Flashcards in Chronic respiratory Deck (26):
decrease _____ and ______
increase _____ and _____
Types of broncodilators
Treats ____ broncoconstriction i.e.
airway resistance and residual volume
vital capacity and airflow
beta 2 receptor agonist
reversible, asthma. reactive airway disease (RAD)
Beta 2 receptor agonists
Target not only ____ but also ______
stimulate beta 2, increase prod CAMP by activation of adenyl cyclase (this enzyme coverts adenosine triphosphate (ATP) to cAMP)
Increased CAMP--> relax bronchial smooth muscle and inhibit release of mediators of immediate hypersensitivity from cells, especially from the mast cells
CV, skeletal muscles and CNS
Short acting beta 2:
Long acting: (LABA)
Albuterol (ProAir, Ventolin, Proventil) *– Most Commonly Used
terbutaline (Brethine, Brethaire)
pirbuterol (Maxair )
levalbuterol (Xopenex) *
What are the two most commonly used short acting beta 2 receptor agonist?
selective*** and minor
beta 2, minor beta1 activity
decrease diastolic blood pressure
skeletal muscle--> tremor
fewer cardiac/cns effects
2 most common LABAs?
Salmaterol more selective than__
Salmeterol and Formoterol
12 hours, shouldnt see cardiac effects
Beta 2 agonists PRECAUTIONS/INDICATIONS
diabetics: potential drug-induced hyperglycemia
hyperthyroid: inc in ADR
Terbutaline Pregnancy Category B (others Cat C)
Inj used to prevent contractions in preterm labor
No reports linking albuterol with congenital abnormalities
Albuterol safe for all age children
Salmeterol should not be used in children < age 4 yrs and never singly
Use for asthma- what is important to know?
Black box warning: not to be used alone for asthma
may be used in combo with corticosteroid
if acute deteriorating asthma DO NOT START on LABA** can actually exacerbate asthma
adrs beta 2 receptor agonist
usually just decrease dose
CNS excitation- tremors, dizzy, shaky, nervous, restless, headaches
drug interactions beta 2 receptor agonist
increased risk of? albuterol?
direct comp of beta sites
potentiate effects of?
albuterol- %30 decrease digoxin levels
Beta adrenergic blocking agents
TCA/MAOI- potentiate on vascular system
Beta 2 agonist
can combine with?
Levalbuterol how many times a day?
asthma, copd, bronchitis (acute, chronic)
2 puffs 4-6 can repeat after 5-10
albuterol 15 minutes before
salmuterol 30-60 minutes (do not use this for rescue if)...
what other class can these people take to reduce EIB symptoms?
if taking salmuterol daily
leukotriene modifiers, decrease %50
theophylline, caffeine, aminophylline
smooth muscle relaxation, cns stimulation, cv, increase gastric acid, stimulate skeletal muscle, increase renal blood flow and gfr
xanthine hypersensitivity, peptic ulcer disease, underlying seizure d/p
CARDIAC (htn, coronary insufficient, stroke, hf, arrythmias)
prolonged clearance in
neonate and greater than 55
toxicity: n/v/d, headache, insomnia, irritability
hyperglycemia, hypotension, arrythmias, seizure, death
irritability, restlessness, reflux, palpitations, hypotension
MANY- metabolized by liver- smoking, benzos, beta agonists, lithium, DIET
long term control asthma
>1 can be used
immediate release and transition to er
s/s toxicity, avoid caffeine, maintain consistent diet as impacted by carb/protein intake/charcoal
used primarily to treat
used in combo with
drug of choice in which patients?
ipratropium bromide (atrovent)
beta blockers or do not tolerate beta2
do not give in known hypersensitivity to
which is cat b or c in pregnancy?
which one is longer acting?
is it used in children?
alone for acute bronchospasm
ipatropium b tiotropium c
tiotropium longer acting
generally not as usually used for copd but can be used in combo with albuterol for acute exacerbations
second line tx asthma copd?
tiotropium only for?
hoarse throat irriation dry mouth (cant see cant spit cant shit)
soybeans, legumes, soy (patients with allergies with these may have hypersensitivity)
Montelukast (contraindicated in, children)
If liver disease avoid which
Zafirkulast (children, contraindicated in, what can increase plasma levels,, interaction with)
Zileuton (avoid in, risk of, interaction with)
LTRAs (KAST- zafirlukast, montelukast) and 5lipoxygenas (zyflo)
contains phenylalanine, contraindicated in phenylketonuria (can be used in kids >1)
Z ones (zileuton, zafirlukast)
LTRAS (B) 5lipox (c)
>5, do not use in liver patients, aspirin, warfarin (increase PT)
liver, hepatic injury, theophylline (reduces)
Treatment of choice chronic asthma, also used for
can be used in which populations
also used ___ for____
anti-inflammatory (reduce asthma symptoms, increase peak flow, decrease airway hyperresponsiveness)
adults and children
ALL HAVE ONE in them
If inhaled corticosteroids taken together with____ increase risk of _____
Avoid in which patients?
start on all patients with
dry mouth hoarsness tongue irriation flushing, oral candidiasis
ORAL, HPA suppression
may inhibit growth if high dose
Budesonide (pulmicort) DOC*
Fluticasone (flovent) and budesonide (pulmicort) inhibit cyp
mild persistent asthma or worse
Mild intermittent (>2 a week, a symptomatic)
Mild persistent (>2, less then daily, may affect activity)
Moderate persistent (daily, may affect NORMAL activity)
Severe persistent (all the time symptoms, limited activity)
Asthma step one
shorting acting beta2 agonist (bronchodilator)
symptoms when exposed to triggers
Asthma step two
beta2 + one long term med daily
LOW DOSE INHALED CORTICOSTEROID
alternative- leukotriene modifier
if more than 2 uses beta 2 a week step up
Asthma step three
beta2+ long term
differs from step two that it is MEDIUM DOSE INHALED corticosteroid
or KEEP LOW DOSE cortico and add LABA (combination product)- adults
alt- medium dose cortico + leukotriene