Adv Pharm 515

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Author:
mhaliday
ID:
177443
Filename:
Adv Pharm 515
Updated:
2012-10-13 21:01:45
Tags:
Respiratory Pharmacology
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Description:
Respiratory Disorders
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  1. Smoking Cessation meds (2)
    • 1. bupropion (Zyban)
    • 2. varenicline (Chantix)
  2. Zyban Rx concerns (1/3)
    • 1. Lowers seizure threshold
    • 2. Generally well tolerated
    • 3. can offset weight gain
  3. Chantix Rx concerns (2/3)
    • 1. "black box" -- worsened psych symptoms
    • 2. "black box" -- increased cardiac risk with CAD
    • 3.  Side effects: abnormal dreams, constipation, dry mouth, nausea
  4. Beta Agonists 
    Adverse effects (2 categories, 3 each)
    • 1. Cardiac: Tachy, angina, HTN
    • 2. CNS: Tremors, insomnia, headache
  5. Short Acting Beta Agonists (SABA) (2)
    • 1. albuterol (Proventil, Ventolin)
    • 2. Levoalbuterol (Xopenex)
  6. SABA Rx concerns (2)
    • 1. generally for PRN use (though Xopenex more likely to be scheduled
    • 2. use more than 2 days/wk = inadequate asthma control
  7. Long Acting Beta Agonists (LABA) (3)
    • Salmeterol (Serovent)/Formeterol (Foradil)
    • Arformeterol (Brovana)
    • Indacaterol (Arcapta Neohaler)
  8. LABA Rx concerns (3)
    • Generally for COPD 
    • "Black box" warnings for asthma, only use when other tx not working
    • Not a monotherapy; use with glucocorticoid then switch to short-acting
  9. Anticholinergics (2)
    • Ipratropium (Atrovent)
    • Tiotropium (Spiriva)

    (Also: Combivent -- alb/atrovent)
  10. Anticholinergics:  Rx concerns (3)
    • Decreases bronchial secretions
    • Adjunctive tx with SABAs (not 1st line tx)
    • SE: dry mouth and cough
  11. Corticosteroids, inhaled (5); oral (1)
    • Inhaled:
    • Beclomethasone (Beclovent, Vanceril) -- HFA, MDI
    • Budesonide (Pulmocort) -- DPI (dry powder inhaler), neb
    • Flu -- ticasone (Flovent) -- HFA, MDI, DPI
    • Ciclesonide (Alvesco) -- MDI
    • Oral: Prednisone
  12. Corticosteroids Combination Products (3)
    (Glucocorticoid and LABA):

    • Fluticasone/Salmeterol (Advair)
    • Budesonide/Formeterol (Symbicort)
    • Mometesone/Formeterol (Dulera)
  13. Corticosteroids Rx concerns (4)
    • Fixed schedule, not prn
    • Can be dose-adjusted for severity
    • SE (short term): thrush, hoarseness, cough
    • SE (Long term): adrenal suppression, OP, PUD, hyperglycemia, psych symptoms
  14. Phosphodiesterase 4 (PDE4) Inhibitor (1)

    (Action)
    Roflumilast (Daliresp)

    Reduces inflammation, NOT a bronchodilator or steroid
  15. PDE4 inhibitor Rx concerns:
    general use: (2)
    SE:
    Contra:
    • NOT a 1st line agent; best when not responding to other tx
    • Works in late copd
    • SE: Diarrhea, nausea, psych effects, insomnia
    • Drug-drug: (increase effects): cimetidine, emycin, fluconazole
    • Contra: hepatic impairment
  16. Leukotriene Modifiers (3)
    • Zafirlukast (Accolate)
    • Zileutin (Zyflo)
    • Montelukast (Singulair)
  17. Leukotriene Modifiers Rx concerns
    General use:
    SE: (3)
    Adverse rx: (1 major)
    • Decrease inflammation in asthma, COPD and allergies
    • SE: Headache, dizziness, GI upseet
    • Adverse rx: agitation, tremors, dreams, depression, suicidal ideation
  18. Prophylaxis Agent (2)
    • Cromolyn (Intal)
    • Nedocromil (Tilade)
  19. Prophylaxis Agents Rx concerns
    General use/not for:
    SE: (2)
    • Mast cell stabilizer
    • NOT for acute attack
    • SE: cough, unpleasant taste
  20. Methylxanthine (1)
    Theophylline
  21. Methylxanthine Rx concerns
    General use: (3)
    SE: (3)
    Toxicity: (4)
    • Bronchodilator, anti-inflammatory, decreases pulmonary edema
    • NOT a first-line drug (but making a comeback)
    • Narrow therapeutic range
    • SE: nervousness, tachycardia, GI upset
    • Toxicity: GI, CNS, dysrhythmias, coma
  22. Monoclonal Antibody (1)
    Omalizulab (Xolair)
  23. Monoclonal Antibody Rx concerns
    General use: (2)
    Black box: 
    SE: (3)
    • Adjunctive for uncontrolled persistant Asthma pts over 12
    • NOT 1st line
    • "Black box" -- anaphylaxis
    • SE: site reactions, HA, viral and upper resp infections
  24. Mild intermittent asthma
    Symptoms: (4)
    • S&S Less than 2x/week
    • Nighttime S&S less than 2/mo
    • Minimal affect on activity
  25. Mild intrmittent asthma TX (3)
    • No daily meds
    • PRN SABA
    • Steroids for exacerbations
  26. Mild Persistent Asthma S&S (3)
    • S&S more than 2/week, less than 1/day
    • Nighttime S&S more than 2/mo
    • Normal activity except exacerbation
  27. Mild Persistent Asthma TX 
    Preferred: (3)
    Alternatives: (2)
    • Preferred: Low-dose inhaled steroid
    • PRN SABA
    • May need LABA/steroid

    • Alternative: cromolyn OR
    • Leukotriene modifier
  28. Moderate Persistant Asthma S&S (4)
    • Requires SABA daily
    • Nighttime S&S more than 1/wk
    • Exacerbations over 2/wk, may last all day
    • Impacts activities
  29. Moderate Persistant Asthma TX 
    Preferred: (3)
    Alternative: (3)
    • Preferred: Low to med dose inhaled steroids
    • LABAs
    • PRN SABAs
    • Alternatives: Increase inhaled steroid dose
    • Leukotriene modifier
    • Consider Theophylline
  30. Severe Persistent Asthma S&S (3)
    • Continual S&S and frequent exacerbations
    • Nighttime S&S frequent
    • Limited physical activity
  31. Severe Persistent Asthma Tx (5)
    • High dose inhaled steroids
    • LABA 
    • Systemic steroids (with attempts to decrease & D/C dose)
    • PRN SABA
    • Consider Theophylline

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