pharm resp info

asthma (especially exercised-induced), COPD, anaphylaxis, aspiration

onset 5 minutes (SABA/formoterol) - 20 minutes (salmeterol). systemic uptake limits maximum dose

LABA should not be given as monotherapy due to increased risk of asthma-related death (LABAs do not relieve sudden wheezing)

regular use (>1 canister/month) is associated with diminished control of asthma. administer prior to other inhalers (dilates lungs)

tachycardia, tremor, nervousness (beta 1 spillover). also hypOkalemia and hypERglycemia

cause relaxation of bronchial smooth muscles by agonizing beta 2 receptors in the lungs

ipratropium onset 15-30 min, duration 5 hours. tiotropium onset <30 min, duration 24 hrs.

reverse vagally mediated bronchospasm (but not allergen- or exercise-induced bronchospasm) -- PREVENTS bronchoconstriction

acute asthma (not first line), bronchospasm prophylaxis, COPD, rhinorrhea (ipratropium)

dry mouth, throat irritation / dysphagia. rarely increased intraocular pressure, urinary retention

bronchospasm prophylaxis, rhinitis, asthma, COPD

inhibit the activity of a variety of cell types and mediators involved in allergic and irritant inflammation

*THRUSH*/dysphona/sore throat, osteoporosis, psychosis, growth retardation (children). also hypOkalemia and hypERglycemia

work at the mast cell to inhibit its degranulation, preventing the release of histamine and other mediators of allergic reactions

asthma/bronchospasm PROPHYLAXIS, allergic rhinitis

either antagonize the leudotriene receptor or inhibit leukotriene synthesis, preventing bronchoconstriction/mucous hypersecretion

HA, N/V, diarrhea, elevated LFTs. rare Churg-Strauss syndrome

asthma (alternative to ICS), COPD (4th line)

theophylline has a narrow therapeutic index (5-15mcg/mL). IV aminophylline is 80% theophylline dose

not fully understood. theophylinne may inhibit phosphodiesterase (PDE) eventually resulting in antiinflammatory effects

CYP 1A2 substrate (metabolism enhanced by smoking). ER tablets peak concentration 4-7h, dosed q12h

active or symptomatic coronary heart disease

simpathomimetic (insomnia, tremor, seizures, restlessness)

asthma

blocks the binding of IgE to high-affinity IgE receptors on mast cells, preventing their activation by allergens

severe COPD associated with bronchitis and hx of exacerbations

selectively inhibit PDE-4, decreasing the migration/action of pro-inflammatory cells

moderate-severe hepatic impairment

treat with calcium channel blockers (dihydropyridines like nifedipine or amlodipine)

antagonize L-type calcium channels, causing vasodilation of arterial smooth muscle

antagonize endothelin receptors resulting in vasodilation/decreased proliferation

*PREGNANCY CATEGORY X*, liver issues

only available through restricted programs due to risk of birth defects and/or hepatotoxicity

result in increased intracellular cGMP, resulting in vasodilation in the pulmonary vessels

HA, flushing. inhibitors/inducers of CYP 3A4.

do not co-administer with nitrates due to life-threatening hypotension (Isordil, Imdur, Minitran, others)

mimic prostacyclin, a potent vasodilator that posesses antithrombotic and antiproliferative properties (increases cAMP)

dry mouth, nausea, insomnia. rarely SEIZURES

lowers seizure threshold (hx seizures, drug/EtOH withdrawal, bulimia/anorexia)

partial agonist at alpha4-beta2 neuronal nicotinic acetylcholine receptors

sedation/drowsiness/dizziness, hypotension

sedation, anticholinergic effects, tremor

nicotine replacement, bupropion, varnicline

clonidine, nortriptyline

serious neuropsychotic events, particularly in people with depression/suicidal thoughts

insomnia/abnormal dreams, HA, nausea