Respiratory agents

Question 1

albuterol

Answer 1

Brand - ProAir HFA, Proventil HFA, Ventolin HFA

Class - Selective Beta2 agonist

Indication - Asthma (acute, bronchospasm, exercise-induced), COPD

Counseling - Inhaler tech, prime/shake, wash mouthpiece once/week, ER tab passes into stool, contact prescriber if more is needed to control, do not use more, deep inhale for 10s!

MoA - Acts on Beta2-adrenergic receptors of adenylyl cyclase to increase cyclic AMP level to relax bronchial smooth muscle

Question 2

albuterol (sulfate) / ipratropium (bromide)

Answer 2

Brand - Duoneb

Class - Beta2 Agonist, Anticholinergic asthma

Indication - COPD

Pregnancy - Risk

Counseling - Avoid alert activates until familiar; may cause respiratory and GI issues

MoA - Bronchial smooth muscle relaxation

Question 3

azelastine (nasal)

Answer 3

Brand - Astelin, Astepro

Class - (Nasal) Antihistamine

Indication - Allergic/vasomotor rhinitis (perennial/seasonal)

Counseling - Blow nose, prime, avoid septum, may cause bad taste, clean tip; avoid spraying in eyes, alcohol, driving until mental effects are realized

MoA - Selective H1 antagonist, also inhibits leukotrienes and reduces chemotaxis and eosinophil activation

Question 4

budesonide / formoterol

Answer 4

Brand - Symbicort

Class - (Inhaled) Corticosteroid / Bronchodilator combo

Indication - Asthma, COPD

Contraindications - Primary treatment of acute episodes

Black Box - Asthma deaths, pediatric hospitalization risk

Counseling - Rinse mouth to avoiud candidiasis; inhaler technique

MoA - budesonide is an anti-inflam / formoterol is a long acting selective beta2 agonist that produces bronchodilation

Question 5

cetirizine

Answer 5

Brand - Zyrtec

Class - Antihistamine

Indication - Chronic urticaria, perennial/seasonal allergic rhinitis

Counseling - Realize mental alertness (may cause dizziness/sedative effects)

MoA - Low-sedating, long-acting H1-receptor antagonist (metabolite of hydroxyzine), competitively inhibitor prevents allergic response

Question 6

fexofenadine

Answer 6

Brand - Allegra

Class - Histamine H1 antagonist, 2nd Gen Piperidine derivative

Indication - Seasonal allergic rhinitis, Idiopathic urticaria

Pregnancy - Risk

Counseling - Realize mental alertness (may cause dizziness/sedative effects), tk shaken suspension or dissolvable tab with water but no fruit juice

MoA - Metabolite of terfenadine, selective peripheral H1 antagonist, both enantiomers display antihistaminic effects

Question 7

fluticasone (nasal)

Answer 7

Brand - Flonase, Xhance

Class - Intranasal adrenal glucocorticosteroid

Indication - Allergic/non- rhinitis, nasal polyps

Counseling - Admin nasal techn; monitor signs of toxicity (adrenal insufficiency); relief may not occur for several days

MoA - Anti-inflammatory, antipruritic, and vasoconstrictive properties; induce phospholipase A2-inhibitory proteins, which control biosynthesis of inflammatory mediators through the inhibition of arachidonic acid

Question 8

fluticasone / vilanterol

Answer 8

Brand - Breo Elipta

Class - Inhaled corticosteroid & long-acting beta2 agonist combo

Indication - COPD, Asthma

Contraindication: milk protein allergy

Counseling - Rinse mouth after use to prevent oral infection, report cataracts/glaucoma, or infection

MoA - fluticasone is anti-inflammatory/itch, vasoconstrictive - inhibits arachidonic acid, precursor to inflam mediators / vilanterol is beta2 agonist to stimulate cyclic AMP to relax bronchial smooth muscle

Question 9

fluticasone [propionate] / salmeterol [xinafoate]

Answer 9

Brand - Advair Diskus/HFA, Wixela Inhub, AirDuo RespiClick

Class - Inhaled corticosteroid / long-acting beta2 agonist combo

Indication - Asthma, COPD

Contraindications - Hypersensitivity to milk proteins, not primary treatment of acute attacks, coadmin of posaconazole

Black Box - Increased asthma-related deaths

Counseling -

MoA - fluticasone is anti-inflammatory/itch, vasoconstrictive - inhibits arachidonic acid, precursor to inflam mediators / salmeterol is beta2 agonist to stimulate cyclic AMP to relax bronchial smooth muscle

Question 10

levocetirizine

Answer 10

Brand - Xyzal

Class - Antihistamine

Indication - allergic rhinitis (idiopathic urticaria, perennial, or seasonal)

Contraindication: Renal impairment or hemodialysis

Counseling - May cause dizziness or sedative effects

MoA - enantiomer of cetirizine, long-acting H1 receptor antagonist

Question 11

loratadine

Answer 11

Brand - Claratin

Class - Antihistamine

Indication - Idiopathic urticaria chronic, seasonal allergic rhinitis

Counseling - May cause dry mouth, headache, drowsiness, or fatigue

MoA - long-acting tricyclic peripheral H1-receptor antagonist

Question 12

montelukast

Answer 12

Brand - Singulair

Class - Leukotriene Receptor Antagonist

Indication - Asthma, exercise-induced bronchoconstriction, seasonal allergic rhinitis

Black Box: Behavior and mood-related effects

Counseling - Not for acute asthma attacks; take dose in the evening

MoA - Inhibits leukotriene released by mast cells and eosinophils

Question 13

tiotropium

Answer 13

Brand - Spiriva HandiHaler

Class - Anticholinergic Bronchodilator

Indication - COPD, Asthma

Contraindication: hypersensitivity to milk protein

Counseling - Not a rescue therapy; may increase HR, dry mouth, constipation, urinary difficult, respiratory infection, and sinusitis. Do not swallow inhalation capsules, inhale twice, maximum benefit may not be seen for 1-2 months

MoA - long-acting antimuscarinic agent, site-specific bronchodilation

Question 14

triamcinolone (nasal)

Answer 14

Brand - Nasacort AQ

Class - Intranasal Glucocorticosteroid

Indication - Perennial or seasonal allergic rhinitis

Counseling - Monitor for adrenal insufficiency and growth delay in children

MoA - Inhibit the release of arachidonic acid which controls the synthesis of inflammatory mediators; also has antipruritic and vasoconstrictive properties