Asthma/COPD Flashcards
Epinephrine / Adrenaline
Indication: Status asthmaticus, anaphylaxis, emergent treatment of asthma
MOA: Non-selective adrenergic agonist. B-2 adrenergic receptor stimulation > increased cAMP > immediate relaxation of bronchial smooth mm,
SE: B-1 agonist > cardiac stimulation > tachycardia, palpitations, arrhythmias, anxiety, increased cardiac oxygen demand. A-1 agonist > dry mouth. Hyperglygemia
Oral administration is ineffective
Albuterol / Ventolin, Proventil
Indication: Acute, uncomplicated asthma symptoms, COPD, chronic bronchitis
No antiinflammatory activity”
MOA: B-2 adrenergic receptor stimulation > increased cAMP > relaxation of bronchial smooth muscle cells, bronchodilation.
SE: B-1 agonist > cardiac stimulation > tachycardia, palpitations, arrhythmias, anxiety. Inhalation route has fewer side effects/
Usually tolerated well. “
Salmeterol / Serevent
Indication: Chronic asthma or bronchospasm. Not for actue symptoms.
DO NOT USE SOLEY. MUST USE IN CONJUNCTION WITH OTHER THERAPIES”
MOA: B-2 adrenergic receptor stimulation > increased cAMP > relaxation of bronchial smooth muscle cells, bronchodilation.
SE: Headache, cough
Ipratropium - Atrovent
Anticholinergic
indication: May be used with adrenergic agonists, or in lieu of them. Fewer cardiac side effects than adrenergic agonists. Similar in structure to atropine. Anti-parasympathetic activity.
MOA: Competitive agonists at muscarinic acetylcholine receptor sites > unopposed sympathetic tone in the airways > smoth muscle relaxation and bronchodilation.
Parasympolytic”
Theophylline / Theo-dur
xanthine–caffeine analog
indication: Asthma therapy used to repalce a beta agonist.
MOA: Exact mechanism unkown. Inhibition of phosphodiesterase (the enzyme that breaks down cAMP). Anti-parasympathetic activity > bronchial smooth muscle dilation.
SE: Narrow therapeutic window. (Has been largely replaced by B agonists and corticosteroids) Fewer cardiac side effects than adrenergic agonists.
Beclomethasone / Beclovent
Corticosteroid
Indication: Asthma that cannot be controlled by bronchodilators (sympathomimetics) alone
MOA: Reduction in macs, eos, and T-cells > decreased inflammation and edema. Decreased capillary permeability > inhibited release of LKs.
No direct effect on airway smooth muscle. “
SE: Oral thrush (reduced risk if rinse mouth after inhalation). Small risk for adrenal suppression. Inhaled steroids have fewer side effects than PO.
Prednisone / Deltasone
Corticosteroid
indication: COPD, worsening asthma
MOA: Decrease inflammation and edema in respiratory tract.
SE: Salt and water retention, fat gain and redistribution (buffalo hump, striae), hyperglycemia/diabetes, osteoporosis, adrenal suppression. Abrupt withdrawal may cause Addisonian crisis.
Zafirlukast / Accolate
Leukotriene Inhibitor
indications: Chronic asthma - not for acute event!
MOA: Competitive antagonism of LK D4 and E4 receptors in bronchial wall smooth muscle > inhibits bronchoconstriction and inflammation
Not indicated for reversal of bronchospasm in acute asthma attacks.”
SE: Headache, GI distress, diarrhea, increased incidence of respiratory infecitons (in older patients)
Codeine
Narcotic Analgesic. Cough Suppressant.
indication: Cough suppression
MOA: Decrease sensitivity of CNS cough centers int the medulla > suppress cough. Broken down by the body into morphine.
SE: Drowsiness, constipation (as w/ all pain relieving narcotics), GI upset when taken on an empty stomach, potential for dependence
Dextromethorphan (DM)
Indication: Synthetic derivative of morphine
. Cough suppressant.
ME: Decrease sensitivity of CNS cough centers > suppress cough.
SE: Drowsiness, constipation (as w/ all pain relieving narcotics), GI upset when taken on an empty stomach, potential for dependence
Diphenhydramine / Bendadryl
Allergic rhinitis Antihistamine (sedating)
indication: Allergic rhinitis, conjunctivitis, urticaria, pruritis. Induce sleep.
MOA: H1 (histamine 1) receptor site bloackade. The production of histamine is not blocked, just the receptor.
SE: Sedation. Drying and thickening of secretions > may worsen asthma or sinusitis. Urinary retention.
Nausea, vertogo, motion sickness. “
Loratadine / Claritin
Non sedating antihistamine
indication: Seasonal allergic rhinitis, hay fever
MOA: H1 (histamine 1) receptor agonist. The production of histamine is not blocked, just the receptor.
SE: Drying of secretions, dry mouth.
Beclomethasone (Beconase), Budesonide (Rhinocort)
allergic rhinitis nasal corticosteroid
Nasal Rhinitis
MOA: Reduction of inflammatory mediators in the nasal mucosa.
SE: Irritation of nasal muscosa, nose bleeds, sore throats, nasal candidiasis, can worsen a bacterial infection Systemic side effects uncommon.
Phenylephrine (Neo-synephrine, Afrin), Oxymetazoline (longer acting)
Alpha Adrenergic Agonist Nasal Spray
MOA: Buildup of CO2, which acts as a vasodilator.
SE: The most addictive OTC drug. Rebound effects: rhinitis medicosum (nasal mucosal swelling and congestion)
