Respiratory Medications Flashcards
(30 cards)
Goals of Resp Meds
- Minimize symptoms of airway disease
- Increase capacity to exercise
- improve overall health
- reduce number and severity of exacerbations
- reduce lung remodeling
- minimize SE of meds
- treat co-existing medical problems
Methods of delivery
Metered-dose inhaler (MDI) Dry powder inhaler (DPI) Nebulizer Orally Intravenously Subcutaneously
Corticosteroids
(anti-inflammatory) (IV, PO, inhaled)
- one of the most effective asthma therapy drugs
- ICS performed route for asthma
- Reduces bronchial hyper-responsiveness
- blocks late phase reaction
- inhibits migration of inflammatory cells
- 1-2 weeks for complete therapeutic effect
Corticosteroid IV meds
- Hydrocortisone (solu-cortef) -iv
- Methylprednisolone (solu-medrol) -Iv
Corticosteroid Systemic Meds
short term basis for mod asthma
daily low dose for severe asthma
Corticosteroid Inhaled meds
- long term prophylactic use
- little systemic absorption
- given on a fixed schedule
- highest dosage levels -> bruising and accelerated bone loss
Side effects of Inhaled corticosteroids
ORAL THRUSH, hoarseness, irritated thorat, dry mouth, cough, few systemic effects
-teach: gargle or rinse mouth after use. spacer may be helpful to both decrease SEs and increase amount of med reaching the lungs.
Names of Inhaled corticosteroids
- Fluticasone (flovent)- MDI w/ spacer, DPI (diskus)
- Budesonide (pulmicort)- DPI
- Mometasone (Asmanex) - DPI
- Beclomethasone (beclovent, vanceril) MDI w/ spacer)
Corticosteroids: IV & PO
- Given po for prompt control
- take on fixed schedule in morning (w/ meals)
- Women take calcium and vit d supplement -participate in weight bearing exercises (due to accelerated bone loss)
Oral Corticosteroids: Prednisone
Long & short term SEs
long term: immunosuppression, skin changes, osteoporosis, increased blood glucose (not for diabetics), wt gain, cushing’s (moon face)
short term: insomnia, increased appetite
Oral corticosteroid teaching
DON’T STOP ABRUPTLY. taper doses until prescription completed.
prednisone mimics the action of cortisol. Causes adrenal cortex to decrease or stop production or cortisol.
results in adrenal insufficiency or crisis which is life threatening.
S/S: HA, confusion, restlessness, vomiting, shock, death.
Leukotriene Modifiers
Leukotrienes are: inflammatory mediators, potent bronchoconstrictors, produce airway inflammation and edema.
- interferes with synthesis of or blocks the action of leukotrienes—>anti-inflammatory, bronchodialator
- not for acute episode-prophylactic and maintenance therapy.
- administered orally.
Leukotriene Modifier Names
-Zafirlukast (Accolate)-po
—SE: HA, dizzy, n/v/d, fatigue, abd pain
-Montelukast (Singulair)-po
—-SE: well tolerated
Leukotriene synthesis inhibitor
—Zileuton (Zyflo) -po
—increases LFTs, dyspepsia, HA
Immunodialators: Anti-IgE
- Not first line Tx
- For moderate to severe asthma not controlled with inhaled steroids.
- Improves asthma control
- small risk anaphylaxis
- decreases circulating IgE levels.-prevents IgE from attaching to mast cells. -prevents release of inflammatory mediators from mast cells
- Not for acute attacks
Immunodilators: name
Omalizumab (xolair)
Sub-Q injection. Dose based on IgE and body weight
-SEs: injection site rxn (bruising, redness, warmth, pain. risk of anaphylaxis. C
Cost $18,000 per year, most insurance companies cover.
Bronchodilators
- Short acting Beta 2 Adrenergic Agonists (SABA)
- Long Acting Beta 2 Adrenergic Agonists (LABA)
- Anti-Cholinergics
SABA
- Decreases bronchospasms
- produces bronchodilation (stimulate beta-2 adrenergic receptors in bronchioles and prevents release of inflammatory mediators from mast cells)
- overuse results in rebound bronchospasms
- used as rescue, not long tern control
SABA Side effects
-tremors, anxiety, tachycardia, palpitations, nausea
Common SABA drugs
- Albuterol (Proventil, ventolin)–MDI, Neb
- Levalbuterol (Xopenex)–MDI, Neb
- Pirbuterol (Maxair)–MDI
- inhaled form directly to site-minimal SEs, caution in patients with cardiac disorders. Rarely given in oral form due to CV side effects.
- teach: always carry rescue inhaler, goal is to never to use. freq use= poor asthma control.
LABA
Long term control -used to prevent acute attacks
- dilates bronchioles to increase airflow
- not for acute symptoms
- not monotherapy for asthma
- often combined with other meds
What to teach about LABAs
-use daily even when feeling well, only use q 12hrs, do not work quickly, not for acute symptoms
Common LABA drugs
-Salmeterol (Serevent)- DPI –not exceed 2 puffs q 12hrs. not to be used acutely. SE: HA dry throat, tremor, dizziness, pharyngitis
-Formoterol (Foradil)- DPI, Neb
SE: angina, tachycardia, nervousness, HA, tremor, dizziness
Anti-Cholinergic Drugs
- blocks bronchoconstricting effects of parasympathetic nervous system. (Inhibits vagal nerve stimulation)
- less effective than beta-2 adrenergic agonists
- used for quick relief when can not tolerate SABA (slower initial onset than SABAs)
- Used in combination with other bronchodilators
- systemic SEs uncommon due to poorly absorbed
- most common SE is dry mouth
Anti-Cholinergic -short acting
- Ipratropium (Atrovent) -Neb, MDI
- -alternate with beta agonist (SABA) may be helpful or can be mixed (Duonebs).
- -Temp blurry vision if eye contact
- -caution with narrow angle glaucoma or enlarged prostate
- -SEs: dry oral mucosa, cough, skin flushing, bad taste
