Quick Relief Medications for Asthma Flashcards
How do Short Acting B2 agonists work
increasing cAMP and antagonizing constriction–> smooth muscle relaxation
-reverses obstruction and improves airflow
Adverse Effects of SABA
Tachycardia, tremor, hypokalemia, irritability
Chronic use of a SABA indicates poor asthma control ( what is considered chronic use?)
> 2 times/ day
Most common SABAs
Albuterol HFA, Albuterol, Levalbuterol HFA, Levalbuterol
Generic: Albuterol HFA
Brand: ProAir, Ventolin, Proventil, or ProAir Respiclick
Generic: Levalbuterol HFA
Brand: Xopenex
All albuterol products come with what dosing strength?
90 mcg/ inhalation
What dosage forms can you receive albuterol products in?
MDI: ProAir, Ventolin, Proventil
or
Aerosol Powder Inhaler: ProAir Respiclick
what age group would it be appropriate to use a mask in
0-4 y/o
When comparing albuterol or levalbuterol, which is FDA approved for ages 0-4
albuterol
Albuterol nebulizer solution comes in what strength?
0.63mg/mL
1.25 mg/3 mL
2.5 mg/ 3 mL
5mg/mL
What dosage form and strength does leavalbuterol HFA come in?
An MDI at 45mcg/ inhalation
What strength does Levalbuterol nebulizer solution come in?
- 31 mg/3 mL
- 63 mg/3 mL
- 25 mg/0.5 mL
- 25 mg/ 3mL
Albuterol nebulizer solution can be mixed with what?
cromylyn solution
budesonide inhalant suspension
ipatropium solution
In mild/ moderate asthma exacerbations and MDI plus_____ can be effective with nebulizer therapy?
valved holding chamber
When would you use levalbuterol
when albuterol does not work for a patient
What kind of suspension is compatible with levalbuterol nevulizer solution ( can mix)
budesonide inhalant suspension
Biggest difference between albuterol and Levalbuterol?
Strength of dosing ( Levo is half strength of albuterol becuase of INC potency)
How do short acting anti-muscarinics work?
competitively inhibit cholinergic receptors in bronchial smooth muscle by DEC cGMP and inducing dilation
AE’s of short acting anti-muscarinics
Dry mouth, urinary retention, infection, sinusitis, bronchitis
Short acting Anti-muscarinics are typically used in combo with what? and for what?
albuterol, asthma exacerbation
This class should not be used as a first line therapy choice, but should be added to SABA therapy for severe exacerbation
SA anti-muscarinics
Most common SA Anti-muscarinics
Ipatropium
ipatropium/ albuterol
Ipatropium HFA: generic
Brand: Atrovent
Dosage forms that ipatropium come in
MDI or nebulizer sln
Ipatropium dose strength of MDI
17mcg/ inhalation
ipatropium nebulizer soln dosage strength
0.25mg/mL
Ipatropium/ albuterol: generic
brand: Combivent respimat
Ipatropium/ albuterol products come in what different dosage forms?
MDI and Nebulizer solution
Ipatropium/ albuterol MDI strength
20mcg/ 100mcg per inhalation
Ipatropium/ albuterol nebulizer soln strength
0.5mg/2.5mg per 3ml vial
What is important to note about ipatropium/ albuterol nebulizer soln?
May be used for up to 3 hours in initial treatment management of severe exacerbation
How do systemic Corticosteroids work?
They decrease inflammation and increase response to B2 agonists
Four main systemic corticosteroids
Methylprednisolone
Prednisolone
Prednisone
Methylprednisolone acetate
AE of short term oral corticosteroid use
hyperglycemia, INC appetite, fluid retention, demargiation of WBC’s, psychiatric disturbances
Contraindications of Systemic Corticosteroids
systemic fungal infections, admin of live vaccines ( if immunocompromised)
Drug interactions associated with systemic corticosteroids
Warfarin INR will INC, and experience a DEC of efficacy in inactivated vaccines
When can you take a systemic CS while also using an ICS
if pt is staking ICS proir to hospitalization
This class can be used in chronic therapy of COPD and Asthma, but only in the severe stages.
Systemic CS
What is a “burst” dosage form and why is it effective
burst is a short term, high dose therapy option. They are useful for establishing control when initiating therapy or during periods of general deterioration
When should injection of a systemic CS be used instead of burst
in case of adherence issues or patient is vomiting
Available dosage forms of methylpredisolone
tablets (2,4,6,8,16,32 mg)
Available dosage forms of prednisolone
tablets (5mg) oral liquid ( 5mg/5ml and 15mg/5ml)
Available dosage forms of prednisone
tablets (1,2.5,5,10,20,50 mg) oral liquid ( 5mg/5ml)
Available dosage forms of methylprednsiolone acetate
repository injection ( 40mg/mL or 80mg/mL)
Max Dose prednisolone
60mg/ day PO for 3-10 days
Additional medications used for asthma exacerbation
epinephrine
Terbutaline
Magnesium Sulfate IV
Dosage form of epinephrine and terbutaline
SubQ
These two drugs have no proven effect over aerosol
epinephrine
terbutaline
How does magnesium sulfate work as a short term / fast acting dilator
inhibit calcium influx into smooth muscle cells, inhibiting muscle contraction–> smooth muscle relaxation
