RT205 - PreFinals: Drug Types 4 Revised (ASTHMA)

Bronchodilators

An agent that relaxes smooth-muscle cells of the bronchioles. As a result, airway diameter increases, improving the movement of gases into and out of the lungs.

Albuterol Inhalers

Referred to as rescue inhalers, the bronchodilator of choice and are used most often for acute attacks.

Epinephrine sub-q (Epi-Pen)

It is used if an attack is life threatening, a self-administered injection usually in the thigh.

Formoterol (Foradil)

A long-acting bronchodilator approved for long-term maintenance of asthma, for preventing bronchospasms and exercise-induced asthma. A selective beta agonist that acts locally in the lungs to relax smooth muscle and inhibit release of mast cells.

Albuterol (Proventil/Ventolin/ProAir HFA)

Bronchodilator used in cases of airway obstruction, such as asthma or COPD. Relaxes bronchial smooth muscle by acting on pulmonary beta receptors with little effect on heart rate. Administered by inhalation or orally.

Ipratropium (Atrovent)

Blocks the action of acetylcholine in bronchial smooth muscle. Derived from atropine and is used for prevention, not for acute management. A short-acting agent and is not absorbed into general circulation when inhaled, so it doesn’t cause arrhythmias. Soy lecithin is used as a suspending agent, dangerous for peanut allergies.

Isoproterenol (Isuprel)

Indicated for treating reversible airway obstruction, as in asthma or COPD. Stimulates beta receptors, resulting in relaxation of bronchial, GI, and uterine smooth muscle, increased heart rate and contractility, and vasodilation of peripheral vasculature. 5x/day no more than 2x/per time and 1-5mins between, 6 inhalations max per hour.

Metaproterenol (Alupent)

Bronchodilator for airway obstruction, has a rapid onset of action within minutes, peak effect in 1 hour, and prolonged effect for 4 hours. Acts primarily on beta receptors with little or no effect on heart rate.

Mometasone-formoterol (Dulera)

A combination long-acting beta agonist for maintenance treatment of asthma. Mometasone is the same corticosteroid used in Nasonex, a drug for seasonal allergies.

Salmeterol (Serevent)

Indicated for maintenance therapy of asthma. A beta agonist with long duration of action and onset of 30-60mins. Taken 2x/day. Reserved for patients with more serious asthma or those already receiving anti-inflammatory therapy, useful for nocturnal symptoms of asthma.

Pirbuterol (Maxair)

A short-acting bronchodilator used to prevent and treat reversible bronchospasm, especially asthma. A selective beta agonist, duration of action is 4-6hrs. Patient should not exceed the recommended dose of 12 inhalations per day. 2mins between inhalations and 5mins before using inhaled steroids.

Theophylline

A phosphodiesterase inhibitor that reverses early bronchospasm associated with antigens or irritants. Improves the contractility of the fatigued diaphragm. Can be used as a bronchodilator in reversible airway obstruction. Used only in lung disease unresponsive to other drugs and neonatal apnea and bradycardia.

Terbutaline (Brethine)

A long-acting bronchodilator for reversible airway obstruction and bronchial asthma. Can be used parenterally for status asthmaticus. Excessive use may lead to paradoxical bronchoconstriction. If this occurs, patient should discontinue medication immediately. It is a beta agonist.

Leukotriene Receptor Antagonists and Leukotriene Synthesis Inhibitors

Type of Antileukotriene Agents

Leukotriene Inhibitors

Metabolized from arachidonic acid, which also forms prostaglandins, and they increase mucus, fluid accumulation, and vascular permeability, making them 100-1000 times more potent that histamine. Inhibitors block their synthesis or the body’s inflammatory response.

Montelukast (Singulair)

A leukotriene receptor antagonist. This drug is indicated for the prophylaxis and chronic treatment of asthma. Shown to reduce incidence of daytime and nocturnal awakenings due to attacks. Can also decrease the need for beta-adrenergic agonists. Approved for use in children over the age of 12 months, 1dose/day opposed to other leukotriene inhibitors.

Zafirlukast (Accolate)

Antagonizes leukotriene receptors, thus reducing edema, mucus, and vascular permeability. Intended for prophylaxis and long-term treatment in patients 5 years or older. Side effects are headache, rhinitis, and cough.

Zileuton (Zyflo)

A leukotriene inhibitor that reduces the production of leukotrienes rather than blocking their receptors. Carries strong warnings about liver toxicity. Can also double theophylline levels if patient is taking that drug. Approved only for patients 12 years of age or older.

Corticosteroids

Resemble certain chemical naturally produced by adrenal glands, stimulate adenylate cyclase to suppress immune response. It can stunt a child’s growth.

Side Effects (Inhaler)

Oral candidiasis, irritation, and burning sensation of the mucosa and dry mouth

Side Effects (Oral)

Growth of facial hair in females, breast development in males buffalo hump, moon face, edema, weight gain, easily bruising.