Respiratory Pharmacology: Asthma and COPD Drugs, Inhalers, and Treatment Steps

What is the therapeutic class of Albuterol?

Short-Acting Beta2-Adrenergic Agonist SABA or Bronchodilator

What is the brand name for Albuterol?

Ventolin or ProAir

What is the MOA of Albuterol?

Stimulates Beta2 receptors to increase cAMP and relax bronchial smooth muscle

What are the ADME highlights for Albuterol?

Inhaled with rapid absorption and local distribution to lungs and minimal liver metabolism and urine excretion

What are common systemic adverse effects of Albuterol?

Tachycardia and tremors and angina

What is the primary use for Albuterol?

Acute asthma attacks and rescue therapy

What is the class of Salmeterol?

Long-Acting Beta2-Adrenergic Agonist LABA

What is the Black Box Warning for Salmeterol in asthma?

Increased risk of asthma-related death if used alone and must use with a steroid

What is the duration of action for Salmeterol?

Up to 12 hours

What is the therapeutic class of Beclomethasone?

Inhaled Glucocorticoid ICS or Anti-inflammatory

What is the MOA of Beclomethasone?

Suppresses airway inflammation and reduces mucus and decreases hyperresponsiveness

What is a key PK fact for Beclomethasone?

Local action in lungs with minimal systemic absorption

What nursing intervention is required after using an ICS?

Rinse mouth with water to prevent thrush

What is the class and brand name of Prednisone?

Systemic Oral Glucocorticoid known as Deltasone

What are long-term risks of systemic Prednisone?

Adrenal suppression and osteoporosis and hyperglycemia and peptic ulcers

Why must Prednisone be tapered?

To prevent adrenal crisis by allowing natural cortisol production to resume

What is the class and brand name of Montelukast?

Leukotriene Receptor Antagonist LTRA known as Singulair

What is the MOA of Montelukast?

Blocks leukotriene receptors to reduce inflammation and mucus

What is the major neuropsychiatric warning for Montelukast?

Risk of mood changes and aggression and suicidal thoughts

What is the class of Zafirlukast?

Leukotriene Receptor Antagonist LTRA

What is the ADME concern for Zafirlukast?

Liver metabolism via CYP450 leads to interactions with Warfarin and Theophylline

What is the class of Cromolyn?

Mast Cell Stabilizer

How does Cromolyn work MOA?

Stabilizes mast cell membranes to prevent release of histamine and leukotrienes

What is a unique ADME fact for Cromolyn?

Very low systemic absorption with only 8 percent absorbed by lungs

Is Cromolyn used for acute attacks?

No it is for chronic prevention and Exercise-Induced Bronchospasm

What is the class of Omalizumab Xolair?

Monoclonal Antibody or IgE Antagonist

What is the ADME for Omalizumab?

Subcutaneous injection with a long 26-day half-life

What is the life-threatening adverse effect of Omalizumab?

Anaphylaxis so monitor patient for 2 hours post-dose

What is the class of Roflumilast?

Selective PDE-4 Inhibitor

What is the primary use for Roflumilast?

Severe stable COPD associated with chronic bronchitis

What is the therapeutic range for Theophylline?

10 to 20 mcg per mL

What are the signs of Theophylline toxicity over 30 mcg per mL?

Severe dysrhythmias and convulsions or seizures

What lifestyle factors affect Theophylline levels?

Caffeine and tobacco and marijuana which change liver metabolism rate

What is the class of Ipratropium?

Short-Acting Muscarinic Antagonist SAMA or Anticholinergic

What is the MOA of the -tropium drugs?

Block muscarinic receptors to inhibit acetylcholine-mediated bronchoconstriction

What are the dry side effects of anticholinergics?

Dry mouth and blurred vision and urinary retention and constipation

Which drug class is first-line for COPD?

Anticholinergics like SAMA or LAMA

In the Stepwise approach what is the Quick Relief drug for all steps?

SABA or Albuterol

What is the proper sequence for using two inhalers?

Use Bronchodilator first to open airways then wait 5 mins then use Steroid

What does FEV1 measure?

How much air can be forced out in 1 second

What is the first step in the asthma stepwise approach for adults?

SABA as needed with no daily medication

What is the therapy for Step 6 asthma?

High-dose IGC plus LABA plus an oral glucocorticoid

What is the difference in SABA use between asthma and COPD?

In asthma it is used PRN while in COPD it can be used PRN or on a fixed schedule

Why should patients avoid caffeine while on Theophylline?

Caffeine is a methylxanthine that can intensify the effects on the heart and CNS and compete for metabolism

What is the most common adverse effect of Tiotropium?

Dry mouth

What is the benefit of the inhalation route for respiratory drugs?

Drugs are delivered directly to the site of action with rapid effects and minimal systemic toxicity

What is a MDI?

A Metered-Dose Inhaler that requires hand-breath coordination

Why is a spacer used with an MDI?

To increase the amount of drug that reaches the lungs rather than the oropharynx

What is the mechanism of Roflumilast?

It inhibits PDE-4 to reduce the release of pro-inflammatory mediators and decrease neutrophil activity

What are the primary therapeutic goals for COPD management?

Reduce symptoms and improve health status and increase exercise tolerance and reduce risks of exacerbations

How does Omalizumab work specifically?

It binds to circulating IgE to prevent it from attaching to mast cells and basophils

What is the age restriction for Omalizumab?

Patients 6 years or older with moderate to severe asthma

What is the clinical use for Prednisone in asthma?

To gain control of symptoms during an acute severe exacerbation

What is the risk of stopping Prednisone abruptly?

Adrenal insufficiency or crisis because the adrenal glands are suppressed

Does inhaled Beclomethasone impact final adult height?

It may slow growth in children initially but usually does not impact final adult height

What is the therapeutic use of Montelukast besides asthma?

Prevention of exercise-induced bronchospasm and relief of allergic rhinitis

Which leukotriene modifier can cause liver injury?

Zileuton and Zafirlukast though it is rare

What is the onset of action for Albuterol via inhalation?

Almost immediate with a peak at 30 to 60 minutes

What is the brand name for Tiotropium?

Spiriva HandiHaler

What is the brand name for Ipratropium?

Atrovent HFA

What is the main difference between SABA and LABA in terms of receptor stimulation?

Both stimulate Beta2 receptors but LABA has a much longer duration of action

What should a patient do if their Peak Flow falls into the Red Zone?

Use their rescue SABA immediately and seek emergency medical care

What is the FVC test?

Forced Vital Capacity which is the total amount of air forced out after a deep breath

What is the PEF test?

Peak Expiratory Flow which measures how fast you can blow air out

What is the clinical sign of Zafirlukast toxicity with Warfarin?

Increased bleeding or bruising due to higher Warfarin levels

Can Theophylline be given IV?

Yes but it must be infused slowly to avoid severe sudden toxicity

What are the three main benefits of Glucocorticoids in asthma?

Reduced swelling and reduced mucus and reduced airway hyperresponsiveness

Why is Tiotropium preferred over Ipratropium for maintenance?

It has a much longer half-life and can be dosed once daily

What is the indication for a combination ICS and LABA inhaler?

Long-term maintenance for patients not controlled on ICS alone

What is the brand name for Budesonide and Formoterol?

Symbicort

What is the brand name for Mometasone and Formoterol?

Dulera

What is the brand name for Fluticasone and Vilanterol?

Breo Ellipta

What is the preferred treatment for Step 2 asthma?

Low-dose inhaled glucocorticoid

What is the preferred treatment for Step 3 asthma?

Low-dose IGC plus LABA or medium-dose IGC

What is the preferred treatment for Step 4 asthma?

Medium-dose IGC plus LABA

What is the preferred treatment for Step 5 asthma?

High-dose IGC plus LABA

What is the goal of Step 1 asthma management?

Managing intermittent symptoms with SABA PRN only

What alternative can be used in Step 2 if steroids are not tolerated?

Cromolyn or a leukotriene modifier or theophylline

What alternative can be added in Step 3 if the preferred therapy is not enough?

Low-dose IGC plus either LTRA or theophylline or zileuton

When is a patient stepped down in therapy?

When asthma has been well controlled for at least 3 months

What is the therapeutic class of Penicillins?

Beta-lactam antibiotics

What is the specific class of Penicillin G?

Narrow-spectrum penicillinase-sensitive

What is the class of Nafcillin and Oxacillin?

Penicillinase-resistant penicillins

What is the class of Amoxicillin and Ampicillin?

Broad-spectrum penicillins or Aminopenicillins

What is the class of Piperacillin?

Extended-spectrum penicillin or Antipseudomonal

What is the MOA of all Penicillins?

Weaken the bacterial cell wall to cause cell lysis and death

What is the most common exam trap for Penicillins?

Allergic reactions and anaphylaxis

What is the timing for an Accelerated allergic reaction?

1 to 72 hours

What is the timing for an Immediate allergic reaction?

2 to 30 minutes

What is the timing for a Delayed allergic reaction?

Days to weeks

What is the primary exam trap for administering Penicillin and Aminoglycosides?

PCN inactivates aminoglycosides so they must never be mixed in the same IV solution

What is the nursing intervention for a patient with a history of mild PCN allergy?

Assess for cross-sensitivity with Cephalosporins but they may be used with caution

What is the nursing intervention for a patient with a severe PCN allergy?

Avoid all Penicillins and avoid Cephalosporins entirely

What is the exam trap regarding PCN and MRSA?

Penicillins do not work on MRSA because of altered Penicillin-Binding Proteins

What is the ADME trap for Ampicillin administration?

It has poor oral absorption and must be taken on an empty stomach

What is the ADME trap for Penicillin G?

It is destroyed by stomach acid and must be given IM or IV

What is the exam trap for high dose Penicillin G Potassium?

It can cause Hyperkalemia and cardiac dysrhythmias

What is the exam trap for Penicillin and Probenecid?

Probenecid competes for renal excretion making Penicillin levels stay higher for longer

What is the exam trap for Penicillin and oral contraceptives?

Penicillin may decrease the effectiveness of the pill

What are the three hallmark signs of anaphylaxis?

Laryngeal edema and bronchoconstriction and severe hypotension