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