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60 Cards in this Set
- Front
- Back
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steroids
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phospholipase A2 inhibitors
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cromolyn sodium
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mast cell inhibitor
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zileuton
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lipoxygenase inhibitor
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zafirlukast, montelukast
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leukotriene receptor antagonist
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omalizumab
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monoclonal Ab to Ig E
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In all steps of asthma tx, _________ should be used to relieve acute Sx
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short-acting B-2 agonists
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MOA of short-acting B2 agonists
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stimulate B2 rec in lung, immediate onset
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short acting B2 agonist selectivity:
1.Epinephrine 2.isoproterenol 3.albuterol |
1.nonselective for B1 and B2
2.nonselective for B1 and B2 3. DOC--selective for B2 |
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indications for short-acting B2 agonists
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1.acute bronchospasm, including status asthmaticus (albuterol, EPI)
2. prevention of exercise-induced bronchospasm (albuterol) |
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adverse drug rxns of short-acting B2 agonists
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tachycardia, palpitations, tremors, nervousness, agitation
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LABA (long acting B2 agonists)
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salmeterol, formoterol fumarate
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salmeterol indications
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prevention of exercise induced bronchospam
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salmeterol boxed warnings
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-not for acute attacks
-increased astham-related deaths if used in addition to regular asthma meds |
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salmeterol comparison to fumarate
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fumarate has faster onset(minutes) and less admin time for EIA(15 min prior)than Salmeterol (30 and 30-60 prior)
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LABA increase asthma deaths when not used with a ___________
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inhaled steroid
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Theophylline MOA
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uncertain--bronchodilator with antiinflammatory immunomodulatory agent affecting the LAR
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DI of throphylline with cimetidine, erythromycin, andciprofloxacin
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these P450 inhibitors increase the halflife of theophylline
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Therapeutic index for theophylline is?
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narrow, requires drug monitoring
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Side effects of theophylline:
1. <20mg/ml 2. >20mg/ml 3. >30mg/ml |
1.nausea, nervousness, anxiety
2. nausea, insomnia, tremor, anxiety,and tachycardia 3. arrythmias, seizures |
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indications for theophylline
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-moderate to severe chronic asthma
-2nd line tx in acute asthma |
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aminophylline
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IV theophylline (considered ineffective in mgmt of status asthmaticus)
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Ipratropium MOA
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anticholinergic--blocks PS stimulation in lungs
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Ipratropium indications and primary use
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-maintenance tx of bronchospasm of COPD
-chronic bronchitis and emphysema |
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MOA of steroids as antiinflammatory agents
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-decrease synthesis and prevent release of chemical mediators
-decrease activation of inflammatory cells -decreases vascular permeability |
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systemic steroids should be initiated in any pt requiring____________
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hospitalization for acute asthma
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Methylprednisone indication
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status asthmaticus
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Tx of choice for acute/severe asthma exacerbations
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systemic steroids and aerosolized B2 agonists
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inhaled steroid indications
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-long term inflammation
-most effective for long term maintenance of asthma -DOC for progressing to persistent asthma |
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inhaled steroids
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-beclomethasone
-fluticasone/salmeterol(Advair) -budesonide/formoterol(Symbicort) -mometasone/formoterol(Dulera) |
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inhaled steroids are not indicated for relief of ______
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acute bronchospasm
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ADR of inhaled steroids
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oral candidiasis, dysphonia
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Cromylyn MOA
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-bind mast cells, block entryof Ca2+, stabilize mast cell membrane--preventing degranulation
-open Cl- channels,hyperpolarization, inhibition of several cell types |
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Cromylyn indication
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prevention of exercise-induced bronchospasm
-NO ROLE in tx of acute asthma!!! |
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Zileuton
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5-lipoxygenase inhibitor--inhibits leukotriene formation
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Zileuton clinical use
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-prophylaxis and chronic tx of asthma age >/=12yrs
-intended for continuous use -not for acute attacks!! |
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Zafirlukast
1. MOA 2. indications 3. pt info |
1. selective and competitive antagonist of leukotrienes D4 and E4
2. prophylaxis/chronic tx of asthma in age >/=5yrs 3. for continuous use/ take on empty stomach |
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montelukast(singulair)
1. MOA 2. dosing 3. pt info |
1.selective inhibitor of LTD4 rec with no agonist activity
2. once daily in evening with or w/o food 3.for continuous use |
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Omalizumab Boxed warning
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risk of anaphylaxis after 1st dose to greater than one year later/ observe 2hrs post dose/ rxn may occur up to 24 hrs later
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Omalizumab MOA
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-monoclonal Ab to IgE
-since binding does not occur at Fab variable allergen specific site--all allergen response inhibited |
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Omalizumab
1. dosing 2.indications |
1. SC every 2-4 wks
2. moderate to severe persistent asthma and pts whose asthma sx not adequately controlled by inhaled steroids |
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central antitussives
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opiate: codiene, hydrocodone
nonopiate: dextromethorpan |
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peripheral antitussives
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benzonatate (tessalon perles)
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central antitussives MOA
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increase threshold for stimulation of medullary cough centerby decreasing sensitivity to afferent impulses
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peripheral antitussives MOA
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decrease sensitivity to irritant receptors (topical local anesthetic effect)
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Codiene is effective at therapeutic doses which are?
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1. not analgesic
2. do not cause respiratory depression 3. not likely to result in abuse |
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Hydrocodone is similar to codeine except______________
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-more habituating
-available as antitussive only in combo with other ingredients |
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Dextromethorpan MOA/effects
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-minimal CNS suppression, no analgesia
-d-isomer similar to codeine, but does not interact with opioid receptors -increase threshold for coughing -not addicting at nl doses |
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high dose effects of dextromethorpan
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euphoric sensations and hallucinations
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use of dextromethorpan in combo with MAO inhibitors can cause___________
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serotonin syndrome--hypotension, fever, and muscle rigidity
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Tx recommendation for acute cough due to common cold
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1st generation antihistamine/decongestant combo (nonsedating antihistamines are ineffective!!)
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tx recommendations for cough due to acute bronchitis
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short acting inhaled B2 agonists if wheezing
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tx recommendations for cough due to chronic bronchitis
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-ipratropium
-short acting inhaled B2 agonistfor bronchospasm -antitussive for persistent cough despite other txs |
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tx recommendations for cough due to acute exacerbation of chronic bronchitis
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-ipratropium, short-acting inhaled B2 agonist, or combo
-oral steroids for 10-15 days |
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OTC cough and cold meds for kids
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should not take if <4yrs
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Expectorants
1. MOA 2. FDA approved agent |
1. facilitate removal of viscous mucus from respiratory passages by decreasing mucus viscosity
2. Guaifenesin |
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Mucolytics
1. drug 2. MOA |
1.acetylcysteine
2. decrease sputum viscosity, liquefies thickened mucus secretions, and facilitates expectoration |
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this mucolytic agent also used as antidote for acetaminophen poisoning
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acetylcysteine
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most potent B2 agonist
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isoproterenol
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short acting B2 selective agent
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albuterol
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LABA selective B2 agents
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formeterol, salmeterol
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