Respiratory Flashcards
Atopic triad
Asthma
Allergic rhinitis
Atopic ezcema
Pharmacological agents used for Asthma
Beta 2 agonists (LABA and SABA)
Muscarinic antagonists (LAMA and SAMA)
Xanthines
Corticosteroids
Leukotriene Modifiers
Step wise approach to asthma management
Beta 1 vs Beta 2 receptors
Beta 2 Agonists Mechanism of Action
Activates beta receptors causing smooth muscle relaxation
SABA vs LABA
SABA examples and indications
Albuterol, levalbuterol (Xopenex), pirbuterol (Maxair), metaproterenol (Alupent), and terbutaline (Brethine, Brethaire)
Used for acute bronchospasm
Asthma is considered poorly controlled if using inhaler more than 2x a week or if going through more than one inhaler/month; consider step up
Albuterol (SABAs) Pharmacodynamics
- acts on the smooth muscle of the bronchi to reverse bronchospasm by activating beta 2 receptors in the lungs increasing vital capacity and airflow
- also has some effect on beta 1 receptors in the heart - causes side effects tachycardia, nervousness, etc.
Albuterol cautions/contraindications
- avoid in arrhythmias that cause tachycardia and pheochromocytoma (adrenal tumor- increased sympathetic response)
- can cause HTN
- caution in pts with CV disease (CHF, HTN), diabetes, glaucoma, and hyperthyroidism
Albuterol/SABA Adverse Drug Reactions (usually transient)
tachycardia, dizziness, palpitations, tremors, nervousness, headache - ** due to effect on beta 1 receptors in the heart**
LABA examples and indications
- Salmeterol
- Formoterol
- vilanterol (Breo Ellipta) - Ultra long acting - taken QD “Very easy to take”
Used in management of asthma and COPD. Do NOT use as monotherapy in asthma patients (usually paired with ICS).
Not for acute symptom management.
Salmeterol (Serevent) [LABA] Mechanism of Action
- relaxes bronchial smooth muscle by selective action on beta 2 receptors
3 advantanges:
- Quick onset of action
- Long MOA- last longer
- More selective to Beta-2 receptors which decreases the prevalence of side effects
LABA cautions/contraindications
- NOT to be used as mono-therapy in patients with asthma (Serevent and Foradil) - causes downregulation of beta-2 receptors if used alone so in emergencies, short-acting beta-2 receptor antagonist medications (Albuterol) will not work - leads to increase in asthma intubations and death
- caution in pts with cardiovascular dz, diabetes, hyperthyroidism, glaucoma
Inhaled Corticosteroids Examples and Mechanism of Action
Beclomethasone, Budesonide, Ciclesonide, Flunisolide, Fluticasone, Mometasone
- potent anti-inflammatory and vasoconstriction action
- inhaled: inhibit IgE in mast cell migration of inflammatory cells into the bronchioles
ICSs indications
- Primarily used in asthma (2nd line if pt is using SABAs more than 2x/week)
- can also be used in COPD to reduce exacerbations - keep pts out of the hospital
ICSs cautions/ contraindications
- NOT for asthma exacerbation
- use caution in active infection
- watch potassium levels, glucose, bone density, growth (high doses for a long time)
Avoid in: Cushing syndrome, herpes, tuberculosis, nasal trauma or ulcers, untreated respiratory infection
ICSs ADRs
-dry mouth (xerostomia), hoarseness, mouth and throat irriation, flushing, bad taste, oral candidiasis, rash, urticaria (rare)
ICS Patient education
- rinse mouth and spit after use
- keep taking as directed - the only way you know this is working is by less use of SABAs
- if using the a bronchodilator - use the bronchodilator 1st and then after a few minutes use the ICS inhaler
- nasal: blow nose prior to application
- effects are not immediate - takes 3-7 days to see full effect
Leukotriene modifier example and mechaism of action
Montelukast (Singulair)
block bronchconstriction by preventing leukotrienes from binding to receptor sites
Leukotriene modifiers contraindication
acute bronchospasm, lactation, liver impairment
Leukotriene modifiers adverse drug reactions
Fatigue, fever, abdominal pain, h/a
Leukotriene modifier indication
maintenance therapy for asthma >1 year, prevention of EIA>15 years old, allergic rhinitis
Pharmacological agents used for COPD
Antimuscarinics (LAMAs and SAMAs)
Beta 2 agonists (LABAs and SABAs)
Anti-muscarinic mechanism of action and indication
Blocks activation of muscarinic receptors which cause bronchocontriction.
LAMA vs SAMA
More commonly used in COPD than asthma
LAMA example
Tiotropium (Spiriva)
SAMA example
Ipratropium
Management for COPD
Start with LAMA/SAMA then add LABA/SABA
ICS 3rd line
Pharmacological options for smoking cessation
Bupropion
Varenicline (Chantix)
Nicotine replacement therapy
Nicotine replacement therapy patient education
Avoid using multiple forms of nicotine to avoid overdosing (ie. cannot continue to smoke while using)
Varenicline (Chantix) adverse drug reactions
CNS depression, hypersensitivity, nausea, cardiac events, nightmares, insomnia
**Can cause depression and SI, use caution**
Bupropion (Wellbutrin, Zyban) adverse drug reactions
Weightloss (good options for patients concerned about weight gain, caution in underweight), insomnia
Contraindicated with seizure disorder
