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99 Cards in this Set

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B2 Agonists MOA
relax bronchial smooth muscle by selective action on B2 receptors
Short acting B2 agonist (SABA) drugs
Albuterol
levalbuterol
pirbuterol
fenoterol
isoproterenol
metaproterenol
long acting B2 agonist drugs
salmeterol
formoterol
alformoterol
systemic B2 agonist drugs
epinephrine
terbutaline
combination B2 agonist drugs
advair (salmetrerol/fluticasone)
sybicort (formoterol/bedesonide)
Indications for SABA drugs
bronchospasms
exacerbation of asthma
prevention of exercise-induced asthma
most effective drug for bronchodilation
SABA
1st choice of management of severe acute asthma
SABA
Indications for long acting B2 agonists
maintenance treatment of asthma
prevention of exercise-induced asthma
B2 agonist drugs that are ineffective for acute severe asthma
long acting B2 agonists
Black box warning for long acting B2 agonists
May increase the risk of asthma-related deaths (because of long onset)
B2 agonist drug not recommended for long term monotherapy for asthma control
long acting B2 agonists
B2 agonist drugs not recommended for regular, scheduled use.
SABA
MOA of corticosteroids
prevention of activation and migration of inflammatory cells
interferes with arachidonic acid metabolism and synthesis of leukotrienes
Corticosteroid drugs for oral inhalation
Beclomethasone (QVAR)
budesonide (pulmicort)
flunisolide (aerobid)
fluticasone (flovent)
mometasone (asmanex)
triamcinolone (azmacort)
Corticosteroids drugs for systemic use
hydrocortisone (solu-cortel)
prednisone (sterapred)
prednisolone (orapred)
methylprednisolone (solu-medrol)
dexamethasone (decadron)
Adverse effects of systemic corticosteroid drugs
Growth retardation (not good for kids)
osteoporosis
cataract formation
impaired wound healing
psychiatric disturbances
Adverse effects of inhalation corticosteroid drugs
h/a
upper respiratory tract infections
burning
throat irritation
Type of drug:
beclomethasone (QVAR)
Corticosteroid oral inhalation
Type of drug:
budesonide (Pulmicort)
Corticosteroid oral inhalation
Type of drug:
Flunisolide (Aerobid)
Corticosteroid oral inhalation
Class of drug:
Fluticasone (Flovent)
Corticosteroid oral inhalation
"flow" "vent"
vent = passageway for air
Type of drug:
Mometasone (Asmanex)
Corticosteroid oral inhalation
Class of drug:
Triamcinolone (Azmacort)
Corticosteroid oral inhalation
Class of drug:
Hydrocortisone (Solu-Cortel)
Systemic corticosteroid
solu = soluble
Class of drug:
Prednisone (Sterapred)
Systemic corticosteroid
Class of drug:
Prednisolone (Orapred)
Systemic corticosteroid
Class of drug:
Methylprednisolone
Systemic corticosteroid
Class of drug:
Dexamethasone (Decadron)
Systemic corticosteroid
Indications for Corticosteroid drugs
prevention of symptoms and acute severe asthma not responding to initial B2 agonists
Class of corticosteroid most effective for long term control in all steps of persistent asthma
Inhalation
Oral, inhalation or topical
MOA of anticholingeric drugs
acts on bronchial muscles causing bronchodilation
Class of drug:
Ipratropium (Atrovent)
Anticholingeric
Adverse effects of anticholingerics
Upper respiratory tract infections
Bronchitis
sinusitis
flu-like symptoms
Treatment use of anticholingerics
Used with SABA to produce added benefit in moderate to severe exacerbations in emergency setting
Alternate bronchodilator for persons who cannot tolerate SABA
Can be used in acute asthma attacks.
MOA of Mast Cell Stabilizers
prevent the mast cell release of histamine, leukotrienes, and slow reacting substances of anaphylaxis
Mast Cell Stabilizer drugs
Cromolyn (inhalation, nasal spray, oral)
Nedocromil (inhalation)
Generic name for Intal
Cromolyn - inhalation mast cell stabilizer
Nasalcrom
Class and Generic name
Cromolyn - nasal spray mast cell stabilizer
gastrocrom
Class and generic name
cromolyn - oral mast cell stabilizer
Generic name for tilade and drug class
nedocromil - inhalation mast cell stabilizer
Class of asthma drugs with no systemic effects
mast cell stabilizers
Leukotriene Modifier MOA
bind to active site of leukotriene receptors, leukotrienes are released after exposure to allergens and inflammation or inhibits leukotriene formation
Two types of leukotriene modifier meds
Leukotriene receptor antagonists
Leukotriene synthesis inhibitor
Two types of leukotriene receptor antagonists
montelukast (singulair)
Zafirlukast (accolate)
Montelukast (Singulair) and Zafirlukast (Accolate) are what types of drugs
Leukotriene modifiers
Luekotriene synthesis inhibitor drug
Zileuton (Zyflo)
Zilueton (Zyflo) is what class of drug
Leukotriene synthesis inhibitor
Adverse reactions to leukotriene modifiers
elevations in LFT's
abdominal pain
rash
dizziness
Indications for leukotriene modifiers
allergen-, exercise-, irritant-, and aspirin-induced asthma
Not for use in acute asthma attacks
Drugs that can be used but are not preferred for step 2 care of asthma
Leukotriene modifiers
mast cell stabilizers
Most common used methylxanthine
Theophylline: Theo-24, Uniphyl
Most common used methylxanthine
Theophylline
Anti-IgE-monoclonal antibody drug
Omalizumab-Xolair
just one!
Theophylline (Theo-24, Uniphyl)
Class of drug
Methylxanthine
MOA of Methylxanthines
directly relaxes smooth muscle of respiratory tract, producing relief of bronchospasms
Indications for Methylxanthines
symptomatic treatment of asthma
relief of acute symptoms
exercise-induced bronchospasms
Adverse effects of Methylxanthines
tachycardia
GI upset
Omalizumab-Xolair
Class of drug
anti-IgE-Monoclonal Antibody
MOA of Anti-IgE-Monoclonal Antibody
decreases IgE binding to its receptors on mast cells and basophils, thereby decreasing activation and release of allergic mediators
Indications for Anti-IgE-Monoclonal Antibody
moderate to severe asthma not well controlled on inhaled corticosteroids
Adverse effects of Anti-IgE-Monoclonal Antibody
h/a
local injection site reactions
Drug steps in treatment of acute asthma exacerbation
B2 agonists: inhaled or nebulized
anticholingerics: inhaled or nebulized
corticosteroids (systemic): oral or IV
oxygen
intubation and mechanical ventilation
Degree (step) of asthma when symptoms are present at least once daily during the day and more than 1 night per week
Step 3- moderate persistent
Category (step) of asthma when symptoms are present continually throughout the day and frequently at night
severe persistent step 4
Preferred dosing for step 4 chronic asthma patient
high dose ICS + LABA + (if needed) oral corticosteroids long term
preferred dosing for step 3 chronic asthma
low to medium dose ICS + LABA
Preferred dosing for step 2 chronic asthma
low dose ICS
Quick relief of asthma symptoms for all asthma patients
2-4 puffs SABA prn: up to 3 tx at 20 min intervals or single nebulizer
Pt should start long-term control therapy if using SABA -
using SABA > 2X per week in intermittent asthma
Treatment drugs for allergic rhinitis
Antihistamines
Decongestants
Corticosteroids
Anticholingerics
Antihistamines MOA
Histamine 1 (H1) receptor antagonists
competitively bind to histamine receptors preventing histamine from binding to receptors
1st Generation antihistamine drugs
Chlorpheniramine (chlor-trimeton)
clemastine (tavist, dayhist)
diphenhydramine (benadryl)
brompheniramine (lodrane)
2nd generation antihistamine drugs
non-sedating
fexofenadine (allegra)
loratadine (claritin, alavert)
desloratadine (clarinex)
2nd generation antihistamines
mildly sedating
cetirizine (zyrtec)
levoceritizine (xyzal)
Nasal antihistamines
azelastine (astelin, optivar)
olopatadine (patanase)
Ophthalmic antihistamines
olopatadine (patanol)
emedastine (emadine)
levocarbastine (livostin)
Other uses for 1st generation antihistamines
insomnia, motion sickness
Degree of sedative effects of 1st generation antihistamines
low-to-high
Degree of anticholingeric effects of 1st generation antihistamines
moderate to high
responsible for clearing up secretions (rhinorrhea)
Treatment tips for prescribing Antihistamines
for symptomatic relief
may have some antiinflammatory effects
use 1-2 hrs prior to exposure
if tolerance develops, change to another agent in different class
MOA of nasal decongestants
sympathomimetic agents, work on adrenergic receptors in nasal mucosa producing vasoconstriction
Types of systemic nasal decongestants
pseudophedrine (sudafed)
phenylephrine (sudafed PE, triaminic)
types of topical nasal decongestants
phenylephrine (neo-synephrine)
naphazoline (privine, naphcon)
tetrahydrozoline (tyzine, visine)
oxymetazoline (afrin, visine LR)
Rhinitis medicamentosa
definition and how it relates to decongestants
"rebound" vasodilation
prolonged use of topical decongestants (3-5 days) can cause "rebound" congestion
Pseudoephedrine is condraindicated in what type of patient
hypertensive
causes tremors, tachycardia, excitability
MOA of corticosteroids
work on nasal mucosa by reducing inflammation by reducing mediator release, cause mild vasoconstriction
Drug class:
beclomethasone (beconase)
corticosteroids
drug class:
budenoside (rhinocort)
corticosteroids
drug class:
flunisolide (nasarel)
corticosteroids
drug class:
fluticasone (flonase, veramyst)
corticosteroids
drug class:
mometasone (nasonex)
corticosteroids
drug class:
triamcinolone (nasacort)
corticosteroids
Adverse effects of corticosteroids
sneezing
stinging
h/a
epistaxis
upper respiratory tract infections
Drug class that treats sneezing, rhinorrhea, itching, conjunctivitis
antihistamines
Drug class that treats nasal congestion
Decongestants
Drug class that treats sneezing, rhinorrhea, itching, nasal congestion
corticosteroids
Drug class that treats sneezing, rhinorrhea, itching, conjunctivitis (not antihistamine)
Mast cell stabilizers (controls same symptoms as antihistamines)
ASTHMA
ASTHMA