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NURP 424 Adv Pharm > Week 6: Bronchodilators > Flashcards

Week 6: Bronchodilators Flashcards

1
Q

What drug class is Albuterol (ProAir) in and indications for use? “terol’s”

A

SABA - short-acting beta-2 receptor agonist - also has a mild effect on beta-1 receptors as well

  • used for asthma and COPD
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2
Q

Albuterol (SABAs) Pharmacodynamics

A
  • activating beta 2 receptors acts on the smooth muscle of the bronchi to reverse bronchospasm by in the lungs, increasing vital capacity and airflow
  • some effect on beta 1 receptors in the heart - causes side effects tachycardia, nervousness, etc.
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3
Q

Albuterol cautions/contraindications

A
  • avoid in arrhythmias that cause tachycardia and pheochromocytoma (adrenal tumor- increased sympathetic response)
  • can cause HTN
  • caution in pts with CV disease (CHF, HTN), diabetes, glaucoma, and hyperthyroidism
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4
Q

Albuterol/SABA ADRs (usually transient)

A

tachycardia, dizziness, palpitations, tremors, nervousness, headache - ** due to effect on beta 1 receptors in the heart**

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5
Q

In Levalbuterol (Xopinex), the S-isomer has been removed. Why is this important?

A

This leaves only the R-isomer which is selective to beta-2 - removes the cardiovascular and CNS ADRs (tremors, tachycardia, etc.)

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6
Q

Examples of other SABAs

A
  • terbutaline (Brethine, Brethaire)
  • metaproterenol (Alupent)
  • pirbuterol (Maxair)
  • levalbuterol (Xopenex)
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7
Q

Three drug classes used for asthma

A

SABA - short-acting Beta 2 receptor antagonists

LABA - long-acting Beta 2 receptor antagonists **not as monotherapy in asthma**

ICS - inhaled corticosteroids

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8
Q

Salmeterol (Serevent) [LABA] MOA

A
  • relaxes bronchial smooth muscle by selective action on beta 2 receptors

3 advantanges:

  • 30-40 min onset
  • Long MOA- last longer
  • More selective to Beta-2 receptors which decreases the prevalence of side effects
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9
Q

Salmeterol (Serevent) drug class

A

Long-acting beta 2 receptor agonist (LABA)

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10
Q

Other examples of LABA medications

A
  • formoterol (Foradil) - taken Q 12 hrs
  • vilanterol (Breo Ellipta) - Ultra long acting - taken QD “Very easy to take”
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11
Q

LABA cautions/contraindications

A
  • black box warning!

NOT to be used as mono-therapy in patients with asthma (salmetrol (Serevent) and Foradil) - causes downregulation of beta-2 receptors if used alone so in emergencies, short-acting beta-2 receptor antagonist medications (Albuterol) will not work - leads to increase in asthma intubations and death

  • caution in pts with cardiovascular dz, diabetes, hyperthyroidism, glaucoma
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12
Q

Should a patient with asthma or COPD be placed on a beta blocker?

A
  • patients who are taking SABA and LABAs should NOT take non-selective beta blockers. (ex. Propranolol, Carvadelol, Labetalol)

MR BEAN is selective and has no Nads. If a beta blocker begins with any letter in MR BEAN - it is beta 1 selective only except Nadolol (is non-selective). These beta-1 selective beta blockers would be OK to give with beta-2 antagonist drugs.

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13
Q

What drug class contains Theophylline?

A

Xanthine dervatives

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14
Q

Theophylline/xanthine dervatives MOA

A
  • inhibits specific phosphodiesterases, increases cAMP = leads to relaxation of smooth muscle
  • sympathamometic agent - works on the sympathetic nervous system: CNS stim., CV effects, increased fight/flight - has similar chemical structure to caffiene
  • metabolized in the liver into caffeine (prodrug)
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15
Q

Theophylline - important to remember

A
  • narrow therapeutic index - requires monitoring through blood draws
  • range: 10-20 mcg/mL
  • metabolized extensively via CYP 450 into caffeine so inhibitors (such as -azoles) will increase the effects and increase chance of toxicity
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16
Q

Xanthine derivatives ADRs and toxicity SE’s

A

SE: tachycardia, palpitations, irritability, GI upset, headache

Serum level >20 - N/V/D, insomnia, greater irritability, change in BP

> 35: hypotension, arrhythmias, seizures, brain damage, DEATH

avoid caffiene and smoking (increases excretion of it)

17
Q

If serum blood of Theophylline is >35 (toxic level), what ADRs can occur?

A
  • seizures, cardiac arrhythmias/torsade’s, death
18
Q

Theophylline/Xanthine derivatives cautions/ contraindications

A
  • monitor closely in cardiovascular disease
  • avoid in pts w/ hx of seizures, peptic ulcer dz, sensitivity to xanthines
  • educate patient to avoid smoking and caffeine
  • educate pt on the signs of toxicity
  • educate pt to maintain a steady diet
19
Q

Ipratropium bromide (Atrovent) / SAMA MOA

A

selectively blocks M3 receptors in the lungs causing bronchodilation - muscarinic receptor antagonist

20
Q

SAMA “-tropium” indictations and MOA

A

Mostly used for COPD - may be used in asthma exacerbation with albuterol (DuoNeb)

  • selectively block the muscarinic 3 receptors in bronchial smooth muscle causing bronchodilation
  • anticholinergic effects because muscarinic receptors are cholinergic receptors

Ipratropium bromide (Atrovent) = Immediate effects

21
Q

Atrovent/Ipratropium bromide cautions/ contraindications

A
  • only for asthma exacerbation IF COMBINED WITH ALBUTEROL (Duoneb)
  • due to anticholinergic effects: avoid in pts with urinary retention, BPH, and closed-angle glaucoma

(Anticholinergic effects: patients can’t see, pee, spit, shit, or think)

22
Q

Atrovent / SAMA adverse drug effects

A

cough, dry mouth, mouth and throat irritation, dyspepsia, nausea and vomiting

23
Q

Ipratropium bromide (Atrovent)/SAMA patient education

A
  • after use, rinse mouth and spit it out
24
Q

Tiotropium bromide (Spiriva) Indications for use and MOA - LAMAs

A

Used primarily for COPD to control symptoms

Selectively block the muscarinic 3 receptors (muscarinic 3 receptor antagonist) in the lungs leading to smooth muscle bronchodilation

  • long acting anticholinergic/muscarinic agent
25
Q

Tiotropium bromide (Spiriva) cautions/ contraindications

A
  • due to anticholinergic effects: avoid in pts with urinary retention, BPH, and closed-angle glaucoma
26
Q

LAMA Adverse Drug Reactions

A
  • dry mouth, pharyngitis, upper respiratory infection, headache, mouth irritation
  • not approved for children < 12 years old
27
Q

LAMA patient education

A
  • Rinse mouth after inhaling medication

NURP 424 Adv Pharm (63 decks)

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