Quiz 5 Respiratory and GI Flashcards
Albuterol
Brand Name: ProAir HFA
Drug Class: Selective Beta 2 Adrenergic Agonist
Indication: Asthma (Acute, bronchospasm, exercise induced) and COPD
MoA: They are selective beta 2 adergenic agonists that act on beta 2 adergenic receptors of intracellular adenylyl cyclase to increase cyclic AMP levels resulting in bronchial smooth muscle relaxation
Pregnancy Category: Compatable
Contraindication: Hypersensitivity
Black Box: None
Counseling: Instruct patient on inhaler technique, including priming and shaking well before using. Wash the mouthpiece and air dry thoroughly at lease once a week (may cease to deliver medication if mouthpiece becomes blocked).
Part of the extended release tablet may pass into stool
Contact prescriber if more albuterol is needed to control symptoms than usual as this may indicate acute asthma exacerbation.
Do not use more frequently than recommended.
DPI does not require shaking or priming but does require deep inhalation for use. When inhaling contents hold for at least 10 seconds if possible to allow albuterol to travel deeper into lungs.
Albuterol sulfate/ Ipratropium bromide
Brand Name: Duoneb
Drug Class: Adreneric System, Antiasthma
Indication: COPD, for patients requiring a second bronchodilator
MoA: Inhalation local: Ipratropium and albuterol combination reduces bronchospasm through both anticholinergic and sympathomimetic mechanisms Both produce a greater bronchodilator effect than when either drug is used alone at recommended dosages.
Albuterol (look above)
Ipratropium is an anticholinergic agent that produces a local, site-specific effect rather than a systemic effect. It appears to produce bronchodilation by inhibition of cholinergic receptors on bronchial smooth muscle
Pregnancy: fetal risk cannot be ruled out
Contraindicated: Hypersensitivty
Black Box: None
Counseling: Avoid activities where you need to be alert until drug effects are realized (can cause dizziness, blurred vision, mydriasis, or accomodation disorders)
Tell patient not to exceed physician recommendation dose as fatalities have occurred
Immediatley stop drug, use alternative therapy, and contact physician with devleopment of paraxodial bronchospasm
Report need for icnreased frequency or amounts of drug to provide symptomatic relief
Drug may cause diarrhea, dyspepsia, nausea, vomiting, xerostomia, cough, dyspnea, pharyngitis, sinusitis, upper respiraotry infections, or taste perservsion.
Report signs/symptoms of arrhythmias.
Avoid spraying drug near eyes as this may cause eye pain or discomfort, temporary blurring of vision, visual halos, mydriasis, or new onset or worsening of narrow-angle glaucoma.
Advise patient on proper inhalation technique, depending on delivery device used.
Wash the mouthpiece at least weekly to avoid medication buildup and blockage of device
Azelastine nasal
Brand Name: Astelin
Drug Class: Nasal Antihistamine
Indication: Allergic rhinitis, Vasomotor rhinitis
MoA: It is a selective H1 receptor antagonist that blocks release of histamine from cells involved in the allergic response. It also inhibits other mediators of allergic reactions, and reduces chemotaxis and eosinophil activation
Pregnancy: N/A
Contraindication: Hypersensitivtity
Black Box: None
Counseling: Avoid spraying in eyes. Somnolence has been reported with nasal administration; instruct patient to avoid alcohol use and hazradout activities such as driving or operating machinery until level of sedation is known.
Review proper instillation technique, including priming the spray with initial use and if not used for over three day.
Blow nose prior to using. Do not spray into wall separating nostrils (septum). May cause taste disturbances that are typically transient and temporary.
To prevent contamination, keep tip of nose spray clean.
Budesonide/Formoterol
Brand Name: Symbicort
Drug Class: Inhaled corticosterpod / Bronchodilator combination
Indication: Asthma, COPD
MoA: Budesonide is an antiinflammatory with potent glucocorticoid and weak mineralcorticoid activity. It exhibits a broad range of active inhibition against multiple cell types and mediators involving allergic and nonallergic/irritant-mediated inflammation. Formoterol is a long-acting selective beta2 adrenergic agonist that produces bronodilation.
Pregnancy Category: Compatible for budesonide. Limited data for formoterol
Contraindication: Hypersensitivity to budesonide or formoterol; primary treatment of status asthmaticus or acute episodes of asthma or COPD
Black Box: Asthma deaths; pediatrics, increased risk of hospitalization
Counseling: Advise patients on proper inhalation technique. If >1 inhalation is prescribed, wait 1 minute after initial inhalation and shake the inhaler again before the next inhalation. After administration, rise mouth with water and spit, and wash face to minimize risk of developing oral candidiasis.
Wash mouthpiece and air-dry thoroughly at least once a week.
Cetirizine
Brand Name: Zyrtec
Drug Class: Antihistamine
Indication: Allergic rhinitis, Urticaria
MoA: Low-sedating, long acting H1 receptor antagonist that is metabolite of hydroxyzine. It competitively inhibits the interaction of histamine with H1 receptors, thereby preventing the allergic response.
Pregnancy: Animal studies suggest low risk, low human data
Contraindication: Hypersensitivity
Black Box: None
Counseling: Patients should avoid activities requiring mental alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.
Fluticasone nasal
Brand Name: Flonase
Drug Class: Intranasal Adrenal Glucocorticosteroid
Indication: Allergic rhinitis, nonallergic rhinitis, nasal polyps
MoA: Fluticasone has anti-inflammatory, antipruritic, and vasoconstrictive properties. Corticosteroids are thought to act by the induction of phospholipase A2-inhibitory proteins, lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor, arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.
Pregnancy: Compatible
Contraindication: Hypersensitivity
Black Box: None
Counseling: Advise patients on the proper administration technique for this product. Instruct patients to monitor for signs of toxicity, especially adrenal insufficiency. Inform patient there may a scent associated with this product. Relief and/or adverse effects may not occur for several days after initiation.
Fluticasone Propionate/ Salmeterol Xinafoate
Brand Name: Advair Diskus
Drug Class: Inhaled Corticosteroid and Long-Acting Beta 2 adergenic Agonist Combination
Indication: Asthma, COPD
MoA: Fluticasone is a synthetic trifluorinated corticosteroid with anti-inflammatory effects. It is a human glucocorticoid receptor agonist that inhibits multiple cell types and mediator production or secretion involved in asthma and COPD. Salmeterol is a long-acting β2-adrenergic agonist, stimulates intracellular adenylyl cyclase in catalyzing the conversion of adenosine triphosphate (ATP) to cyclic-3’,5’-adenosine monophosphate (cyclic AMP). The increased cyclic AMP levels result in the relaxation of bronchial smooth muscle and inhibition of the release of mediators of instantaneous hypersensitivity from mast cells.
Pregnancy: Compatible (fluticasone, probably compatible salmeterol
Contraindication: Hypersensitivity to any component of the product, including milk proteins (included in the inhalation powder); should not be used as primary treatment of status asthmatics or acute episodes of asthma or COPD, posaconazole coadministration
Black Box: Increased Asthma related deaths
Counseling: Proper administration technique for specific inhaled product prescribed; rinse mouth with water after each use to prevent oral infections. Monitor for signs of toxicity, especially adrenal insufficiency, oral candidiasis, and worsening pulmonary function.
Fluticasone/vilanterol
Brand Name: Breo Elipta
Drug Class: Adrenal glucocorticoid
Indication: COPD, Asthma
MoA: Vilanterol trifenatate, a long-acting beta-2-adrenergic agonist, increases cyclic AMP levels which results in the relaxation of bronchial smooth muscle and inhibition of the release of mediators of instantaneous hypersensitivity from mast cells
Fluticasone furoate is a synthetic trifluorinated corticosteroid with powerful antinflammatory effects. Its mechanism of action in treating COPD is unknown, but corticosteroids have a wide range of actions on multiple cell types and mediator involved in inflammation
Pregnancy: Unknown
Contraindication: A) Primary treatment of status asthmatic or other acute episodes of COPD or asthmas where intensive measures are required [2]
B) Hypersensitivity to fluticasone furoate, vilanterol, or any component of the product [2]
C) Severe hypersensitivity to milk proteins [2]
Black Box: None
Counseling: Advise patient that drug is not used for acute symptoms of COPD or asthma
Warn patient to report symptoms of an infection, hypercorticism, or adrenal suppression
Instruct patient to avoid exposure to chickenpox or measles. If an exposure occurs, patient should notify physician
Side effects may include nasopharyngitis, cough, bronchitis, sinusitis, oropharyngeal pain, and dysphonia
Inform patient to report symptoms of cataracts or glaucoma
Instruct patient not to exceed maximum recommended dose of 1 inhalation/day
Counsel patient against abrupt discontinuation as symptoms may recur
Advise patient to rinse mouth with water (do not swallow) after use to reduce risk of oropharyngeal candidiasis.
Levocetirizine
Brand Name: Xyzal
Drug Class: Antihistamine
Indication: allergic rhinitis (idiopathic urticaria, perennial, or seasonal)
MoA: Levocetirizine, an enantiomer of cetirizine, is a low-sedating, long-acting H1-receptor antagonist that is a metabolite of hydroxyzine. It competitively inhibits the interaction of histamine with H1 receptors, thereby preventing the allergic response.
Pregnancy: No human data
Contraindication: Hypersensitivity to cetirizine, levocetirizine, hydroxyzine, patients with CrCl <10 mL/min, children <12 y with any renal impairment, any patient on hemodialysis
Black Box: None
Counseling: Patients should avoid activities requiring metal alertness or coordination until drug effects are known, as drug may cause dizziness or sedative effects.
Loratadine
Brand Name: Claratin
Drug Class: Antihistamine
Indication: Idiopathic urticardia chronic
Seasonal allergic rhinitis
MoA: Loratadine, a long-acting tricyclic antihistamine, selectively blocks peripheral histamine H(1)-receptor activity
Pregnancy: Fetal risk cannot be ruled out
Contraindication:Hypersensitivity to loratadine or any of its ingredients hypersensitivity to desloratadine, an active metabolite of loratadine
Black Box: None
Counseling: Patient should avoid activities requiring mental alertness until drug effects are realized.
This drug may cause xerostomia, headache, somnolence, or fatigue.
Rapidly disintegrating tablets may be taken with or without water.
Meclizine Hydrochloride
Brand name: Antivert
Drug Class: Antihistamine, Antiemetic
Indication: Motion sickness, Vertigo
MoA: Meclizine is an antihistamine that suppresses the vasodepressor response to histamine while only slightly inhibiting acetylcholine.
Pregnancy: Compatible
Contraindication: Hypersensitivity
Black Box: None
Counseling: May cause drowsiness; avoid driving or operating dangerous machinery until you know how this medication affects you. Avoid alcoholic beverages and other CNS depressants while taking this drug. Take with food to decrease GI symptoms. Because of its potential anticholinergic action, this drug should be used with caution in patients with asthma, glaucoma, or enlargement of the prostate gland. Formulations that are not identified as chewable should not be crushed or chewed.
Methylprednisolone
Brand Name: Medrol
Drug Class: Adrenal corticosteroid
Indication: Allergic states (eg, asthma, etc)
Dermatologic diseases (eg, exfoliative erythroderma, etc)
Endocrine disorders (eg, adrenocortical insufficiency, etc)
GI diseases (eg, regional enteritis, ulcerative colitis, etc)
Hematologic disorders (eg, acquired hemolytic anemia, etc)
Neoplastic diseases (eg, palliative management of leukemias and lymphomas, etc)
Nervous system (eg, multiple sclerosis, cerebral edema, etc)
Renal diseases (eg, idiopathic nephrotic syndrome, systemic lupus erythematosus, etc)
Respiratory diseases (eg, idiopathic eosinophilic pneumonia, etc)
Rheumatic disorders (eg, rheumatoid arthritis, etc)
MoA: Corticosteroids are naturally occurring and synthetic adrenocortical steroids that cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.
Pregnancy: Weigh risks and benefits
Contraindication: Hypersensitivity to methylprednisolone or other glucocorticosteroids, administration of live vaccines, fungal infections
Black Box: None
Counseling: For short-term treatment, inform patients to take doses with meals to prevent GI upset. For high-dose or longer-term treatment, inform patients to monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection.
Montelukast
Brand Name: Singulair
Drug Class: Leukotrienene Receptor Antagonist
Indication: Asthma, Exercised-induced bronchoconstriction, seasonal allergic rhinitis
MoA: Leukotrienes are products of arachidonic acid metabolism and are released from various cells, including mast cells and eosinophils, and bind to leukotriene receptors. Montelukast binds with leukotriene receptors to inhibit physiologic actions of leukotriene.
Pregnancy: Limited human data
Contraindication: Hypersensitivity
Black Box: Behavior and mood-related effects
Counseling: Not indicated for acute asthma attacks. Report increased use of short-acting inhaled bronchodilators and advise patients not to discontinue or decrease the dose of other asthma medications unless instructed by a health-care professional. Patients with asthma or allergic rhinitis should take dose in the evening.
Prednisolone
Brand Name: Orapred
Drug Class: Adrenal glucocorticoid
Indication: Allergic states (eg, asthma, etc): 1-2 mg/kg/d divided 1-2 times daily, max 60 mg/dose
Dermatologic diseases (eg, exfoliative erythroderma, etc)
Endocrine disorders (eg, adrenocortical insufficiency, etc)
GI diseases (eg, regional enteritis, ulcerative colitis, etc)
Hematologic disorders (eg, acquired hemolytic anemia, etc)
Neoplastic diseases (eg, palliative management of leukemias and lymphomas, etc)
Nervous system (eg, multiple sclerosis, cerebral edema, etc)
Renal diseases (eg, idiopathic nephrotic syndrome, systemic lupus erythematosus, etc)
Respiratory diseases (eg, idiopathic eosinophilic pneumonia, etc)
Rheumatic disorders (eg, rheumatoid arthritis, etc)
MoA: Glucocorticosteroids are naturally occurring and synthetic adrenocortical steroids that cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.
Pregnancy: Human data suggest risk
Contraindication: Hypersnsitivity to prednisolone or other glucocorticosteroids, administration of live vaccines, fungal infections
Black Box: None
Counseling: Take with food or milk to prevent GI upset. Take in the morning to help prevent insomnia. For high-dose or longer-term treatment, monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection.
Prednisone
Brand Name: Deltasone
Drug Class: Adenal Corticosteroid
Indication: Allergic states (eg, asthma, etc)
Dermatologic diseases (eg, exfoliative erythroderma, etc)
Endocrine disorders (eg, adrenocortical insufficiency, etc)
GI diseases (eg, regional enteritis, ulcerative colitis, etc)
Hematologic disorders (eg, acquired hemolytic anemia, etc)
Neoplastic diseases (eg, palliative management of leukemias and lymphomas, etc)
Nervous system (eg, multiple sclerosis, cerebral edema, etc)
Renal diseases (eg, idiopathic nephrotic syndrome, systemic lupus erythematosus, etc)
Respiratory diseases (eg, idiopathic eosinophilic pneumonia, etc)
Rheumatic disorders (eg, rheumatoid arthritis, etc)
MoA: Glucocorticosteroids are naturally occurring and synthetic adrenocortical steroids that cause varied metabolic effects, modify the body’s immune responses to diverse stimuli, and are used primarily for their anti-inflammatory effects in disorders of many organ systems.
Pregnancy: Human data suggest risk
Contraindication: Hypersnsitivity to prednisone or other glucocorticosteroids, administartion of live vaccines, fungal infections
Black Box: None
Counseling: Take with food or milk to prevent GI upset. Take in the morning to help prevent insomnia. For high-dose or longer-term treatment, monitor for signs of hyperglycemia, osteoporosis, adrenocortical insufficiency, and infection.
