Ati Respiratory System Meds (Airflow Disorders) (Asthma)

Front 1

beta-adrenergic agonists

Back 1

albuterol

Front 2

formoterol (Foradil Aerolizer)

Back 2

beta-adrenergic agonists

Front 3

salmeterol (Serevent)

Back 3

beta-adrenergic agonists

Front 4

terbutaline (Brethine)

Back 4

beta-adrenergic agonists

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beta-adrenergic agonists MOA

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acts by selectively activating the beta2- receptors in the bronchial smooth muscle, resulting in bronchodilation
as a result:
bronchospasm is relieved
histamine release is inhibited
ciliary motility is increased

Front 6

beta-adrenergic agonists albuterol (Proventil, Ventolin) use

Back 6

inhaled, short-acting- prevention of asthma episode (exercise-induced)
prevention of asthma

oral, long-acting- (treatment for bronchospasm)
long-term control of asthma

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beta-adrenergic agonist formoterol (Foradil Aerolizer)
Salmeterol (Servent) use

Back 7

inhaled, long-acting- long-term control of asthma

Front 8

beta-adrenergic agonist terbutaline (Brethine) use

Back 8

oral, long-acting- long term control of asthma

Front 9

beta-adrenergic agonist adverse

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oral agents can cause tachycardia and angina because of activation of alpha receptors in the heart- check pulse and report an increase of greater than 20-30 beats per minute, avoid caffeine

tremors caused by activation of beta receptors in skeletal muscle- tremors usually resolve with continued med use, dosage may need to be reduced

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beta-adrenergic agonist contraindications

Back 10

tachydysrhythmia
diabetes, hyperthyroidism, heart disease, hypertension, angina

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beta-adrenergic agonist interactions

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beta-adrenergic blockers should not be used together
MAOI, TCA can increase risk of tachycardia and angina

Front 12

beta-adrenergic agonist admin

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when taking beta2 agonist and glucocorticoid together: inhale beta 2 first because it promotes bronchodilation and enhances absorption of glucocorticoid

formoterol and salmeterol are both long-acting beta-agonist inhibitors. These inhalers are used every 12 hours for long term control and not used to abort an acute asthma attack, or exacerbation.
These long-acting agents are not used alone but are prescribed in combination with an inhaled corticosteroid
short-acting beta 2 is used to treat an acute episode

Front 13

beta-adrenergic agonist effectivenss

Back 13

long-term control of asthma
prevention of exercise-induced asthma
resolution of asthma exacerbations

Front 14

methylxanthines

Back 14

theophylline (Theolair, theo-24)

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methylxanthines MOA (theophyline)

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casues relaxation of bronchial smooth muscle, resulting in bronchodilation

Front 16

methylxanthines uses (theophyline)

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long-term control of chronic asthma or COPD
oral or IV

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methylxanthines adverse

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mild toxicity reaction: GI distress and restlessness- monitor theophylline levels to keep within therapeutic range 5-15 mcg/mL
severe reactions can occur with higher therapeutic ranges that can include dysrhythmias and seizures

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methylxanthines contraindications

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heart disease, hypertension, liver and kidney dysfunction and diabetes

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methylxanthines interactions

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caffeine increases CNS and cardiac adverse effects of theophylline
caffeine can increase theophylline levels
phenobarbital and phenytoin decrease theophylline levels- when these meds are used with theophylline, increase dosage of theophylline
cimetidine (Tagament), ciprofloxacin (Cipro), and other fluroquinone antibiotics increase theophylline levels- decrease dosage of theophylline

Front 20

methylxanthines effectiveness

Back 20

long term control of asthma and COPD

Front 21

inhaled anticholinergics

Back 21

ipratropium (Atrovent)
tiotropium (Spiriva)

Front 22

inhaled anticholinergics MOA

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block muscarine receptors of the bronchi, resulting in bronchodilation

Front 23

inhaled anticholinergic use

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relieve bronchospasm associated with COPD
allergen-induced and exercise induced asthma

Front 24

inhaled anticholinergic adverse

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local anticholinergic effects (dry mouth, hoarseness)

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inhaled anticholinergic contraindications

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peanut allergy because medical preparations may contain soy lectin
caution with narrow-angle glaucoma and benign prostatic hyperplasia due to anticholinergic effects

Front 26

inhaled anticholinergic admin

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usual adult dosage is two puffs, instruct clients to wit the length of time directed between puffs
of two inhaled meds are prescribed, instruct clients to wait at least 5 min between meds

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inhaled anticholinergic effectiveness

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control of bronchospasm in clients who have COPD
prevention of allergen-induced and exercise induced asthma

Front 28

glucocorticoids

Back 28

inhalation: beclomethasone (QVAR)
Oral: prednisone (Deltazone)

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budesonide (Pulmicort)

Back 29

glucocorticoid

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budesonide and formoterol (Symbicort)

Back 30

glucocorticoid

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fluticasone and salmetrerol (Advair)

Back 31

glucocorticoid

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fluticasone (Flovent)

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glucocorticoid

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mometasone furoate and formoterol fumarate dihydrate (Dulera)

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glucocorticoid

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prednisolone (Prelone)

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glucocorticoid

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hydrocortisone sodium succinate (Solu-Cortel)

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glucocorticoid

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methylprednisolone sodium succinate (Solu-medrol)

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glucocorticoid

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glucocorticoid MOA

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prevents inflammation, supress airway mucus production, and promote responsiveness of beta 2 receptors in the bronchial tree
does not provide immediate effects, but rather promotes decreased frequency and severity of exacerbations and acute attacks

Front 38

glucocorticoid Use

Back 38

short-term IV agents are used for status asthmaticus
inhaled agents are used for long-term prophylaxis of asthma
short-term oral therapy is used to treat manifestations following an acute asthma episode
long-term oral therapy is used to treat chronic asthma
promote lung maturity and decrease respiratory distress in fetuses at risk for preterm birth

Front 39

glucocorticoid adverse

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difficulty speaking, hoarseness, and candidiasis

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prednisone when used 10 days or more adverse

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suppression of adrenal gland function-administer oral glucocorticoid on an alternate day dosing schedule
bone loss, hyperglycemia and glucosuria
myopathy as evidenced by muscle weakness
PUD- avoid NSAIDS
Infection
fluid and electrolytes, edema, hypokalemia

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glucocorticoid contraindications

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clients who have received a live virus vaccine and those with systemic fungal infections
caution in children, diabetes, hypertension, PUD, kidney dysfunction
NSAIDS

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glucocorticoid interactions (prednisone)

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concurrent use of postassium-depleting diuretics increases the risk of hypokalemia
concurrent use of NSAIDS
concurrent use of glucocorticoids and hypoglycemic agents (oral and insulin) counteract the effects

Front 43

glucocorticoid admin

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inhaled glucocorticoids are to be used on a fixed schedule for long term therapy of asthma- they are not to be used to treat acute episodes
oral glucocorticoids are used for short-term, 3-10 days following an acute asthma exacerbation

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glucocorticoid effectiveness

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long-term control of asthma
resolution of acute exacerbation

Front 45

leukotriene modifiers

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proto: montelukast (Singulair)
other: zileuton (Zyflo), zafirlukast (Accolate)

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leukotriene modifier MOA

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prevent effects of leukotrienes, thereby suppressing inflammation, bronchoconstriction, airway edema, and mucus production

Front 47

leukotriene modifier use

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long-term therapy of asthma in adults and children, and to prevent exercise-induced bronchospasm

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leukotriene modifier adverse

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liver injury with use of zileuton (Zyflo) and zafirlukast (Accolate)

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leukotriene modifier contraindications

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liver dysfunction
Singulair and Accolate pregnancy category B

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leukotriene modifier interactions

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zileuton and zafirlukast inhibit metabolism of warfarin leading to increased warfarin levels
zileuton and zafirlukast inhibit metabolism of theophylline, leading to increased theophylline levels

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leukotriene modifier admin

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zileuton can be given with or without food
avoid taking zafirlukast with food, and take it 1 hour before or 2 hours after meals
take montelukast once daily at bedtime

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leukotriene modifier effectiveness

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long-term control of asthma