COPD drugs Flashcards
(24 cards)
B1 antagonism causes what
Decreases inotropy and chronotropy of the heart (B1 targets heart)
B2 antagonism causes what
Bronchocontstriction
B2= 2 lungs, targets lungs
B1 selective drugs, exceptions, and Preferred tx
A-N (Atenolol, metoprolol, nebivolol)
Exception: Carvedilol, labetalol
Preferred in Bronchospastic disease because they only act on the heart
B1, B2 nonselective drugs
O-Z (Propanolol, timolol)
AVOID in bronchospastic disease, as this could cause bronchospasm
Non-selective B blockade and a1 blockade drugs
Carvedilol, labetalol (A1 blockade adds VASODILATION)
-Olol vs -ilol or -alol
-olol= no Alpha activity
-ilol or -alol= A activity
Which BB drugs need to be cautioned in pts with Asthma, COPD?
Propanolol, carvedilol, labetalol– they are not B1 selective and can cause B2 blockade (bronchospasm)
SABAs
-Albuterol (Ventolin, Proventil)
Lev-albuterol
Terbutaline – oral or IM agent, acute exacerabation use.
LABAs
-terol (but not albuterol)
-Formoterol
-Salmeterol
-Vilanterol
Not choosing a LABA over a LAMA, only better if the pt has optic Sx that contraindicates a LAMA
SAMAs
Ipratropium (Atropine)
Muscarinic antagonist
Similar efficacy to SABAs, often combined albuterol-ipratropium, esp for COPD.
NOT Tiotropium (A LAMA). “I” pratropium has “I” for Immediate/short acting.
LAMAs
Tiotropium
Aclidinium
Umeclidinium
-IUM
BUT not Ipratropium (I= immediate, short acting).
Only for chronic control, don’t use as a rescue inhaler
CIs: narrow angle glaucoma
Urinary obstruction
Albuterol Class of inhaler
SABA
Terbutaline Class of inhaler
SABA
CIs for SABAs
PVCs or Anxiety, can make worse and cause tachycardia or anxiety
vilanterol Class of inhaler
LABA (- terol)
ipratropium Class of inhaler
SAMA- ium but I for immediate
umeclidinium Class of inhaler
LAMA- ium
formoterol Class of inhaler
LABA
Is an ICS +LAMA appropriate for COPD tx
NO!
Must combine an ICS with LAMA+ LABA
Only use if blood eosinophils >300 cells/uL
Monitering of ICS
1) Hyperglycemia
2) decrease bone density
3) increase occular pressure, glaucoma)
ICS drugs
budeSONide
fluticaSONe
mometaSONe
beclomethaSONe
If a patient experiances COPD exacerbations despite optimized inhaler therapy, or is unable to optimize inhaler therapy, which agent is next to use?
Roflumilast
Oral PDE-4 inhibitor, relaxes SM, decrease inflammatory cells
Consider if FEV1 is <50% of predicted
Use with LAMA+LABA+ ICS
Place in therapy for theophylline (mexylaxanthene) or mucolytics (n-acetylcysteine)
If patient cannot optimize inhaler therapy
May be considered if pt is not on ICS and has chronic bronchitis
