughout the lungs
–mimic action of SNS (fight or flight)
non-selective adrenergic drugs
stimulate both beta-1 and beta-2 receptors AND alpha receptors
non-selective beta adrenergic
stimulate both beta-1 and beta-2 receptors
selective beta-2 receptors
preferred meds to treat pulmonary conditions
what do non-selective drugs stimulate? And what does this cause?
–alpha receptors, vasoconstriction (decreases swelling in mucous membranes, limits amt of secretions)
–beta-1, cardiovascular effects
what do beta-1 receptors trigger?
heart
what do beta-2 receptors trigger?
lungs
indications for beta agonists
prevention or relief of bronchospasm related to asthma/bronchitis/other pulm conditions
contraindications for beta agonists
–uncontrolled HTN
–cardiac dysrhythmias
–high risk for stroke
specifics of beta agonists
–can be given with beta blockers, but may diminish effect
–avoid use with MAOIs and sympathomimetics = HTN
–diabetics may need more meds because raises blood sugar
adverse effects of beta agonists
–insomnia
–restlessness
–anorexia
–cardiac stimulation
–hyperglycemia
–tremor
–vascular headache
relationship between beta agonists and beta blockers
beta agonists can reverse OD of beta blockers
who is a DPI best for?
cognitively impaired or children
indications for albuterol
–asthma
–bronchitis
–emphysema
–acute episodes of wheezing, chest tightness, SOA
indications for salmeterol
–worsening of COPD
–moderate-severe asthma
–always given with inhaled corticosteroid
warning for salmeterol
has been associated with increased asthma-related deaths
MOA of anticholinergics
type of bronchodilator that works on acetylcholine receptors, not adrenergic receptors. Creates bronchodilation.
what does giving anticholinergic agents result in?
–turning off cholinergic response (PNS)
–turning on SNS (bronchodilation)
example of anticholinergic
ipatroprium
indications for ipatroprium
prophylaxis and maintenance therapy
anticholinergic effects
–dry as a bone
–hot as a hare
–blind as a bat
–red as a beet
–mad as a hatter
examples of xanthine derivatives
–theophylline
–aminophylline
MOA of xanthine derivatives
increasing levels of cAMP enzyme by inhibiting phosphodiesterase
what level of treatment are xanthine derivatives used at?
second line d/t high risk of toxicity and drug-drug interactions
indication for theophylline/aminophylline
preventative treatment of asthma attacks and COPD exacerbation
what happens to theophylline in the body?
metabolized to caffeine
side effects of xanthine derivatives
Toxicity
–N/V/D
–insomnia
–HA
–tachycardia
–dysrhythmias
–seizure disorders
contraindications for xanthine derivatives
–uncontrolled cardiac dysrhythmias
–seizure disorders
–hyperthyroid
–peptic ulcers
interactions with xanthine derivatives
–caffeine –> may increase side effects
–smoking –> decreased absorption
what to give with xanthine derivative toxicity
activated charcoal
drug interactions with xanthine derivatives
–macrolides
–allopurinol
–cimetidine
–quinolones
–flu vaccine
–oral contraceptives
what do leukotrienes cause?
inflammation, bronchoconstriction, mucus production
examples of leukotriene receptor antagonists (LTRAs)
–montelukast
–zafirlukast
MOA of LTRAs
prevent leukotrienes from attaching to receptors located on immune cells and within the lungs –> prevents inflammation
route for LTRAs
PO
indications for LTRAs
oral prophylaxis and chronic treatment of asthma in adults and children
–NOT for acute attacks
adverse effects of LTRAs
–HA
–nausea
–dizziness
–insomnia
–diarrhea
examples of inhaled corticosteroids
–beclomethasone
–budesonide
–fluticasone
route for inhaled corticosteroids
via neb or MDI
MOA of inhaled corticosteroids
reduce inflammation and enhance activity of beta agonists
–help with bronchodilation
timeline for inhaled corticosteroids
can take several weeks before full effects are realized
teaching for inhaled corticosteroids
for asthma:
–take on regular schedule
–give bronchodilator first for more thorough absorption
adverse effects of inhaled corticosteroids
–pharyngeal irritation
–coughing
–dry mouth
–oral fungal infections
RINSE MOUTH AFTER USE
what combinations are used for moderate to severe asthma (maintenance)?
–budesonide and formoterol
–fluticasone and salmeterol
MOA of mast cell stabilizers
stabilize membranes of mast cells and prevent release of broncho-constrictive inflammatory substances
indications for mast cell stabilizers
prevention of acute asthma attacks
example of mast cell stabilizer
cromolyn
time frame for giving cromolyn
15-20 minutes prior to known triggers
example of monoclonal antibody anti-asthmatic
omalizumab
MOA for omalizumab
monoclonal antibody that selectively binds to IgE and limits release of mediators of allergic response
route for omalizumab
injection
indication for omalizumab
add-on therapy for asthma
monitoring for omalizumab
monitor closely for hypersensitivity reactions (anaphylaxis)
MOA for selective PDE-4 inhibitor (roflumilast)
selectively inhibits PDE4 enzyme in lung cells (anti-inflammatory effects)
indication for roflumilast
COPD exacerbations
route for roflumilast
PO
side effects of roflumilast
–N/V/D
–HA
–muscle spasms
–decreased appetite
–uncontrollable tremors
long term control medications (preventers)
–anticholinergics
–xanthine derivatives
–inhaled corticosteroids
–leukotriene modifiers
–mast cell stabilizers
–LABA
quick relief medications (rescue)
–SABA
–albuterol/Proventil
