Asthma and COPD Medications

Beta 2 Adrenergic Agonists

• Cause bronchodilation and depress histamine levels by activating beta 2 receptors in the lungs
• Used to evaluate asthma
• Common adverse effects include tachycardia, tremors and angina
• Should be used cautiously in patients with DM, it can interact with oral hypoglycemics
• Interact with beta-adrenergic blockers, MAOIs, and TCAs

Common Beta 2 drugs

• Albuterol SA = inhaled
• Albuterol LA = oral
• Formoterol = inhaled
• Levalbuterol SA = inhaled
• Levalbuterol LA = oral
• Salmeterol = inhaled
• Terbutaline: Oral tablet , LA = oral

Implications

• Albuterol is given FIRST for acute asthma attacks
• If a patient uses Albuterol more than twice per week, a long-acting method is needed

Inhaled Anticholinergics

• Ipratropium (atrovent) and Tiotropium (spiriva).
• Useful for COPD induced bronchospasm
• Block muscarinic receptors = bronchodilation
• Reduce COPD secretions
• Common adverse effects include bitter taste in throat and throat irritation
• Rinse mouth after use

Inhaled Anticholinergics Contraindications

• Allergy to peanut and soy
• Anticholinergic effects
• Use cautiously with urinary retention and benign prostatic hyperplasia

Methylxanthines

• Theophylline used as daily asthma control and as a last resort for COPD
• Should not be doubled if a dose is missed
• Causes bronchodilation by relaxing bronchial muscles
• Common adverse effects include dysrhythmias, restlessness, insomnia, N/V/D, and seizures
• Use cautiously with heart disease, HTN, liver and kidney disease, and DM
• Intensified by caffeine and nicotine

Glucocorticoids

• Beclomethasone (QVAR), Prednisone, Fluticasone (Flonase), Budesonide, Hydrocortisone, and Methylprednisolone
• Work slowly and should not be given first
• Prevent and decrease inflammation and promote beta 2 receptors response

Route(s):

• Beclomethasone (QVAR) = inhaled
• Prednisone = oral
• Fluticasone (Flonase) and budesonide = intranasally
• Hydrocortisone and methylprednisolone = IV

Key Facts

• Acute use for 5-10 days requires alternating the dose to protect adrenal glands
• Inhaled drugs can cause hoarseness and oral candidiasis (thrush), so rinse mouth after use

Glucocorticoids: Oral

• Can cause pharyngitis, suppression of adrenal gland function, bone loss, infection, hyperglycemia, electrolyte imbalance, and weight gain
• Contraindicated with live virus vaccines or systemic fungal infections and used cautiously with DM
• Prednisone interacts with K+ depleting diuretics, NSAIDs, and hypoglycemia agents

Leukotriene Modifiers

• Montelukast and Zafirlukast are prescribed for maintenance and NOT a super strong medication
• -lukast ending
• Administered PO daily in the evening or 2 hours before exercise
• Actions include reducing inflammation, bronchoconstriction, airway edema, and mucus production
• Adverse effects include suicidal ideation and liver injury, monitor liver labs
• Interact with phenytoin, warfarin, and theophylline

First Generation Antihistamines

• For mild allergies (not helping w/ congestion) and motion sickness
• "Sedating antihistamine"

Common First Gen Antihistamines drugs

• Diphenhydramine (Benadryl)
• Promethazine

Facts

• Blocks histamine release and mild cholinergic blockers
• Common adverse effects: Sedation, dizziness, anticholinergic effects, GI discomfort
• Children under 2 and newborns should not take
• Contraindicated with acute exacerbation asthma and during breastfeeding

Interactions

• Alcohol
• CNS depressants

Decongestants

• “Sympathomimetic” and -phrine ending
• Treats nasal congestion, relieves respiratory tract mucosa constriction
• Short term duration medicine

Common Drugs

• Phenylephrine
• Ephedrine
• Pseudoephedrine

Key Points

• Nasal drops adverse effects if use for 10 days become nasal congestion
• Topical agents are more effective and work faster
• Oral medications have a higher risk of CNS stimulation, and should not be used >3-5 days cause rebound congestion

Contraindications

• CAD
• HTN
• Cerebrovascular disease
• Dysrhythmias
• Interacts with caffeine

Antitussives

• Opioids should not be used if have cough or respiratory disorder
• Used to suppress cough
• common meds Codeine and Hydrocodone

Codeine

• schedule II when alone
• schedule V when mixed with another antitussive
• Common adverse effects include CNS depression, dizziness, lightheaded, N/V/D and opioid use disorder
• Do not use for respiratory depression, acute asthma or with a Hx of substance abuse

Non-opioids

• Dextromethorphan, Benzonatate and Diphenhydramine
• Monitor for sedation
• Suppresses cough
• Adverse effects: Mild dizziness and Nausea
• Dex causes Sedation (potential for abuse)
• Diphenhydramine leads to: Dry mouth, drowsiness, urinary hesitancy

Expectorants

• Guaifenesin thins secretions within body, making cough more productive
• Reduce surface tension of secretions (makes thinner)
• Adverse effects can cause: Dizziness, Drowsiness, HA, N/D and a possible Rash
• Encourage Report cough if lasting >1wk
• Encourage Increase fluid intake

ACE Inhibitors

• Block production of angiotensin 2
• RAAS suppressants and are -prils ending
• Captopril, Enalapril, Fosinopril and Lisinopril
• Oral administration ONLY

Adverse effects:

• First dose orthostatic hypotension, Dry non-productive cough, Tachycardia and Hyperkalemia
• Angioedema Cough Elevated K+

Contraindications:

• Electrolyte imbalances (K+), Pregnancy
• Decreased renal function
• Bone marrow depression

Interactions:

• K+ supplements and sparing diuretics
• Caution: if Autoimmune disorder
• Other antihypertensive
• Avoid: NSAIDs and Lithium
• Evalute for Elevated K+

Cardiac Glycoside

• Digoxin will increase heart contraction and decreases vasoconstriction and Slows HR
• Route of adminitarion: Oral or IV
• Adverse effects: Cardiac dysrhythmias, Fatigue, Visual changes, Digoxin toxicity, Hypokalemia
• Contraindications: with Other antidysrhythmics, Corticosteroids, Diuretics and Metoclopramide
• Interactions: Avoid antacids
• Eat high K+ diet
• HOLD if HR <60

Loop Diuretics

• Prototype medicine Furosemide (lasix)
• Action: Block reabsorption of sodium and chloride and Prevent water reabsorption
• Adverse effects: Dehydration, Electrolyte imbalance (hypokalemia), Hypotension and Ototoxicity
• Contraindications: will cause Hyperglycemia, Use caution w/ renal or hepatic disorders and DM
• Only give w/ normal K+ levels: 3.5-5.0 and Give w/ K+ rich foods: Bananas, Potatoes, Dried fruits and Citrus fruits

Beta Blockers

• olol ending
• Take it same time each day
• Prototype meds: Atenolol and Metoprolol
• Action: Blocks beta1 = decreases HR and contractility and Decrease release of renin
• Contraindications: Found in ATI
• Caution if: Peripheral vascular disease or Raynaud's disease
• Caution for asthma, COPD, or respiratory disorder pts and Renal or liver disorder, MG, HTN, DM, depression
• Interactions: digoxin

Antipliemcs

• inhibits LDL and enzymes
• HMG Coa reductase inhibitors (-statins)
• Prototype drugs: Atorvastatin, Simvastatin, Lovastatin and Rosuvastatin
• Action: Inhibits HMG-CoA - an enzyme synthesizing cholesterol in liver
• Route if adminterstion: Oral take in evening because because cholesterol is synthesizable while sleeping
• Adverse effects: Hepatotoxicity, routine lab work needed: ALT, AST, CK, HDL, LDL, Myopathy and muscle pain, and GI disturbances
• Contraindications: with liver disease and Alcoholism
• Interactions: others meds used to to control high cholesteral; grapefruit juice
• Avoid warfarin
• teratogenic

Calcium Channel Blockers

• Blocks Calcium (nife)

Nitrate facts

• For angina
• Nitroglycerin dialate
• NO more than 3 and adminitered under the tongue
• Causes HypOtension and dizziness
• Avoid alcohol and viagra
• Short duration

Hemtologic meds and uses

• Check liver functuin first
• Iron Defincency - give Vit B12 for pernisous anemia
• Give on empty stomach - causes issues if pt has kidney problem
• Check to detirmeine what is in the blood or what is going on in the blood