Respiratory Medications Flashcards
Goals of Resp Meds
- Minimize symptoms of airway disease
- Increase capacity to exercise
- improve overall health
- reduce number and severity of exacerbations
- reduce lung remodeling
- minimize SE of meds
- treat co-existing medical problems
Methods of delivery
Metered-dose inhaler (MDI) Dry powder inhaler (DPI) Nebulizer Orally Intravenously Subcutaneously
Corticosteroids
(anti-inflammatory) (IV, PO, inhaled)
- one of the most effective asthma therapy drugs
- ICS performed route for asthma
- Reduces bronchial hyper-responsiveness
- blocks late phase reaction
- inhibits migration of inflammatory cells
- 1-2 weeks for complete therapeutic effect
Corticosteroid IV meds
- Hydrocortisone (solu-cortef) -iv
- Methylprednisolone (solu-medrol) -Iv
Corticosteroid Systemic Meds
short term basis for mod asthma
daily low dose for severe asthma
Corticosteroid Inhaled meds
- long term prophylactic use
- little systemic absorption
- given on a fixed schedule
- highest dosage levels -> bruising and accelerated bone loss
Side effects of Inhaled corticosteroids
ORAL THRUSH, hoarseness, irritated thorat, dry mouth, cough, few systemic effects
-teach: gargle or rinse mouth after use. spacer may be helpful to both decrease SEs and increase amount of med reaching the lungs.
Names of Inhaled corticosteroids
- Fluticasone (flovent)- MDI w/ spacer, DPI (diskus)
- Budesonide (pulmicort)- DPI
- Mometasone (Asmanex) - DPI
- Beclomethasone (beclovent, vanceril) MDI w/ spacer)
Corticosteroids: IV & PO
- Given po for prompt control
- take on fixed schedule in morning (w/ meals)
- Women take calcium and vit d supplement -participate in weight bearing exercises (due to accelerated bone loss)
Oral Corticosteroids: Prednisone
Long & short term SEs
long term: immunosuppression, skin changes, osteoporosis, increased blood glucose (not for diabetics), wt gain, cushing’s (moon face)
short term: insomnia, increased appetite
Oral corticosteroid teaching
DON’T STOP ABRUPTLY. taper doses until prescription completed.
prednisone mimics the action of cortisol. Causes adrenal cortex to decrease or stop production or cortisol.
results in adrenal insufficiency or crisis which is life threatening.
S/S: HA, confusion, restlessness, vomiting, shock, death.
Leukotriene Modifiers
Leukotrienes are: inflammatory mediators, potent bronchoconstrictors, produce airway inflammation and edema.
- interferes with synthesis of or blocks the action of leukotrienes—>anti-inflammatory, bronchodialator
- not for acute episode-prophylactic and maintenance therapy.
- administered orally.
Leukotriene Modifier Names
-Zafirlukast (Accolate)-po
—SE: HA, dizzy, n/v/d, fatigue, abd pain
-Montelukast (Singulair)-po
—-SE: well tolerated
Leukotriene synthesis inhibitor
—Zileuton (Zyflo) -po
—increases LFTs, dyspepsia, HA
Immunodialators: Anti-IgE
- Not first line Tx
- For moderate to severe asthma not controlled with inhaled steroids.
- Improves asthma control
- small risk anaphylaxis
- decreases circulating IgE levels.-prevents IgE from attaching to mast cells. -prevents release of inflammatory mediators from mast cells
- Not for acute attacks
Immunodilators: name
Omalizumab (xolair)
Sub-Q injection. Dose based on IgE and body weight
-SEs: injection site rxn (bruising, redness, warmth, pain. risk of anaphylaxis. C
Cost $18,000 per year, most insurance companies cover.
