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Flashcards in Chronic respiratory Deck (26):
1

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)

2

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

3

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)



4

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

5

2 most common LABAs?

half life?

dosing?

Salmaterol more selective than__



Salmeterol and Formoterol

12 hours, shouldnt see cardiac effects

BID

albuterol

6

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

7

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

8

adrs beta 2 receptor agonist

usually just decrease dose
tachy, palpitations
CNS excitation- tremors, dizzy, shaky, nervous, restless, headaches

9

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

10

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

11

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

12

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)

13

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

14

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

15

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

16

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

17

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

18

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

19

Treatment of choice chronic asthma, also used for

Leukotriene modifiers
allergic rhinitis

20

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)

21

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

22

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)

23

Asthma step one

shorting acting beta2 agonist (bronchodilator)
flu shot

symptoms when exposed to triggers

24

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

25

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

26

Asthma step 4-6

4-
medium dose cortico + LABA
medium dose cortico + leuko or theoph

5-
high dose + LABA

6-
high dose + LABA + oral cortico

THESE REQUIRE CONSULTATION