Chronic respiratory Flashcards
(26 cards)
Bronchodilators
decrease _____ and ______
increase _____ and _____
Types of broncodilators
Treats ____ broncoconstriction i.e.
airway resistance and residual volume
vital capacity and airflow
beta 2 receptor agonist
xanthine derivatives
anticholinergics
reversible, asthma. reactive airway disease (RAD)
Beta 2 receptor agonists
MOA:
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 metaproterenol (Alupent) terbutaline (Brethine, Brethaire) bitolterol (Tornalate) pirbuterol (Maxair ) levalbuterol (Xopenex) *
salmeterol (Serevent)
formoterol (Foradil)
What are the two most commonly used short acting beta 2 receptor agonist?
selective*** and minor
se
Albuterol, levalbuterol
beta 2, minor beta1 activity
vasodilation
decrease diastolic blood pressure
increase hr
skeletal muscle–> tremor
fewer cardiac/cns effects
2 most common LABAs?
half life?
dosing?
Salmaterol more selective than__
Salmeterol and Formoterol
12 hours, shouldnt see cardiac effects
BID
albuterol
Beta 2 agonists PRECAUTIONS/INDICATIONS
Pregnancy?
Children?
cardiac arrythmias
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
PRECAUTIONS/INDICATIONS
LABA
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
- Salmeterol/Fluticasone (Advair)
- Formoterol/Budesonide (Symbicort
- Formoterol/Mometasone (Dulera)
if acute deteriorating asthma DO NOT START on LABA** can actually exacerbate asthma
adrs beta 2 receptor agonist
usually just decrease dose
tachy, palpitations
CNS excitation- tremors, dizzy, shaky, nervous, restless, headaches
drug interactions beta 2 receptor agonist 1 increased risk of? albuterol? 2 direct comp of beta sites
3
potentiate effects of?
Digoxin
dysrhythmia
albuterol- %30 decrease digoxin levels
Beta adrenergic blocking agents
TCA/MAOI- potentiate on vascular system
Beta 2 agonist
bronchodilator treat:
Albuterol
can combine with?
Levalbuterol how many times a day?
asthma, copd, bronchitis (acute, chronic)
2 puffs 4-6 can repeat after 5-10
ipatropium (anticholinergic)
levalbuterol- tid
exercise induced
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
BRONCHODILATORS
Xanthine examples
pharmacodynamics
contraindicated in:
Caution with:
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)
Theophylline (xanthine)
prolonged clearance in
pregnancy cat?
monitor
adrs
interactions
neonate and greater than 55
c
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
theophylline cont.
reserved for
children?
start on…
education
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
BRONCHODILATOR cont
Anticholinergic example used primarily to treat used in combo with drug of choice in which patients?
ipratropium bromide (atrovent)
COPD
albuterol (combivent)
beta blockers or do not tolerate beta2
anticholinergic continued
do not give in known hypersensitivity to
not used..
which is cat b or c in pregnancy?
which one is longer acting?
is it used in children?
atropine
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
anticholinergic cont
ADRs
allergic reaction?
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)
ipotropium
copd
Leukotriene modifiers
decrease
Two types:
Montelukast (contraindicated in, children)
If liver disease avoid which
Pregnancy
Zafirkulast (children, contraindicated in, what can increase plasma levels,, interaction with)
Zileuton (avoid in, risk of, interaction with)
ADR
airway edema
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)
not many
Treatment of choice chronic asthma, also used for
Leukotriene modifiers
allergic rhinitis
Inhaled corticosteroids
effects
can be used in which populations
examples
also used ___ for____
anti-inflammatory (reduce asthma symptoms, increase peak flow, decrease airway hyperresponsiveness)
adults and children
ALL HAVE ONE in them beclomethasone (QVAR) triamcinolone (azmacord) budesonide (pulmicort) Mometasone (asmanex) fluticasone (flovent)
Inhaled corticosteroids
ADRs
If inhaled corticosteroids taken together with____ increase risk of _____
Avoid in which patients?
Children
Pregnancy
Interactions
start on all patients with
dry mouth hoarsness tongue irriation flushing, oral candidiasis
ORAL, HPA suppression
cushings syndrome
may inhibit growth if high dose
Budesonide (pulmicort) DOC*
Fluticasone (flovent) and budesonide (pulmicort) inhibit cyp
mild persistent asthma or worse
Asthma classifications
-
-
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)
flu shot
symptoms when exposed to triggers
Asthma step two
beta2 + one long term med daily
long term=
LOW DOSE INHALED CORTICOSTEROID
alternative- leukotriene modifier
if more than 2 uses beta 2 a week step up
