Drugs for Disorders of the Respiratory System Flashcards
“Albuterol / Salbuatmol” (PROAIR, PROVENTIL, VENTOLIN)
Pharmacodynamics: short-acting direct b2 adrenergic agonists relax airway (bronchiole) smooth muscle;
Indications for use: quick relief of asthma symptoms (rapid onset (5 - 30 minutes with 4 - 6 hours of relief) - monotherapy for intermittent asthma or exercise induced bronchospasm;
Side - effects: tachycardia, hyperglycaemia, hypokalemia, hypomagnesemia are minimal in inhaled form.
Levalbuterol (XOPENEX)
Pharmacodynamics: short-acting direct b2 adrenergic agonists;
Indications for use: quick relief of asthma symptoms (rapid onset (5 - 30 minutes with 4 - 6 hours of relief) - monotherapy for intermittent asthma or exercise induced bronchospasm;
Side - effects: tachycardia, hyperglycaemia, hypokalemia, hypomagnesemia are minimal in inhaled form.
Arformoterol (BROVANA), Formoterol (FORADIL, PERFOROMIST), Indacaterol (ARCAPTA), “Salmeterol (SEREVENT)”
Pharmacodynamics: long-acting b2 adrenergic agonists;
Indications for use: long term treatment of asthma AND COPD (bronchodilation lasts for 12 hours);
Clinical information: should not be used as monotherapy, inhaled corticosteroids are still preferred as long term controllers;
Side - effects: tachycardia, hyperglycaemia, hypokalemia, hypomagnesemia are minimal in inhaled form.
“Beclomethasone (BECONASE AQ, QVAR)”, Budesonide (PULMICORT, RHINOCORT), Ciclesonide (ALVESCO, OMNARIS, ZETONNA), Fluticasone (FLONASE, FLOVENT), Mometasone (ASMANEX, NASONEX), Triamcinolone (NASACORT AQ) methylprednisolone IV / oral prednisilone given for severe exacerbation.
Pharmacodynamics: b2 adrenergic agonists (inhaled corticosteroids) inhibiting the release of arachadonic acid (AA) by inhibiting PLA2 (anti-inflammatory) - reverses mucosal oedema, decreases permeability of capillaries and inhibits release of leukotrienes;
Indications for use: long term treatment of asthma (can be inhaled or given orally / systemically);
Side - effects: oropharyngeal candidiasis; hoarseness (must rinse mouth out after use).
Formoterol/budesonide (SYMBICORT), Formoterol/mometasone (DULERA), Salmeterol/uticasone (ADVAIR), Vilanterol/uticasone (BREO ELLIPTA)
Pharmacodynamics: long-acting beta 2 adrenergic agonist / corticosteroid combination;
Indications for use: long term treatment of asthma.
Ipratropium (ATROVENT)
Pharmacodynamics: short-acting anticholinergic blocking vagally stimulated contraction of bronchiole smooth muscle and mucus secretion;
Indications for use: used for asthma patients who can’t tolerate SABAs and those with concomitant COPD;
Side - effects: xerostomia, bitter taste.
Aclidinium bromide (TUDORZA PRESSAIR), “Tiotropium (SPIRIVA)”
Pharmacodynamics: long-acting anticholinergic;
Indications for use: COPD, decreased contractility in lungs –> bronchodilation –> reduction in mucus secretion – treats bronchospasm in COPD treats rhinorrhea.
“Montelukast (SINGULAIR)”, Zafirlukast (ACCOLATE), Zileuton (ZYFLO CR)
Pharmacodynamics: leukotriene modifiers inhibit 5 - lipoxygenase (Zil) and the production / selective antagonists (Mon and Zar) of cysteinyl leukotrienes which constricts bronchiolar smooth muscle, increases vascular permeability and promotes mucus secretion;
Indications for use: used in conjunction with inhaled cortico-steroids to treat asthma;
Side - effects: elevated serum hepatic enzyme, headache and dyspepsia.
Azelastine (ASTELIN, ASTEPRO), Cetirizine (ZYRTEC), Desloratadine (CLARINEX), Fexofenadine (ALLEGRA), Loratadine (CLARITIN)
Pharmacodynamics: H-1 receptor blockers (anti-histamines);
Indications for use: for the treatment of allergic rhinitis (often given as nasal or ophthalmic preparations for targeted relief and reduction of systemic symptoms).
Oxymetazoline (AFRIN, DRISTAN), Phenylephrine (NEOSYNEPHRINE, SUDAFED PE), Pseudoephedrine (SUDAFED),
Pharmacodynamics: alpha - 1 adrenergic agonists constricting dilated arterioles in the nasal mucosa and reducing airway resistance;
Indications for use: to reduce symptoms of allergic rhinitis (nasal symptoms);
Clinical information: should not be used for more than three days due to risk of rebound congestion.
“Codeine” (with guaifenesin), “Dextromethorphan”, Dextromethorphan (with guaifenesin), Guaifenesin
Pharmacodynamics: opioid receptor antagonist (decreasing sensitivity of cough centre in CNS to peripheral stimuli and decreases mucus secretion) and expectorant (guaifenesin);
Indications for use: treatment of cough;
Side - effects of codeine: constipation, dysphoria and fatigue.
Benzonatate (TESSALON PERLES)
Pharmacodynamics: lung stretch receptor antagonist (anaesthetic);
Indications for use: to treat coughs;
Side - effects: dizziness, numbness of tongue / mouth / throat.
Cromolyn (NASALCROM)
Pharmacodynamics: mast cell stabiliser reducing release of histamine;
Indications for use: alternative therapy for mild persistent asthma (short duration requires multiple doses throughout the day - affecting adherence);
Side - effects: cough, irritation and unpleasent taste.
“Omalizumab (XOLAIR)”
Pharmacodynamics: Inhibits binding of IgE to FcεRI on mast cells and basophils as it is a recombinant monoclonal antibody binding to IgE limiting degranulation of mast cell –> reducing bronchonconstriction;
Indications for use: for those with moderate or severe persistent asthma and whose asthma is poorly controlled with conventional therapy;
Clinical information: high cost, subcutaneous administration;
Side - effects: anaphylaxis, arthralgias, fever and rash (report of secondary malignancies).
Roflumilast (DALIRESP)
Pharmacodynamics: Inhibits PDE-4 increasing cAMP reducing inflammation;
Indications for use: reduces exacerbation of chronic bronchitis reducing inflammation by increasing cAMP;
Side-effects: nausea, vomiting, diarrhoea, headache.
