Pharm_Exam4MegaReview.

PHARM EXAM 4 STUDY GUIDE Respiratory Drugs Intermittent Asthma:  Step 1 = w/ SABA (ex. albuterol) up to 3 txs for 20-min intervals as needed  Use of SABA greater than 2 days/wk for symptom relief means it is poorly ...

PHARM EXAM 4 STUDY GUIDE Respiratory Drugs Intermittent Asthma:  Step 1 = w/ SABA (ex. albuterol) up to 3 txs for 20-min intervals as needed  Use of SABA greater than 2 days/wk for symptom relief means it is poorly controlled and tx should be moved up to next step Persistent Asthma: needing daily medication so start w/ =  Step 2 = Preferred: low-dose inhaled corticosteroid (ICS) o Alternative: LTRA (Singulair)  Step 3 = Preferred: low-dose ICS + LABA OR medium-dose ICS o Alternative: low-dose ICS + either LRTA, or Zileuton  Step 4 = Preferred: medium-dose ICS + LABA o Alternative: medium-dose ICS + either LRTA, or Zileuton  Step 5 = high-dose ICS + LABA AND consider Omalizumab (anti-inflammatory) for pts w/ allergies  Step 6 = high-dose ICS + LABA + oral corticosteroid AND consider Omalizumab for pts w/ allergies  Step down if possible = after asthma is well controlled for at least 3 months  Consult w/ asthma specialist at Step 4 or higher, consider consult at Step 3  Steps 2-4 = consider subq allergen immunotherapy for pts w/ allergic asthma Asthma is obstructive, while COPD is destructive In exercise-induced asthma, the muscle bands around the airways are sensitive to these changes in temperature and humidity and react by contracting, which narrows the airway. Respimat SMI (SMI indicates "Soft Mist Inhaler") is an advanced drug delivery device in comparison to MDIs (metered-dose inhalers) or DPIs (dry powder inhalers) used for the treatment of asthma, chronic obstructive pulmonary disease (COPD), and other respiratory conditions. Bronchodilate FIRST…wait one minute between each puff….then wait 5 min and use the other inhaler(s) Beta 2-receptor Agonists:  For tx of bronchospasm associated with asthma, bronchitis, and COPD; for acute symptoms of SOB  Stimulate beta2-adrenergic receptors in the lungs to increase cAMP, which causes relaxation of bronchial smooth muscle and inhibits release of mediators of immediate hypersensitivity, especially mast cells o Direct stimulation of beta2 receptors in the heart muscle = ↑ HR o Stimulation of beta2 receptors in smooth muscles = vasodilation = ↓ BP = ↑ HR  SE = HA, GI upset, supraventricular and ventricular ectopic beats; overuse can lead to seizures, hypokalemia, angina, and HTN  Contraindications = cardiac arrhthymias, angina, narrow-angle glaucoma, avoid use in presence of pheochromocytoma due to risk of severe HTN  Education = do not overuse, educate on how to use MDIs  Tremor and tachycardia may occur when they initially begin medication, but these effects should lessen if they use it correctly  Short-acting (SABA): albuterol (ProAir, Ventolin, Proventil), terbutaline (Brethine, Brethaire), levabuterol (Xopenex) o Albuterol: selective for beta2 but does have minor beta1 activity  Inhaled = absorbed in bronchi with low systemic concentration  Oral = well absorbed in GI tract, rapid effect, widely distributed  May be used in infants and children  Digoxin levels need to be monitored closely o Levabuterol: has less of these adverse effects  May be used in used in children and adults o Terbutaline: also inhibits uterine contractions due to action on uterine smooth muscle  used in preterm labor to prevent contractions (off label)  given inhale, oral, and SC  Crosses placenta and excreted in breast milk  Long-acting (LABA): formoterol (Foradil), salmeterol (Serevent) o Long-acting beta agonist = not for acute attacks, used for prevention/long term o African Americans should NOT be prescribed long-acting beta agonists o Long-acting beta-agonists (LTBAs) received a Black Box Warning from the U.S. Food and Drug Administration due to ↑ risk of asthma-related deaths o Should NOT be prescribed to children or adolescents o Salmeterol: selective for beta2, minor beta1  small amounts absorbed in lungs  powder for inhalation in specific delivery device  SE = increased risk of exacerbation of severe asthma symptoms if pt is deteriorating o Formoterol: 200-fold more action on beta2 than beta1 receptors  powdered medication is quickly absorbed in the lungs with onset of 1-3 minutes Inhaled Corticosteriods: Beclomethasone (QVAR), Budesonide (Pulmicort), fluticasone (Flovent)  Used for long-term management of asthma  Used for preventative therapy only, NOT to be used as abortive asthma meds  Primary action of orally inhaled are anti-inflammatory (inhibits IgE and mast cell migration)