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Stepwise Approach to asthma
- classification of severity
- mild intermittent, mild persistant, moderate persistant, severe persistant
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Glucocorticoids
suppress inflammation Ex)budesonide (pulmicort), fluticasone (flovent), Triamcinolone (azmacort)
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Glucocorticoids ADRs
- Oropharyngeal Candidiasis (gargle/spit after each use, use a spacer)
- Growth delay in young children (admin lowest effective dose)
- Bone loss (lowest effective dose for long term use, Ca & vit D, weight bearing exercises)
- Adrenal suppression-long term high dose therapy
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Beta-2 agonists
- selectively activates B2 receptors of lung resulting in bronchodilation Ex) short- albuterol (ventolin, proventil), long-salmeterol (serevent), formoterol (foradil)
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Theophylline
- no longer drug of choice (safer options)
- A methylxanthine, (caffeine)
- narrow therapeutic range-10-20 if >25 dysrhythmias, seizures, death
- ADRs-GI, insomnia/restles
- smoking <effects, cimetidine, fluoroquinolones > levels
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Inhaler types
- Metered Dose Inhaler (MDI)- Puffer
- Dry-Powder Inhaler (DPI)- inhale products of a capsule
- Nebulizer- creates a mist, good for elderly & children. (admin over 5 min)
- Spacer=A device that directly attaches to the metered dose inhaler & serves to increase delivery of drug to the lungs & decrease deposition of drug to oropharyngeal mucosa (especially important in admin of glucocorticoids)
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correct order/ admin of inhaler
- Short B2, Long B2, Glucocorticoid
- 1 min btwn each puff, 5 min btwn each Med
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Cromolyn (intal)
- preferred to glucocort- safer & non-steroidal
- mast cell stabilizer- <histamine release suppress inflam.
- effective prophylaxis to seasonal allergy & can be used for exercise induced
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leukotriene modifiers
- singular-maintenance/prophylaxis >6mo oral only not for acute asthma
- well tolerated slight suicide risk
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Combination med
- advair
- fluticasone (inhalled glucoco)
- salmeterol (inhaled long B-2 agonist)
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Anticholinergic for COPD
- Ipratropium (atrovent), tiotropium (spiriva), combovent (ipratropium + albuterol)
- block cholinergic receptors in bronchi to cause bronchodilation
- ADR-systemic effects rare- dry mouth/throat
- (inhaled)
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Antihistamine use/action
- blocks H1 receptors to block effects of histamine
- use: mild allergic disorder, motion sickness, OTC sleep aid, cold med
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Antihistamine 1st gen
Dimetapp, chlor-trimeton, tavist, Benadryl
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1st gen ADRs
- sedation, neurologic effect (dizzy, uncoordinated, confusion), paradoxical effect (staying awake, anxiety), anticholinergic effect
- Dont give to elderly
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2nd gen antihistamine
Zyrtec, Xyzal, Allegra, Claritin, Clarinex, Astelin (nasal spray)
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intranasal decongetants action & ADR
- Afrin, Neo-synephrine (oral or nasal)
- rapid onset of action->intense but shorter in duration
- ADR- rebound congestion (esp >3-5 days), >BP & HR when used in excess
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Oral decongestant
- Neo-Synephrine, Sudafed
- CNS stimulant, >BP, abuse potential
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Drugs for cough
- Dextromethorphan (robitussin DM)-most effective nonopiod
- Benzonatate (Tessalon)- <sensitivity resp t
- Opiods (Robitussin AC, Tussionex)-dont drive
- Guifenesin (mucinex, Robetussin)- expectorant
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