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42 Cards in this Set
- Front
- Back
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What are the classes of drugs that are in the bronchodilator category?
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Beta-2 adrenergic receptor agonists
Anticholinergics Methyxanthines |
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What is the MOA of beta-2 receptor agonists?
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Catalyze conversion of ATP to cAMP, cause bronchial smooth muscle relaxation
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What are the long-acting effects of B2 receptor agonists?
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Improves airway obstruction
Reduces use of rescue meds Reduces exacerbations Improves quality of life |
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What are the short-acting inhaled beta2 receptor agonists?
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Albuterol
Levalbuterol Pirbuterol |
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What are the long-acting inhaled beta2 receptor agonists?
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Arformoterol
Formoterol Salmeterol |
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What is the MOA of the inhaled anticholinergics?
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Muscarinic receptor antagonists
Reduce smooth muscle tone and glandular mucus |
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What are the benefits of the inhaled anticholinergics?
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Decreases symptoms and improves exercise tolerance
Reduces exacerbations |
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What are the local adverse effects of the inhaled anticholinergics?
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Unpleasant/bitter taste
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What are the anticholinergic effects of the inhaled anticholinergics?
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Dry mouth, blurred vision, urinary retention, constipation, tachycardia
Caution w/narrow angle glaucoma or BPH |
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What is the MOA of methylxanthines?
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Phosphodiesterase inhibition
Adenosine receptor antagonism Increased contractility of fatigued diaphragm |
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What are the short-acting inhaled anticholinergics?
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Ipratropium
Albuterol/ipratropium |
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What is the long acting inhaled anticholinergic?
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Tiotropium (Spiriva)
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What are the methylxanthines?
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Theophylline
Aminophylline |
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What are the GI adverse effects of methylxanthines?
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N/V/D
abd pain |
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What are the CNS adverse effects of methylxanthines?
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headache, insomnia, dizziness, agitation, seizure
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What are the musculoskeletal adverse effects of methylxanthines?
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tremor, muscle cramp
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What are the cardiac adverse effects of methylxanthines?
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tachycardia, PVC, ventricular tachycardia
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What is the MOA of glucocorticoids?
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protein, CHO, lipid metabolism
Bind to intracellular glucocorticoid receptors in target cells, anti-inflammatory actions |
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What is the MOA of mineralocorticoids?
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Fluid & electrolyte balance, Bind to intracellular glucocorticoid receptors in target cells, anti-inflammatory actions
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What are the clinical applications of inhaled corticosteroids in COPD?
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Documented spirometric response
FEV1 <50% + repeated exacerbations |
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What are the corticosteroids for COPD?
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Fluticasone/salmeterol HFA and DPI (Advair)
Budesonide/formoterol DPI (Symbicort) |
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Oral corticosteroids are used for what?
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Add-on in severe asthma
Used in exacerbations (COPD or asthma) |
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What is the most potent corticosteroid?
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Hydrocortisone
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What should you give for stable COPD with intermittent symptoms?
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Short-acting bronchodilator PRN
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What should you give for stable COPD with chronic/more severe symptoms?
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Short acting bronchodilator PRN
Consider combination beta-agonist + anticholinergic |
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What are the criteria for COPD exacerbation?
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Sputum volume
Sputum purulence Dyspnea Cough |
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What are the indications for hospital admission in COPD?
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Poor response to outpatient managment
Marked increase in dyspnea Onset of new physical signs High-risk comorbid conditions Altered mental status New or worsening cor pulmonale New or worsening blood gases |
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What bacteria are commonly involved in a COPD exacerbation?
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H. influenzae
Strep pneumoniae Moraxella catarrhalis |
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What antibiotics would you give for a mild exacerbation of COPD?
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Beta-lactam
Tetracycline TMP/SMX 2nd/3rd gen cephalosporin |
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What antibiotics would you give for a moderate exacerbation of COPD?
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beta lactam/beta lactamase inhibitor combination
fluoroquinolone |
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What antibiotics would you give for a severe exacerbation of COPD?
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Fluoroquinolones
Parenteral beta-lactam w/pseudomonas activity |
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What oral products are available for nicotine replacement?
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Gum - Nicorette
Lozenge - Commit Inhaler - Nicotrol |
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What are the adverse effects of the oral nicotine replacement agents?
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Mouth/throat irritation
Headache GI upset |
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What are the adverse effects of NicoDerm CQ?
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local reactions, headache, sleep disturbances
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What are the adverse effects of Nicotrol NS?
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nasal irritation
headache |
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What nicotine product has the fastest onset of action?
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Nicotrol NS (nasal spray)
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NicoDerm CQ has a peak CNS level of what?
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6-8 hours
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Oral nicotine replacement products have peak CNS levels of what?
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20-30 min
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What is the MOA of bupropion (Zyban)?
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Inhibits reuptake of dopamine & norepinephrine in CNS
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What are the adverse effects of buproprion (Zyban)?
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Insomnia
Dry mouth Lowers seizure threshhold |
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What is the MOA of Varenicline (Chantix)?
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alpha4/beta2 nicotinic receptor partial agonist
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What are the adverse effects of Varenicline (Chantix)?
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Nausea
Sleep disturbances constipation Psychiatric disturbances |
