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NURS 572 Ch 75 asthm
Pharm Ch 75 asthma
Question | Answer |
---|---|
What 2 classes of drugs are used to tx asthma | anti-inflammatory-----bronchodilators |
What drugs in the anti-inflamm class are used | glucocorticoids---NSAIDs |
what drugs are in the bronchodilator class | Beta-2 agonists---anticholinergics---leukotriene modifiers---methylxanthines |
what is the advantage to inhalation tx | delivers drug where it's needed ---especially with spacer---21% to lung vs. 9% without spacer |
3 types of inhalation tx | MDIs = metered dose inhalers-----DPI = dry powder inhaler -----nebulizer |
what are the MOST EFFECTIVE anti-asthma drugs | inhaled glucocorticosteroids most effective |
local ADRs of inhaled steroids | oropharyngeal candidiasis----dysphonia (voice impairment)----prevent by gargline after admin, using a spacer |
systemic ADRs of long-term use of inhaled steroids | osteoporosis-----retarded growth rate, may catch up----cataracts/glaucoma------rare HPA axis suppression |
name 3 inhaled steroids ending in -ide | budesonide-----ciclesonide-----flunisolide |
name 4 inhaled steroids ending in -one | beclomethasone-----fluticasone-----mometasone----triamcinolone |
name 2 oral/systemic steroids generally used for asthma | prednisolone----predenisone |
name 2 oral/systemic steroids if don't need mineralcorticoid activity (prolong action preferred) | methylprednisolone-----dexamethasone |
Action of Beta-2 adrenergic agonists | most effect for ACUTE bronchospasm------prevention of exercise induced bronchospasm-----often included in routine tx----also prophylactic |
how can Beta-2 agonists be admin | inhaled or oral |
ADRs of oral Beta-2 agonists | tremor common, tol developse----systemic Beta-1 SEs possible (tachy, angina)-----HYPOKALEMIA |
ADRs of inhaled Beta-2 agonists | much lower incidence of tremor, systemic Beta-1, hypokalemia |
name 4 quick/short acting inhaled Beta-2 agonists | albuterol----levabuterol----bitolterol----pirbuterol |
albuterol | quick/short inhaled B-2 agonist |
levalbuterol | quick/short inhaled B-2 agonist |
bitolterol | quick/short inhaled B-2 agonist |
pirbuterol | quick/short inhaled B-2 agonist |
name 2 long acting inhaled Beta-2 agonists | salmeterol---formoterol (and alfrometerol) |
what are 2 oral beta-2 agonists | albuterol, terbutaline |
what is are 2 non-steroidal anti-inflammatory inhaled drugs | cromolyn-----nedocromil |
what drug is SAFEST of all anti-asthma meds | that would be cromolyn |
what is MOA of cromolyn, nedocromil | NOT A BRONCHODILATOR-----phrophylaxis---suppresses inflammation |
ADRs of cromolyn, nedocromil | virtually no systemic bwo 8% absorption---cough---bronchospasm |
name 2 anti-cholinergics that can be inhaled with or without addition of albuterol | ipratropium----tiotropium |
cromolyn class | nonsteroidal anti-inflamm |
nedocromil class | nonsteroidal anti-inflamm |
MOA anti-cholinergics | blocks the muscarinic receptors that would cause bronchocon--> bronchoDIL |
are anticholinergics more/less effective than Beta-2 agonists | less effective, but additive for pts who are difficult to control |
ADRs of anicholinergics | dry mouth, throat irritation---system effects rare |
ipratropium class | anticholinergic |
tiotropium - longer acting - its class | anticholinergic |
methylxanthines MOA | this class not established |
name 1 drug in methylxanthine class | theophylline - rarely used |
why is theophylline rarely used | has a very narrow therapeutic window. ADRs a,n,v,d----CNS nerv/insom,conv-----CV tachy,dys,angina |
theophylline class | methylxanthine |
leukotriene modifier MOA | suppress leukotrienes so they can't bronchocon--> net effect bronchDIL |
name 1 leukotriene modifiers | montelukast-qd |
which leukotriene has no liver toxicity SE | montelukast |