Pharm- Pulm

Fluticasone (Flovent)

Drug Class: anti-inflammatory: inhaled glucocoticoid

MOA: anti-inflammatory, immunosuppressive, anti-proliferating activity

Indications: asthma, COPD

Common SEs/ADRs: headache, oral thrush, URI, throat irritation, cough

Contraindications: hypersensitivity, acute bronchospasm, latent TB, glaucoma, cataracts

Dx-Dx: minimal

Monitor: spirometry (peak flow meter)

PG: C

Lactation: caution

MDI / DPI

MDI 44 mcg//inh,110 mcg/inh, 220 mcg/inh

DPI 50mcg/inh, 100mcg/inh, 250mcg/inh

Inhalation long-term prophylaxis of bronchospasm, children possible growth slowing but “catch up”, rinse mouth after use, Budesonide [Pulmocort inhalers]

Prednisone

Drug Class: anti-inflammatory: oral glucocorticoid

MOA: anti-inflammatory early after administration by decreasing migration of WBCs, reversal capillary permeability, immunosuppressant; later onset of inhibition of protein synthesis

Indications: adjunct therapy in exacerbation of bronchospasm, multiple others

Common SEs/ADRs: short-term, minimal, more than 10-14 days then multiple systemic

Contraindications: hypersensitivity, acute bronchospasm (unless as adjunct), latent TB, glaucoma, cataracts

Dx-Dx: tNSAIDs, anti-diabetic medications, anti-hypertensives

Monitor: spirometry

PG: caution

Lactation: caution

Short-term oval “burst” therapy in exacerbation, avoid long-term use, oral or IV

Dexamethasone (Decadron)

Drug Class: anti-inflammatory glucocorticoid

MOA: long-acting corticosteroid with minimal sodium-retaining potential, decrease inflammation by suppression of neutrophil migration, decrease production of inflammatory mediators and reversal of increased capillary permeability; suppresses normal immune response

Indications: acute mountain sickness, suppression of normal immune response

Common SEs/ADRs: adrenal suppression, CNS psych/behavior effects, Cushingoid effects (weight gain, fluid retention), elevated serum glucose, thinning of skin, skin striae, acne, hypokalemia, tendon rupture, intra-ocular pressure if greater than 6 weeks of use

Contraindications: systemic fungal infections

Dx-Dx: see Lexicomp

Monitor: H&H, BP, weight, bone mineral density, serum glucose, K+

PG: only for fetal lung maturity

Lactation: inadequate information

PO, IV, IM, ophthalmic formulation

Cromolyn MDI (Crolom or Intal)

Drug Class: anti-inflammatory: mast cell stabilizer

MOA: stabilizes mast cell membrane to prevent degranulation and release of histamine, leukotrienes, slow-reacting substances of anaphylaxis

Indications: childhood asthma

Common SEs/ADRs: headache, unpleasant taste, hoarseness, cough

Contraindications: hypersensitivity, acute asthma

Dx-Dx:

Monitor: spirometry

PG: B

MDI/nebulizer solution MDI 0.8mg/inh, works better in children than adult, PO route investigational for food allergy, IBD

Zafirlukast (Accolate)

Drug Class: anti-inflammatory: oral leukotriene receptor antagonist

MOA: selective and competitive antagonist of leukotriene receptors D4 and E4, SRS4

Indications: asthma

Common SEs/ADRs: headache, nausea, diarrhea, hepatitis

Contraindications: hypersensitivity, acute exacerbation of asthma, caution in alcoholic cirrhosis

Dx-Dx: concomitant food decreases availability by 40%

Monitor: spirometry, LFT

PG: B

Lactation: not recommended

do not start during acute exacerbation, can continue if already using it

Montelukast (Singulair)

Drug Class: leukotriene receptor antagonist

MOA: selective, competitive leukotriene receptor antagonist

Indications: maintenance treatment of asthma; allergic rhinitis (not 1st line); chronic urticaria, ASA- related respiratory disease

Common SEs/ADRs: neuropsychiatric side effects; multiple others at low frequency

Contraindications: hypersensitivity

Dx-Dx: see Lexicomp

Monitor: neuropsych changes

PG: can continue if prior to pregnancy, DO NOT START DURING PREGNANCY

Lactation: OK

Neuropsych side effects= agitation, depression, suicidal thoughts, weigh risk vs benefit, no renal dosing, not sure if OK in severe hepatic disease

Albuterol (Ventolin HFA)

Drug Class: bronchodilators: inhaled short-acting Beta2 adrenergic agonist (SABA)

MOA: bronchial smooth muscle beta 2 (sympathetic) receptor stimulation; racemia mixture with R isomer active and R isomer inactive

Indications: bronchospasms in asthma and COPD, EIB

Common SEs/ADRs: angina, increase or decrease BP, arrhythmias, palpitation, CNS stimulation, angioedema, restlessness, wakefulness

Contraindications: caution with HTN, CHF, arrhythmias, seizure disorder, diabetes, glaucoma, hyperthyroidism, low serum K+

Dx-Dx: beta blockers

Monitor: spirometry

PG: C

MDI/nebulizer solution, MDI 90mcg/inh, DPI

Treatment or prophylaxis: multiple formulations, use with anti-inflammatory agent for long term use, tolerance develops

Levalbuterol (Xopenex HFA)

Drug Class: bronchodilators: inhaled short-acting beta2 adrenergic agonist (SABA)

MOA: rapid acting selective beta2 receptor agonist to counteract bronchospasm; pure R-isomer of the drug

Indications: treatment/prophylaxis of bronchospasm in reversible airway disease (asthma, EIB, COPD)

Common SEs/ADRs: tremor, rhinitis, viral infection, headache, pharyngitis

Contraindications: active cardiac disease

Dx-Dx: increase levels of loop diuretics, sympathomimetics, levels decrease by beta blockers, combination alpha/beta blockers

Monitor: spirometry, BP/HR

PG: C

Lactation: caution

MDI/nebulizer solution, MDI: 45mcg/inh, use in conjunction with anti-inflammatory agent for long term use for other than mild asthma or EIB

Salmeterol (Serevent Diskus)

Drug Class: bronchodilators: inhaled long-acting beta2 adrenergic agonist (LABA)

MOA: selective long-acting beta2 agonist

Indications: long term control of COPD, asthma control; EIB

Common SEs/ADRs: headache, muscle pain, anxiety, insomnia

Contraindications: acute asthma or COPD, seizure disorder, CVD, DM, hyperthyroidism

Dx-Dx: increases levels of loop diuretics, sympathomimetics; levels increased by CYP3A4 inhibitors; impact decreased by beta blockers

Monitor: spirometry, HR?BP/glucose

PG: C

Lactation: caution

Dry powder inhaler (DPI), BBW: asthma deaths, CVD outcomes, Use in EIB discouraged

Drug Class:

MOA:

Indications:

Common SEs/ADRs:

Contraindications:

Dx-Dx:

Monitor:

PG

Lactation:

Drug Class:

MOA:

Indications:

Common SEs/ADRs:

Contraindications:

Dx-Dx:

Monitor:

PG

Lactation:

Drug Class:

MOA:

Indications:

Common SEs/ADRs:

Contraindications:

Dx-Dx:

Monitor:

PG

Lactation:

Drug Class:

MOA:

Indications:

Common SEs/ADRs:

Contraindications:

Dx-Dx:

Monitor:

PG

Lactation: