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Short Acting Beta 2 (rol)
- Racemic epinephrine
- Prevention of exercised induced bronchospasm.
- An effect begins within 5 minutes. peaks in 30-60 mintues.
- Duration may last 2-8 hours.
- Exercised induced asthma may be inhaled 15 minutes prior to activity as prophylaxis against attack.
- Used for quick relief known as "reliever"
- Most effective drugs available for relief of acute bronchoconstriction and bronchospasm associated with asthma and COPD.
- Sympathetic system (stress, nausea due to decrease peristalsis
- Hyperglycemia, Hypokalemia.
- Beta blockers can decrease effectiveness
- Allow 5 minutes before taking other inhaled medications.
- Allow 1 minute between puffs.
- Given via nebulizer
- Used mostly with young children.
- Can result in peripheral vasoconstriction
- Drug of choice for acute symptoms
- Use albuterol before any other medications
Long Acting Beta 2 Agonists
- Used for chronic pulmonary disorders as maintenance treatment.
- Not indicated for acute symptoms or as a "rescue medication" May increase the risk of severe asthma and asthma related death.
- It can protect against bronchospasm over an extended time.
- Approximately 12 hours
- Onset of action 15-25 minutes.
- Should be taken on a fixed schedule and not PRN
- Combivent, Duoneb (Ipratropium and albuterol)
- Blocks parasympathetic nervous system.
- Onset of action is longer than albuterol
- Affects GI system more.
- Maintenance therapy of reversible airway obstruction due to COPD
- Preferred in patients taking beta blockers.
- Blurred vision
- GI irritation
- Bad taste
- Contraindicated in patients with glaucoma and bladder obstructions
- Contraindicated in peant and soy allergies.
Xanthines (Methylxananthines) (ine)
- Theophylline PO
- Aminophylline IV. Must be administered slowly. Rapid infusion can cause cardiovascular fatalities
- It's like a big shot of caffeine.
- Relaxation of smooth bronchial muscles.
- Reserved for long term management of persistent asthma that is unresponsive to beta agonists or inhaled corticosteroids.
- S/S of toxicity
- Respiratory arrest
- Contraindicated for patients with untreated seizure disorders or peptic ulcer disease. Use with caution in patients with heart disease, liver or kidney dysfunction or severe hypertension.
Mast Cell Stabilizers
- Chromolyn (Intal)
- Nedocromil (Tilade)
- Inhibit the release of histamine from mast cells. Acts as an anti inflammatory
- Maximum therapeutic benefit may take several weeks.
- Used as maintenance therapy
- Very safe and effective drug for prophylaxis of asthma
- Not useful in aborting an ongoing episode
- Not a bronchodilator
- May cause cough
- Bitter taste
- Inhaled with MDI or mebulizer
- Take on a regular schedule.
- More potent than mast cells
- Decreases inflammation and suppresses the immune system.
- Decreases edema of the airway mucosa
- Reduce bronchial hyper reactivity and decrease airway mucus production
- Brush teeth and gargle to prevent oral thrush
- Dosage must be tapered down
Used for prophylaxis
- Cushings Syndrome
- Growth retardation
- Dry mouth
- Monteluckast (Singulair)
- Zafirlukast (Accolade)
- Zileuton (Zyflo)
- Does not work right away
- Blocks the inflammatory process in the airways by antagonizing the effects of leukotrienes
- Has a mild anti inflammatory and bronchodilator effect
- Maintenance therapy for chronic asthma
- Used for long term control
- Elevated Liver enzyme
- May be toxic to the liver- use cautiously in patients with hepatic impairment and chronic alcoholism
- Antagonizes action of histamine
- Relieves allergy symptoms
- Does not relieve congestion
- Can reduce symptoms of mild allergic reactions
- Most effective when taken prophylactically and less helpful when taken after symptoms have appeared.
- Urinary retention, constipation
- Dry mouth
- Thickening of bronchial secretions
- Respiratory depression
- Paradoxical excitation
- Contraindicated with acute asthma episode, impaired GI motility, urinary tract obstruction, heart disease.
- May cause excitation of the CNS
- Do not operate heavy equipment
- Pseudoephedrine (sudafed)
- Phenylephrine (Afrin)
- Neosynephrine (Oxymetazoline)
- Ephedrine (Pretz-d)
- Relieve nasal congestion, only relieve stuffiness, they do not reduce rhinorrhea, sneezing or itching.
- Vasoconstriction: Tacycardia, HTN, cardiac arrythmias
- Chronic nasal sprays can cause rebound congestion
- Difficulty voiding
- Contraindicated: HTN, cardiac arrythmias, CAD
- These drugs are subject to abuse.
- Suppress cough reflex
- Used for dry, hacking, nonproductive cough
N/V, constipation, excessive suppression of cough reflex
- Instruct patients to avoid driving
- Opioid containing products can suppress respirations.
Liquefies respiratory secretions and allow for easier removal
Drowsiness, Headache GI upset
- Acetylcysteine (Mucomyst)
- Dornase Alfa (Pulmozyme) - used for thick bronchial secretions: Cystic Fibrosis.
- Reacts directly with mucus to make it more watery. This action makes the cough more productive
- Administered by nebulization
- Can trigger bronchospasm
- Sulfur odor
Treatment is always done with 2 or more drugs
- Isoniazid (INH)
- Streptomycin (secondary drug)
- PO/IM daily
- Hepatoxicity, hepititis. Give Vitamin B6 to prevent/decrease neuropathy
- Avoid tyramine foods
- PO/IV daily
- Rifamate (INH + rifampin)
- Orange discoloration of urine and other secretions.
- Contact discoloration
- Affects kidneys.
- Hepatoxicity, hyperuricemia arthralgia (joint pain), GI irritation
Monitor AST,ALT, uric acid
- PO twice weekly
- Affects the eyes
- Optic neuritis, impaired red green color discrimination.
- May lead to blindness
- IM twice weekly
- Secondary drug
- Affects the ears
- Ototoxicity, nephrotoxicity, hypokalemia