Naplex

inflammatory airway disease

aspirin, NSAIDS, beta blockers

low to moderate beta-1 selective agents such as atenolol or metoprolol XL

COX-2 inhibitors

inhaled corticosteroids

in pt. with moderate to severe persistent asthma

• omalizumab (Xolair)-is an inti IgE
• given SQ q2-4wks.

• Peak expiratory flow meter (PEF)
• green zone: 80-100%
• yellow: 50-79% (advised cosultation with MD)
• red: <50% (medical attention, implemented plan)
• spirometry is performed at MD office

are antinflammatory; block late reaction to allergen and decrease airway hyperresponsiveness; inhibit cytokine production...;reverse beta2 receptor downregulation

• beclomethasone HFA (QVAR)-MDI
• budesonide (Pulmicort)-DPI
• budesonide-formoterol (Symbicort)-MDI
• flunisolide (Aerobid)-MDI
• fluticasone (Flovent (MDI) Flovent Diskus (DPI))
• fluticasone-salmeterol (Advair HFA or Advair Diskus)
• mometasone (Asmanex)-DPI
• triamcinolone (Azmacort)-MDI

• MDI-metered dose inhaler
• DPI-dry powder inhaler

• cough, oral thrush (candidiasis), dysphonia(disturbance in vocal function)
• -high doses may cause growth suppression (not established yet)

• CYP450 inducers: carbamazepine, phenobarbital, phenytoin, rifamin
• inhibitors: erythromycin, clarythromycin, itraconazole, oral contraception, conjugated estrogens

• relax bronchial smooth muscle by acting on beta2 receptors
• duration of action is about or more than 12hrs

• formaterol (Foradil aerolizer)-DPI
• salmeterol (Serevent Diskus)-DPI

tachycardia, tremor, hypokalemia, prolong QTc (used in combos with corticosteroids for asthma)

bronchodilation, smooth muscle relaxation results from phosphodiaterase inhibition

• theophylline (Uniphyl)-tabs.
• (not really used in asthma)
• theraputic conc. 5-15mcg/ml

• dose related toxicities: tachycardia, CNS stimulation, hyperglycemia, hypokalemia
• SE at usual doses: insomnia,hyperactivity in kids...

• leukotriene receptor antagonist
• inhibiton of CysLT receptor
• 5-lipoxygenase inhibitors

• montelukast(Singular)-granuel,chew tab,tabs (taken HS)
• zafirlukast (Accolate)-bid
• zileuton(Zyflo, CR)-qid; CR:bid

• singular and accolate are usually well tolerated
• zyflo-may cause liver dysfunction

• take accolate 1hr before food or 2hr after meals
• zyflo and accolate may increase warfarin and theophylline levels

• role is to relax bronchial smooth muscle by acting on beta2 receptors (little effect on heart rate)
• albuterol HFA(Ventolin,Proventil,ProAir)-2puffs q4hours as needed
• pirbuteol(Maxair Autohaler)

tachycardia, tremor, hypokalemia, rarely hyperglycemia

block action of acetylcholine; with bronchodilation there is competitive inhibition of muscarinic cholinergic receptors

• ipratropium(Atrovert)
• ipratropium with albuterol(Combivent)-2puffs q6hrs

dry mouth, increased wheezing, blurry vision if sprayed into eyes

• methylprednisolone(Medrol)
• prednisone,prednisolone
• SE:altered glucose levels,fluid retention, gain weight, HTN,mood alteration

true

chronic obstructive pulmonary disease characterized by airflow limitation that is not fully reversible (4th leading cause of death)

• FEV(forced expiratory volume)/FVC(forced vital capacity) is <0.7 for all classes
• 1.mild FEV> or equal to 80%
• 2.moderate FEV 50-80%
• 3.severe FEV 30-50%
• 4.very severe FEV <30% or FEV<50% with respiratory failure

smoking

long acting inhailed bronchodilators (ex.Spiriva(tiotropium-anticholinergic) and long acting beta2 agonist)

short acting inhaled beta2 agonist

severe COPD or very severe disease and exacerbations

pt. that are not controlled with beta2 agonist and anticholinergics

• stage:
• 1. short acting bronchodilator prn
• 2. add one or more long acting bronchodilator
• 3.scheaduled tx. with one or more long acting bronchodilators
• add corticosteroids if pt. has recurrent exacerbations
• 4. same as stage 3. consider surgery
• long term oxygen if pt. has chronic respiratory failure

• inhaled albuterol, ipratropium or both
• systemic corticosteroids
• oxygen
• oral antibiotic for sputum and increased dyspnea(shortness of breath)