Rescue Medications (Asthma/COPD) Flashcards
Inhaled short acting beta-2 agonists (SABA) action?
increase cAMP, antagonize bronchoconstriction –> smooth muscle relaxtion (reverse obstruction and improve airflow)
albuterol HFA brand names?
ProAir, Ventolin, Proventil, ProAir Respiclick, ProAir Digihaler
albuterol HFA dosage forms?
MDI, Aerosol Powder Inhaler, nebulizer solution (albuterol only, not HFA)
albuterol adverse effects/clinical pearls?
- Tachycardia, tremor, hypokalemia, irritability
- Chronic use (> 2x/day) indicates poor asthma control
- May mix nebulizer solution with cromolyn solution, budesonide inhalant suspension, or ipratropium solution
- In mild to moderate exacerbations, MDI plus valved holding chamber is as effective as nebulized therapy with appropriate administration technique and coaching by trained personnel
albuterol age usage?
All ages can use albuterol
levalbuterol HFA brand name?
Xopenex
levalbuterol HFA dosage form?
MDI, nebulizer solution (levalbuterol only, not HFA)
levalbuterol adverse effects/clinical pearls?
- Tachycardia, tremor, hypokalemia, irritability
- Reserved for patients who do not respond to albuterol for quick relief
- Nebulizer solution compatible with budesonide inhalant suspension
- Levalbuterol administration in 1/2 the mg dose of albuterol provides comparable efficacy and safety
- Has not been evaluated by continuous nebulization
levalbuterol age usage?
All ages can use levalbuterol
Short acting anticholinergics action?
Competitively inhibit cholinergic receptors in bronchial smooth muscle –> decrease cGMP leading to bronchodilation
ipratropium brand name?
Atrovent
ipratropium dosage forms?
MDI, nebulizer solution
ipratropium adverse effects/clinical pearls?
- Dry mouth, urinary retention, infection, sinusitis, bronchitis
- Used in combo with albuterol for asthma exacerbation treatment
- May mix in same nebulizer with albuterol
- Should not be used as first-line therapy; should be added to SABA therapy for severe exacerbations
ipratropium/albuterol brand name?
Combivent Respimat, DuoNeb
ipratropium/albuterol dosage forms?
MDI, Nebulizer Solution
ipratropium/albuterol adverse effects/clinical pearls?
- Adverse effects are individualized
- Nebulizer solution may be used for up to 3 hours in initial management of severe exacerbations
Short acting anticholinergic age usage?
All ages can use them
System corticosteroids action?
decrease inflammation, increase response to beta-2 agonists
methylprednisolone dosage form
tablets
prednisolone dosage form?
tablets, oral liquid
prednisone dosage form?
tablets, oral liquid
dexamethasone dosage form?
oral liquid, tablets, injection
methylprednisolone acetate dosage form?
repository injection
systemic corticosteroids adverse effects/clinical pearls?
- Short term use: hyperglycemia, increased appetite, fluid retention, demargination of WBCs, psychiatric disturbances
- CI: systemic fungal infections, administration of live vaccines if immunocompromised
- DI: Warfarin increases INR, decreases efficacy of inactivated vaccines
- May be used with ICS if patient is already taking ICS before hospitalization
- May also be used for chronic therapy in both asthma (and COPD) only in severe stages
- “Bursts” effective for establishing control when initiating therapy or during period of gradual deterioration
- Injection may be used in place of “burst” if adherence is an issue or patient is vomiting
epinephrine comments
- no proven advantage of systemic therapy over aerosol
- indicated in addition to standard therapy for acute asthma associated with anaphylaxis and/or angioedema
terbutaline comments
- no proven advantage of systemic therapy over aerosol
systemic subcutaneous beta-2 agonists
epinephrine and terbutaline
magnesium sulfate action?
smooth muscle relaxation through inhibition of calcium influx into smooth muscle cells
