Respiratory drugs Flashcards
fluticasone (Flovent)
Class: corticosteroid (inhaled)
MoA: Suppresses inflammation by decreasing migration of neutrophils and eosinophils
Use: Prevention of moderate-severe asthma and COPD
Administration: MDI/DPI
AE: Dry mouth, sore throat, hoarseness, candidiasis, adrenal suppression causing bone loss & growth stunt (most serious but very rare)
Considerations: Gargle with H2O after admin to reduce AE. Use spacer.
prednisone
Class: corticosteroid (oral)
MoA: Suppresses inflammation by decreasing migration of neutrophils and eosinophils
Use: Severe asthma when sx not controlled with safer drugs
Administration: PO: starts high and tapers off
AE: Not significant if given for < 10 days. Hyperglycemia, immunocompromise, adrenal suppression, fluid retention, insomnia, euphoria, mania, depression, osteoporosis, hypokalemia, stomach ulcers
Considerations: Don’t stop abruptly. May need increased insulin dose if DM. Increase dose with increased stress.
albuterol (Ventolin)
Class: Selective Short Acting Beta2 Adrenergic Agonist (SABA)
MoA: activation of beta 2 receptors in the lungs resulting in bronchodilation
Use: Short acting relief of bronchospasm and prevents exercise induced bronchospasm.
Administration: MDI, DPI, neb
AE: Few… hypokalemia with high doses, tachycardia
Considerations: Beta blockers decrease therapeutic effect. When taken with inhaled steroid, take albuterol first then wait 5 minutes before taking steroid.
salmeterol (Serevent)
Class: Long acting Beta 2 agonist (LABA)
MoA: Same as SABA
Use: Long-term control of asthma and prevention of bronchospasm
Administration: DPI
AE: Similar to SABA, HA most common
Considerations: beta blockers reduce therapeutic effect. Should never be used alone–always with corticosteroid. Not for acute attacks.
formoterol/budesonide (Symbicort) and
fluticasone/salmeterol
combination corticosteroid and LABA. treats both inflammation and bronchoconstriction, more effective given together than individually, better for pt adherance. Smaller doses of each can be given in combos potentially decreasing adverse effects.
theophylline
Class: methylxanthines
MoA: produces bronchodilation by relaxing bronchial smooth muscle
Use: treatment of asthma, bronchospasm of chronic bronchitis and emphysema
Administration: PO. Narrow therapeutic range: theo levels should be 5-15 mcg, levels >30mcg/ml = serious AEs
AE: Numerous and dangerous: Hold & contact provider if N/V, anxiety, insomnia, convulsions.
Considerations: Drink plenty of water, take w full glass of water, best on empty stomach. Avoid caffeine, smoking, weed.
ipratropium (Atrovent)
Class: Anticholinergics
MoA: Blocks action of AcH at muscarinic receptors in the lung, producing bronchodilation
Use: Bronchospasm a/w COPD, off label use for stable asthma
Administration: MDI, neb
AE: Dry mouth, no systemic AEs
Considerations: Rinse mouth after use. Incr. anticholinergic AEs if given with other anticholinergics
montelukast (Singular)
Class: leukotriene stabilizers
MoA: suppress effects of leukotrienes by blocking receptor sites, producing reduction of inflammation
Use: long term prevention of bronchospasm, prevents EIB and treats seasonal allergies
Administration: PO.
AE: minimal. N/V/D most common, churg-strauss syndrome rare.
Considerations: take 2 h before exercising to prevent EIB
omalizumab (Xolair)
Class: anti monoclonal antibody
MoA: inhibits IgE binding to receptors on mast cells, causing reduced inflammation
Use: 2nd line for allergy related asthma when other options fail
Administration: SQ every 3-4 weeks
AE: anaphylaxis, local reactions @ injection site, HA, nausea
Considerations: $$$$
roflumilast (Daliresp)
Class: PDE4 inhibitors
MoA: anti-inflammatory and anti-modulatory effects in pulmonary system
Use: reduces risk of COPD exacerbation in severe COPD
Administration: PO.
AE: diarrhea, nausea, HA, weight loss, back pain, insomnia, dizziness
Considerations: interactions with cipro. Use with caution w hx depression. Not a treatment of acute bronchospasm.
H1 antagonists
1st gen diphenhydramine, 2nd gen cetirizine, 3rd gen fexofenadine
MoA: blocks histamine at H1 receptors
Use: allergic disorders, hypersensitivity reactions, motion sickness, insomnia, itching, cold sx
Administration: diphen: PO/IV/IM. 2nd/3rd gen PO.
AE: CNS, anticholinergic & GI effects mostly w/ diphen
Considerations: interacts w other CNS depressant for increased AEs, cautious use in elderly, pregant/breastfeeding, pts w severe liver disease, seizures, asthma. Hold fruit juices w fexo
guaifenesis (Mucinex)
SE nervousness, restlessness, tremor, palpitations, HA, hypokalemia, hyperglycemia, paradoxical bronchospasms
Take w food to decrease GI upset
pseudoephedrine (Sudafed)
Class: nasal decongestants
MoA: activates alpha 1 adrenergic receptors on nasal blood vessels resulting in vasocontriction & shrinking swollen mucus membranes in nasal passage
Use: nasal congestion
Administration:
AE: rebound congestion, CNS stimulation
Considerations: high abuse potential
