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Alpha receptor
- vasoconstriction (narrow vessels)
- vasopressor (inc bp)
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Beta1 receptor
- increased hr
- increased heart muscle contraction
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Beta2 receptor
- relaxation of bronchial smooth muscles
- increased mucociliary activity
- inhibit inflammatory mediator release
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Two types of asthma medications
- Relievers - short acting B2 agonists and anthichlinergics
- Controllers - corticosteroids, leukotriene modifiers and long acting B2 agonists
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Short acting B2 drugs
- Albuterol
- Pirbuterol
- Levalbuterol
- Terbutaline
- Metaproteronol
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Albuterol facts
- Ventolin and Proventil
- Very selective B2
- TX of bronchospasm
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Albuterol SVN
Solution in (0.63, 1.25, 2.5 and 5 mg)/3ml
- 0-4: 0.63 - 2.5 mg Q 4-6 hrs prn
- 5-11: 1.25 - 5.0 mg Q 4-6 hrs prn
- > 12: 1.25 to 5.0 mg Q 4-6 hrs prn
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Albuterol MDI
Solution: 90 mcg/puff (200 puff per canister)
- 0-4: 2p Q 4-6 prn
- 5-11: 2p Q 4-6 prn
- >12: 2p Q 4-6 prn
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Albuterol TAB
- Sol: 2mg or 4mg
- TID or QID
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Albuterol DPI
Sol: 200 or 400 mcg
4-adult: Q 4-6 hrs
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Albuterol Syrup
- 2-6: 0.1mg/kg TID. DNE 2mg (1tsp) TID
- 6-14: 2mg (1tsp) TID to QID. DNE 24 mg/day
- >14: 2mg (1tsp) or 4mg (2tsp) TID to QID. DNE 8mg QID
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Pirbuterol MDI
Sol: 200 mcg/puff. 400 puff per canister
- 0-4: NA
- 5-11: NA
- >12: 2p Q4-6 prn
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Levalbuterol facts
- Xopenex
- Selective B2
- Tx of bronchospasm
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Levalbuterol MDI
Sol: 45 mcg/puff. 200 puff per canister
- 0-4: NA
- 5-11: 2puff Q 4-6 prn
- >12: 2puff Q 4-6 prn
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Levalbuterol SVN
Sol: (0.31, 0.63 and 1.25 mg)/3 ml and 1.25 mg/0.5ml
- 0-4: 0.31 to 1.25 mg Q 4-6 prn
- 5-11: 0.31 to 0.63 mg Q 8 prn
- >12: 0.63 to 1.25 mg Q 8 prn
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Terbutaline facts
- Bricanyl Oral and DPI, Brethaire MDI
- Symptomatic tx of asthma
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Terbutaline MDI
- Sol: 200 mcg/puff
- 2puff Q 4-6
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Metaproteronol facts
- Alupent and Metaprel
- Symptomatic tx of asthma and reversible bronchospasm
- Shortest duration of all drugs
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Metaproteronol SVN
- Sol: 5%
- 0.3ml (15mg) TID to QID
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Metaproteronol MDI
- Sol: 650 mcg/puff
- 2-3 puff TID to QID
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Metaproteronol TAB
- Sol: 10 or 20 mg
- 20 mg TID to QID
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Metaproteronol Syrup
Sol: 10 mg/5ml
1-2 tsp TID to QID
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Short acting Catecholamine
- affect A1, B1 and B2
- exposure to light, heat, air or alkaline sol oxidizes drug
- turns from clear to pink then brown
- epinephrine, racemic epi and bitolterol
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Epinephrine facts
- Adrenaline, AsthmaHaler, Medihaler-Epi, Dysneinhal, Bronkaid
- Not for routine tx of asthma exacerbations
- In aerosol and parenteral solution
- Aerosol strong, NOT FOR INJECTION
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Epinephrine SVN
- Sol: 1% solution
- 0.25 to 0.5 ml (2.5 to 5.0 mcg) QID
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Epinephrine MDI
- SOL: 0.2 mcg/puff
- 2puff prn
OTC: primatine mist. severe side effects. do not take with prescribed inhaler
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Racemic Epinephrine facts
- Micronefrin, Vaponefrin, Asthmanefrin
- Relief of bronchospasms and mucus production c asthma
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Racemic Epinephrine SVN
- SOL: 2.25% SOL
- 0.25 to 0.5 ml QID
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Bitolterol facts
- Tornolate
- relief of reversible bronchospasm
- MDI and SVN
- once inhaled, undergoes chemical changes leading to B2
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Biltolterol SVN
1.25 ml (2.5 mcg) BID to QID
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Bitolterol MDI
- SOL: 370 mcg/puff
- 2 puff Q8
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Inhaled Corticosteroids facts
- Most effective in long term control by red inflammation
- Once controlled, red to lowest dose to maintain
- Growth suppression in children
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Inhaled Corticosteroid Drugs
- Fluticasone HFA
- Budesonide
- Beclomethasone CFC
- Beclomethasone HFA
- Triamcinolone
- Flunisolide
- Flunisolide HFA
- Mometasone
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Fluticasone HFA facts
- Flovent
- allergies
- MDI, nasal spray and DPI
- Prime MDI if not used 7 days or if dropped
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Fluticasone Nasal Spray
- Adults - 2 sprays each nostril daily
- Ped - 1 spray each nostril daily (not for <4)
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Fluticasone MDI
Sol: (44, 110 and 220 mcg)/puff. 120 puff per canister.
- >12: 88 mcg BID. MD 440 mcg BID. HD > 440 mcg
- 5-11: 88 mcg BID. MD 352 BID. HD > 352 mcg
- 0-4: 88 mcg BID. HD > 352 mcg
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Fluticasone DPI
- SOL: (50, 100 and 250 mcg) diskus.
- Use 50 within 6 wks, and 100 or 250 within 2 mo
- Red at 5 doses. DNU if no feel or taste.
- >12: 100 mcg BID. MD 500 mcg QD. HD > 500mcg
- 4-11: 50 mcg BID. MD 400 mcg QD. HD>400mcg
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Budesonide facts
Rhinocort, Pulmicort, Entocort
Pulmicort is compatible with albuterol, atrovent and xopenex
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Pulmicort Turbohaler DPI
Sol: 200 mcg/inh, 200 doses
- >=6: 1-2p QD to BID
- Prime the first time, not needed to reprime ever
- May not taste or feel
- No spacer needed.
- Red line appears at 20 doses, at bottom when empty.
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Pulmicort Respules
SOL: (0.25, 0.5 and 1.0 mg) 2ml amps, 30/carton
- 1-8... if pt was on:
- BD: 0.5 mg QD or BID in 2 doses. HD: 0.5 mg QD
- ICT: 0.5 mg QD or BID in 2 doses. HD: 1.0 mg QD
- OCT: 1.0 mg QD or BID in 2 dose. HD: 1.0 mg QD
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Pulmicort Flexhaler
SOL: 90 mcg in 60 inh can, 180 mcg in 120 inh can
- 6-17: SD 180 mcg BID. MD 360 mcg BID
- =>18: SD 360 mcg BID. MD 720 mcg BID
- prime first time, never again
- countdown in interval of 10
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Rhinocort
- Sol: 32 mcg per inhalation
- 120 sprays after priming (8 sprays)
- Not used 2 days, reprime 1 spary
- Not used 14 days, rinse and reprime 1 spray
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Beclamethasone facts
- Vanceril
- start bronchodilator therapy before IST
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Beclamethasone
Sol: 42 mcg / puff
- >12: 1-2 puff TID to QID. DNE 840 mcg
- 6-12: 2 puff TID to QID. DNE 420 mcg
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Beclamethasone HFA facts
- QVAR
- prime if not used > 10 days
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Beclamathasone HFA
Sol: 40 and 80 mcg inh, 100 inh per canister
- If no IST 5-11: 40 mcg BID. HD 80 mcg BID
- If IST 5-11: 40 mcg BID. MD 80 mcg BID
- If no IST>12: 40-80 mcg BID. HD 320 BID
- If IST >12: 40-160 mcg BID, HD 320 BID
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Trimicinolone facts
- Azmacort
- prime with 2 puff, stays primed 3 days
- max benefits not seen for 2 weeks
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Trimicinolone
Sol: 75 mcg /puff. 240 puff per canister
- >12: ;75 mcg 2p TID to QID or 4p BID. MD 16p QD
- 6-12: ;75 mcg 1-2p TID to QID or 2-4p BID. MD12pQD
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Flunisolid facts
- Aerobid
- not recommended under 6
- improvement in 1-4 weeks
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Flunisolide
Sol: 250 mcg/puff. 100 puff canister
- >15: 2p BID. MD rp BID
- 6-15: 2p BID.
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Flunisolide HFA facts
- Aerospan
- improvement 2-4 weeks prime initial and 2 week nonuse
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Flunisolide HFA
SOL: 120 puff per canister
- 6-11: 80 mcg BID. MD 160 mcg BID.
- >12: 150 mcg BID. MD 320 mcg BID.
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Mometasone facts
- Nasonex, Asmanex
- Hay fever and allergies
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Mometasone Nasal Spray
- Nasonex
- Allergies =>12: 2spray each nostril QD
- Allergies 3to11: 1spray each nostril QD
- Sinusitis =>12: 2 spray each nostril QD
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Mometasone DPI
- Asmanex Twisthaler
- Sol: 220 and 110 mcg (delivers 200 and 100)/ 30 dose
- Discard after 45 days or at 00 count
- If c BD: 200 mcg QPM
- If c ICT: 200 mcg QPM
- If c OCT: 400 mcg BID
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