Lecture 14 & 15: Respiratory Drugs

Fluticasone (Flovent)

MOA: Inhaled corticosteroid

Indication: Prevention of asthma

SE:

• Administered twice daily

• Oral candidiasis (thrush)

Prednisone (Deltasone)

MOA: oral corticosteroid

Indication: Long-term tx of COPD

SE: Weight gain, hyperglycemia

Fluticasone/Salmeterol (Advair)

MOA: inhaled corticosteroid/Beta-2 agonist combination medication

Indication: Asthma and COPD maintenance therapy

SE:

• Fluticasone:

  • administered twice daily

  • oral candidiasis (thrush)

• Salmeterol:

  • tachycardia, HTN, hyperglycemia

  • decreased systemic SEs by use of inhaled formulations

  • duration of action up to 24hrs

  • should only be used in combination w/ an ICS in asthma

Cromolyn Sodium (Intal)

MOA: Mast cell stabilizer

• Prevent degranulation and release of histamine, leukotrienes and other substances that cause airway inflammation

Indication: asthma, allergic rhinitis

SE: minimal SEs

Montelukast (Singular)

MOA: Leukotriene receptor antagonist

Indication: Prevention of asthma in people unable to take steroids

SE: May be safer (though less effective) as add-on therapy to corticosteroids for asthma tx

Roflumilast (Daliresp)

MOA: PDE4 inhibitor

Indication: reduce COPD exacerbations in patients with chronic bronchitis with history of exacerbations

SE: psychiatric SEs

Albuterol (ProAir/Ventolin)

MOA: Rapid acting Beta-2 agonist; direct relaxation of bronchial smooth muscle

Indication: Prevent or treat acute bronchospasm

SE:

• tachycardia, HTN, hyperglycemia

• decreased systemic SEs by use of inhaled formulations

• dosing every 4-6hrs in acute exacerbations (onset 5-30 minutes)

Salmeterol (Serevent)

MOA: Long-acting Beta-2 agonist; direct relaxation of bronchial smooth muscle

Indication: long-term treatment of asthma and emphysema

SE:

• tachycardia, HTN, hyperglycemia

• decreased systemic SEs by use of inhaled formulations

• duration of action up to 24 hrs

• should only be used in combination w/ an ICS in asthma

Ipratropium (Atrovent)

MOA: Muscarinic receptor antagonist

Indication:

• Combined form (Albuterol/Ipratropium or a “duoneb”) is used as treatment for COPD

• Combined therapy with Beta-2-agonist in moderate to severe asthma is more effective than each medication alone

SE:

• dry mouth (most common)

• “anti- cholinergic” SEs (constipation, tachycardia, urinary retention)

Tiotropium (Spiriva)

MOA: Muscarinic receptor antagonist

Indication: Long-term inhaled once daily treatment for patients with mild to severe COPD

SE: dry mouth

Umeclidinium (Incruse Ellipta)

MOA: Muscarinic receptor antagonist

Indication: Long-term treatment for patients with mild to severe COPD

SE: dry mouth

Omalizumab (Xolair)

MOA: IgE antagonist

Indication: Patients >12 years old with moderate to severe allergic asthma

SE: Can cause allergic reactions

Dextromethorphan (Delsym/Robitussin DM)

MOA: D-isomer of a potent opioid agonist

Indication: Antitussive drug

SE: Most widely used opioid antitussive drug

Guaifenesin (Mucinex)

MOA: Expectorant

Indication: relieve chest congestion and coughs by thinning and loosening mucus in the airways, making it easier to cough up phlegm

Trelegy Ellipta (Fluticasone furoate/Umeclidium/Vilanterol)

MOA: Combination of three medications:

• Fluticasone furoate: corticosteroid

• Umeclidinium: anticholinergic

• Vilanterol: LABA

Indication: Once daily medication for GOLD Stage E COPD

SE:

• Fluticasone furoate: Administered twice
  per day; oral candidiasis (thrush)

• Umeclidnium (Incruse Ellipta): dry mouth