Respiratory Drugs Flashcards
Classification of Asthma based on Severity
Severity;Symptom Frequency; Nighttime awakening
Intermittent; < 2 per week; < 2 per month
Mild Persistent; > 2 but not daily; 3-4 times per month
Moderate Persistent; Daily; > 1 time a week but not daily
Severe Persistent; Throughout the day; 4-7 times/week
Drugs used to manage Asthma
Bronchodilators: acute management
- b2 agonist
- anticholinergics
- methylxanthines
Anti-Inflammatory Drugs: Long term therapy
- corticosteroids
- Release inhibitors
- immunomodulators
- Leukotriene-modifying agents
b2 adrenergic agonist Drugs
Inhaled SABA’s
- Albuterol
- Terbutaline
- Pirbuterol
Inhaled LABA’s
- Salmeterol
- Formoterol
Inhaled b2 agonist MOA
1) Binds b2 receptors in airway smooth muscle cells
2) activates Adenylyl cyclase
3) increase cAMP production
4) cAMP activates PKA and phosphorylation of MLCK occurs (inactivation)
5) Results in bronchodilation
Inhaled SABA’s Uses
DOC for relief of acute asthma symptoms and prevention of exercised-induced bronchospasm1
Inhaled LABA’s Uses:
LABA’s combined with inhaled corticosteroids (ICS) for long term control in moderate and sever persistent asthma
Should not be used as mono therapy (no anti-inflammatory actions)
LABA’s are not used in the treatment of acute symptoms or exacerbations
b2 agonist AE
Administration via inhalation minimizes AE.
AE: Tachycardia, tremor, and Hypokalemia
LABA’s increase risk of serious asthma related events (hospitalization, intubation, and death)
Anticholinergics Drugs
Inhaled SAMA’s
- Ipratropium
Inhaled LAMA’s
- Tiotropium
Anticholinergics MOA
Block Muscarinic (M3) receptors on the airways causing bronchodilation and reduction of respiratory secretions
Anticholinergic Uses
Ipratropium less effective than SABA’s
Ipratropium paired with SABA’s (addictive effect) to manage moderate-severe exacerbations of asthma
Ipratropium: DOC for b-blocker induced bronchospasm
Tiotropium may be added to ICS for long-term control of severe persistent asthma
Anticholinergic AE
Quaternary Ammoniums: (not very lipophilic)
Low access to systemic circulation (low systemic AE)
Minor anticholinergic effects
- xerostomia
May be safer than SABA’s in patients with CVD
Mehylxanthines Drugs
Theophylline
Theophylline MOA
inhibits PDE
Inc. cAMP evokes Bronchodilation
Theophylline Uses:
can be given orally or IV
Alternative therapy for patients with persistent asthma
Theophylline AE
Replaced by b2 agonist b/c Narrow Therapeutic Window, AE, and potential for drug interactions
Most Common AE:
headache, N/V, abdominal discomfort, and restlessness
** at high concentrations: cardiac arrhythmias and seizures