Respiratory Pharm I Flashcards
Three components influencing bronchoconstriction
Activation of Mast Cells
Local Inflammation
Vagal Stimulation
Agents tat reduce bronchoconstriction and increase relaxation all increase levels of intracellular _____
cAMP
How do sympathomimetics act to treat asthma
Increase cAMP via Gs receptor subunit
Relaxes smooth muscle/Decreases Mast cell release
Examples of selective short acting beta adrenergic agents
Albuterol, terbutaline
metaproterenol, pirbuterol
Which beta adrenergic agent is a Pure R mixture
Levabuterol
Two main examples of long acting beta-agonists
Salmeterol and Formoterol
When to use a long acting beta agonist
Used w/ inhaled steroids for mainenence therapy
NOT for acute exacerbations
Antimuscarinic agonists are especially helpful in what conditions
Non-allergic (COPD)
Antimuscarinic agents used to help out COPD paients
Ipatropium
Tiotropium
How do methylxanthines work?
They block phosphodiesterase activity, preventing breakdown of cAMP. This causes bronchodilation and inhibition of inflammatory cells. This leads to a non-specific, inexpensive treatment.
Examples of methylxanthines that can be used to treat asthma?
Theophylline, Caffeine, Theobromine
Aside from asthma/COPD treatment, methylxanthines may also cause…
Increased Alertness, Nervousness, Tremor
Tachycardia, Rare arrythmias
Increased gastric acid, digestive enzyme secretion
Increased diaphragmatic fxn
Main issues with using the methylxanthine THEOPHYLLINE
Wide variation in blood levels
Narrow window to therapeutic range
Example of an Anti-IgE antibody
Omalizumab
How do anti-IgE antibodies work
They target the Fc portion of IgE, preventing its attachment to mast cells and basophils. This reduces the frequency/severity of exacerbations for llergen induced.
Downside of treating with omalizumab
Given parenterally
VERY expensive
How does Cromolyn work?
Inhaled powder that inhibits mast cell degranulation by a poorly understood mechanism (membrane stabolization)
When to use Cromolyn
Prophylactically, NOT during attack
Two approaches of leukotriene modifiers
Inhibition of 5-lipoxygenase (zileuton)
LTD4 receptor antagonist (montelukast)
Aerosol steroid treatments to know…
Beclomethasone, Fluticasone
Oral/parenteral steroids used in emergencies
Prednisone, Dexamethasone
Talk through the stepwise increase in asthma treatment
SABA PRN Add in Low Dose ICS Plus LABA Increase Steroid Dose If really bad, add omalizumab
Why do nebulizers work better than inhalers
Continuous use over minutes
Larger particles generated, so higher doses given
Problem – Bacterial contamination
How do spacers help improve inhaler activity?
Aids in aerosolization
More makes it to lungs
Typical approach to therapy with COPD
Long acting beta agonists and anticholinergic agents
Can add theophylline – but dangerous side effects
Inhaled steroids can be added in
Drugs that are not helpful for COPD exacerbations
NSAIDs
anti-leukotrienes
What to keep in mind when treating a COPD exacerbation
Keep patient out of hospital – infection
Steroids may help, but less than asthma
Antibiotics for infections – Doxy
Avoid O2, Dehydration
General strategies for treatment of nasal allergies
Avoidance of Triggers Antihistamines Nasal Steroids Saline Possibly antileukotrienes to decrease secretions
Commonly used antihistamines
Diphenhydramine, Chlorpheniamine, hydroxyzine
Fexofenadine, Loratadine, Certirizine
Name nasal steroids
Mometasone
Fluticasone
Commonly used decongestants
Pseudophedrine or phenylephrine
