Pulmonary Pharm Flashcards by Morgan Stone

which meds dilate the bronchioles?

–Beta-2 adrenergics
–inhaled anticholinergics
–Xanthine derivatives

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which meds decrease bronchial inflammation?

–glucocorticoids
–mast cell stabilizers
–LTRAs

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examples of Beta-2 adrenergic agonist meds

–albuterol
–levalbuterol
–salmetrol
–formoterol

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short acting beta-2 adrenergic agonists

–albuterol
–levalbuterol

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long acting beta-2 adrenergic agonists

–salmetrol
–formoterol

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how often should short acting beta agonist meds be taken?

every 4-6 hours

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how often should long acting beta agonist meds be taken?

every 12 hours

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which are considered rescue drugs?

short acting

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which are considered preventer drugs?

long acting

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MOA of beta-adrenergic agonists

relax and dilate the airways by stimulating the beta-2 adrenergic receptors throughout the lungs
–mimic action of SNS (fight or flight)

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non-selective adrenergic drugs

stimulate both beta-1 and beta-2 receptors AND alpha receptors

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non-selective beta adrenergic

stimulate both beta-1 and beta-2 receptors

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selective beta-2 receptors

preferred meds to treat pulmonary conditions

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what do non-selective drugs stimulate? And what does this cause?

–alpha receptors, vasoconstriction (decreases swelling in mucous membranes, limits amt of secretions)
–beta-1, cardiovascular effects

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what do beta-1 receptors trigger?

heart

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what do beta-2 receptors trigger?

lungs

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indications for beta agonists

prevention or relief of bronchospasm related to asthma/bronchitis/other pulm conditions

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contraindications for beta agonists

–uncontrolled HTN
–cardiac dysrhythmias
–high risk for stroke

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specifics of beta agonists

–can be given with beta blockers, but may diminish effect
–avoid use with MAOIs and sympathomimetics = HTN
–diabetics may need more meds because raises blood sugar

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adverse effects of beta agonists

–insomnia
–restlessness
–anorexia
–cardiac stimulation
–hyperglycemia
–tremor
–vascular headache

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relationship between beta agonists and beta blockers

beta agonists can reverse OD of beta blockers

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who is a DPI best for?

cognitively impaired or children

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indications for albuterol

–asthma
–bronchitis
–emphysema
–acute episodes of wheezing, chest tightness, SOA

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indications for salmeterol

–worsening of COPD
–moderate-severe asthma
–always given with inhaled corticosteroid

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warning for salmeterol

has been associated with increased asthma-related deaths

MOA of anticholinergics

type of bronchodilator that works on acetylcholine receptors, not adrenergic receptors. Creates bronchodilation.

what does giving anticholinergic agents result in?

--turning off cholinergic response (PNS) --turning on SNS (bronchodilation)

example of anticholinergic

ipatroprium

indications for ipatroprium

prophylaxis and maintenance therapy

anticholinergic effects

--dry as a bone --hot as a hare --blind as a bat --red as a beet --mad as a hatter

examples of xanthine derivatives

--theophylline --aminophylline

MOA of xanthine derivatives

increasing levels of cAMP enzyme by inhibiting phosphodiesterase

what level of treatment are xanthine derivatives used at?

second line d/t high risk of toxicity and drug-drug interactions

indication for theophylline/aminophylline

preventative treatment of asthma attacks and COPD exacerbation

what happens to theophylline in the body?

metabolized to caffeine

side effects of xanthine derivatives

Toxicity --N/V/D --insomnia --HA --tachycardia --dysrhythmias --seizure disorders

contraindications for xanthine derivatives

--uncontrolled cardiac dysrhythmias --seizure disorders --hyperthyroid --peptic ulcers

interactions with xanthine derivatives

--caffeine --> may increase side effects --smoking --> decreased absorption

what to give with xanthine derivative toxicity

activated charcoal

drug interactions with xanthine derivatives

--macrolides --allopurinol --cimetidine --quinolones --flu vaccine --oral contraceptives

what do leukotrienes cause?

inflammation, bronchoconstriction, mucus production

examples of leukotriene receptor antagonists (LTRAs)

--montelukast --zafirlukast

MOA of LTRAs

prevent leukotrienes from attaching to receptors located on immune cells and within the lungs --> prevents inflammation

route for LTRAs

indications for LTRAs

oral prophylaxis and chronic treatment of asthma in adults and children --NOT for acute attacks

adverse effects of LTRAs

--HA --nausea --dizziness --insomnia --diarrhea

examples of inhaled corticosteroids

--beclomethasone --budesonide --fluticasone

route for inhaled corticosteroids

via neb or MDI

MOA of inhaled corticosteroids

reduce inflammation and enhance activity of beta agonists --help with bronchodilation

timeline for inhaled corticosteroids

can take several weeks before full effects are realized

teaching for inhaled corticosteroids

for asthma: --take on regular schedule --give bronchodilator first for more thorough absorption

adverse effects of inhaled corticosteroids

--pharyngeal irritation --coughing --dry mouth --oral fungal infections **RINSE MOUTH AFTER USE**

what combinations are used for moderate to severe asthma (maintenance)?

--budesonide and formoterol --fluticasone and salmeterol

MOA of mast cell stabilizers

stabilize membranes of mast cells and prevent release of broncho-constrictive inflammatory substances

indications for mast cell stabilizers

prevention of acute asthma attacks

example of mast cell stabilizer

cromolyn

time frame for giving cromolyn

15-20 minutes prior to known triggers

example of monoclonal antibody anti-asthmatic

omalizumab

MOA for omalizumab

monoclonal antibody that selectively binds to IgE and limits release of mediators of allergic response

route for omalizumab

injection

indication for omalizumab

add-on therapy for asthma

monitoring for omalizumab

monitor closely for hypersensitivity reactions (anaphylaxis)

MOA for selective PDE-4 inhibitor (roflumilast)

selectively inhibits PDE4 enzyme in lung cells (anti-inflammatory effects)

indication for roflumilast

COPD exacerbations

route for roflumilast

side effects of roflumilast

--N/V/D --HA --muscle spasms --decreased appetite --uncontrollable tremors

long term control medications (preventers)

--anticholinergics --xanthine derivatives --inhaled corticosteroids --leukotriene modifiers --mast cell stabilizers --LABA

quick relief medications (rescue)

--SABA --albuterol/Proventil

Pulmonary Pharm Flashcards

(68 cards)