N720 Pulmonary Meds PDF

**N720 Pulmonary Medications- Week 6** **[1. Compare the advantages and disadvantages of the various types of devices used to deliver aerosol therapies for the administration of pulmonary medications.]** \-- Lauren H **Aerosol Therapies** **Advantages** **Disadvantages** --...

**N720 Pulmonary Medications- Week 6** **[1. Compare the advantages and disadvantages of the various types of devices used to deliver aerosol therapies for the administration of pulmonary medications.]** \-- Lauren H **Aerosol Therapies** **Advantages** **Disadvantages** ----------------------- -------------------------------- ---------------------------------------------------------------------------------------------------------- MDI More effective with the spacer It is harder with younger kids for coordination, deposited at back of through not getting to lung tissue Disk Nebulizer More effective with the spacer It is harder with younger kids for coordination, deposited at back of through not getting to lung tissue **[2. Compare and contrast pharmacotherapy necessary for the treatment of acute versus chronic asthma and COPD.]** \-- Kristen C Acute Asthma Chronic Asthma -------------- ---------------- SABA Acute COPD Chronic COPD ------------ -------------- SABA **[3. For each of the following drug classes, explain mechanism of action, primary actions (respiratory focus), dosing, important adverse effects and special considerations: Bronchodilators (Beta-Adrenergic Agonists \[Albuterol, Levalbuterol, Formoterol, and Salmeterol\], Anticholinergics \[Ipratropium and Tiotropium\]) , and Anti-inflammatory Drugs (Inhaled Corticosteroids \[Beclomethasone, Budesonide, and Fluticasone\]), Others (Leukotriene Modifiers \[Montelukast\], and Antihistamines \[Diphenhydramine, Brompheniramine, Cetirizine, Fexofenadine, and Azelastine\], Decongestants \[Phenylephrine, Pseudoephedrine, and Oxymetazoline\], and Cough Preparations \[Dextromethorphan and Guaifenesin\]]** \-\-\-\-\-\-\-\-\-\-- EVERYONE +-------------+-------------+-------------+-------------+-------------+ | **Name/Type | **MOA** | **Indicatio | **SE** | **Considera | | ** | | ns** | | tions** | +=============+=============+=============+=============+=============+ | Bronchodila | Stimulates/ | Reversible | | -metabolize | | tors | agonizes | bronchospas | | d | | | Beta 2 | m | | by liver, | | Beta 2 | adrenergic | | | excreted in | | Adrenergic | receptors | After age 2 | | urine | | | in the | not | | | | Agonists | lungs to | considered | | -lower | | | increase | RAD anymore | | doses in | | | cAMP(cyclic | | | elderly | | | AMP) | AKA | | | | | production | Bronchiolit | | -if | | | by | is | | prescribed | | | activating | | | with | | | adenyl | COPD and | | Digoxin- | | | cyclase, | asthma PRN | | monitor | | | the enzyme | | | EKGs d/t | | | that | | | increased | | | catalyzes | | | risk of | | | the | | | arrhythmias | | | conversion | | | | | | of ATP to | | | -Avoid | | | cAMP. | | | NSAIDS | | | Increased | | | | | | cAMP | | | -one minute | | | concentrati | | | between | | | ons | | | puff | | | relax | | | | | | bronchial | | | -Use before | | | smooth | | | controller, | | | muscle and | | | not a | | | inhibit the | | | controller | | | release of | | | | | | mediators | | | -All age | | | of | | | groups | | | immediate | | | | | | hypersensit | | | -Monitoring | | | ivity | | | includes: | | | from cells, | | | if they are | | | especially | | | being | | | mast cells. | | | controlled | | | | | | with it, | | | | | | peak flows | +-------------+-------------+-------------+-------------+-------------+ | Albuterol | Selective | Bronchospas | -Tremors | -less | | (SABA) | B2 with | m | | Cardia and | | | minor B1 | r/t - | -Heart | CNS SE as | | | | | Palps | other | | | | Asthma | | Beta-agonis | | | | | -Increased | ts | | | | COPD | HR | so FIRST | | | | | | LINE | | | | RAD | -Decrease | | | | | | in DBP | -Absorbed | | | | Bronchitis | | in Bronchi- | | | | | -anxiety | low | | | | | | systemic | | | | | -insomnia | concentrati | | | | | | on | | | | | -nausea | | | | | | | -MAOI's, | | | | | | TCAs | | | | | | potentiate | | | | | | | | | | | | \- Thyroid | | | | | | hormones | | | | | | enhance | | | | | | cardiac | | | | | | effects of | | | | | | both drugs | | | | | | | | | | | | --not to be | | | | | | used with | | | | | | BB | | | | | | | | | | | | -Contraindi | | | | | | cated | | | | | | in CAD | | | | | | | | | | | | -\>4 year | | | | | | old | +-------------+-------------+-------------+-------------+-------------+ | Levalbutero | Similar to | Same as | Same as | Same as | | l | albuterol | above | above | above | | (SABA) | where the | | | | | | s-isomer | | | 3-X the | | | from | | | cost of | | | racemic | | | Albuterol | | | albuterol | | | | | | is removed | | | | | | leaving the | | | | | | R-isomer, | | | | | | which has | | | | | | fewer | | | | | | adverse | | | | | | effects | | | | +-------------+-------------+-------------+-------------+-------------+ | Formoterol | 200 fold | -long-lasti | -anxiety | -half life | | (LABA) | great | ng | | 10-12 hours | | | agonist | bronchoprot | -tachycardi | | | Inhalation | activity at | ection | a | -use after | | powder | beta 2 | effects | | rescue | | | receptors | against | -tremors | inhaler | | 12 mcg | than at | Allergen, | | | | capsule | beta 1. | Exercise, | -insomnia | -the use of | | | | Histamine, | | LABAs is | | Black box | | and | | contraindic | | warning | | methacholin | | ated | | | | e | | without the | | | | induced | | use of an | | | | Bronchospas | | ICS SHOULD | | | | m | | NOT BE USED | | | | | | ALONE | | | | | | | | | | | | -Should | | | | | | only be | | | | | | used | | | | | | long-term | | | | | | in patients | | | | | | whose | | | | | | asthma | | | | | | cannot be | | | | | | adequately | | | | | | controlled | | | | | | on asthma | | | | | | controller | | | | | | meds | | | | | | | | | | | | \- Should | | | | | | only be | | | | | | used for | | | | | | the | | | | | | shortest | | | | | | amount of | | | | | | time | | | | | | necessary | | | | | | to achieve | | | | | | control of | | | | | | asthma | | | | | | symptoms | | | | | | then | | | | | | DISCONTINUE | | | | | | D | | | | | | | | | | | | -Pediatric | | | | | | pts should | | | | | | be | | | | | | prescribed | | | | | | a combo med | | | | | | to ensure | | | | | | compliance | | | | | | | | | | | | -DO NOT | | | | | | GIVE IN | | | | | | ACTIVELY | | | | | | DETERIORATI | | | | | | NG | | | | | | ASTHMA | | | | | | PATIENTS- | | | | | | can make | | | | | | worse | +-------------+-------------+-------------+-------------+-------------+ | Salmeterol | More | Same as | Same as | Same as | | (LABA) | selective | above | above | above | | | for Beta-2 | | | | | Diskus | receptors | | | | | inhaler | than | | | | | | Albuterol, | | | | | 50mcg | has minor | | | | | | Beta 1 | | | | +-------------+-------------+-------------+-------------+-------------+ | AntiCholine | Blocks | | Blurry | -avoid in | | rgics | muscarinic | | vision | pts with | | | cholinergic | | | urinary | | | receptors | | Urinary | retention, | | | by | | retent | | | | antagonizin | | | Bladder | | | g | | Dry mouth | neck | | | the action | | | obstruction | | | of ACh | | Constipatio | , | | | which | | n | and | | | decreases | | | | | | formation | | Anhidrosis | BPH | | | of cGMP | | | | | | which leads | | Tachycardia | | | | to | | | | | | decreased | | | | | | contractili | | | | | | ty | | | | | | of smooth | | | | | | muscle of | | | | | | the lungs | | | | | | d/t the | | | | | | actions of | | | | | | gCMP on | | | | | | intracellul | | | | | | ar | | | | | | Calcium | | | | +-------------+-------------+-------------+-------------+-------------+ | Ipratropium | Blocks | COPD | BUDCAT | -contraindi | | (SAMA) | muscarinic | | | cated | | | cholinergic | Asthma | | in pts with | | | receptors | Exacerbatio | | a | | | by | n | | hypersensit | | | antagonizin | if | | ivity | | | g | intolerant | | to atropine | | | the action | to Beta | | | | | of ACh | | | | | | | -Not for | | | | | | treatment | | | | | | of acute | | | | | | exacerbatio | | | | | | n | | | | | | except if | | | | | | Ipratropium | | | | | | in combined | | | | | | with | | | | | | Albuterol | | | | | | in acute | | | | | | setting | | | +-------------+-------------+-------------+-------------+-------------+ | Tiotropium | Inhibits M3 | Bronchospas | BUDCAT | -not for | | | receptors | m | | children | | (LAMA) | causing | in COPD | URI | | | | bronchodila | | | -contraindi | | | tion | | Pharyngitis | cated | | | | | | in pts with | | | | | | hypersensit | | | | | | ivity | | | | | | to | | | | | | Ipratropium | +-------------+-------------+-------------+-------------+-------------+ | Anti-Inflam | Most potent | | -Xerostomia | -Contraindi | | matory | and | | | cated | | | effective | | -Hoarsness | in acute | | Inhaled | anti-inflam | | | status | | Corticoster | matory | | -tongue and | asthmaticus | | oids | medication | | mouth | and acute | | | currently | | irritation | bronchospas | | (ICS) | available | | | m | | | | | -flushing | | | | Inhaled | | | -Avoid in | | | adrenocorti | | -dysgeusia | Cushings | | | costeroids | | | Syndrome | | | inhibit IgE | | -thrush | | | | and mast | | | \- | | | cell-mediat | | | | | | ed | | | | | | migration | | | | | | of | | | | | | inflammator | | | | | | y | | | | | | cells into | | | | | | the | | | | | | bronchial | | | | | | tissue. | | | | | | | | | | | | The exact | | | | | | MOA by | | | | | | which ICS | | | | | | inhibits | | | | | | bronchocons | | | | | | triction | | | | | | and | | | | | | produces | | | | | | smooth | | | | | | muscle | | | | | | relation is | | | | | | unknown | | | | +-------------+-------------+-------------+-------------+-------------+ | Beclomethas | | asthma | | -rinse | | one | | | | mouth after | | | | | | each use | | | | | | | | | | | | -use | | | | | | bronchodila | | | | | | tor | | | | | | first | +-------------+-------------+-------------+-------------+-------------+ | Budesonide | | Asthma | | -rinse | | | | | | mouth after | | | | | | each use | | | | | | | | | | | | -rapid | | | | | | onset | +-------------+-------------+-------------+-------------+-------------+ | Fluticasone | | Asthma | | \- | | | | | | | | 44mcg Low | | | | | | | | | | | | 110mcg med | | | | | +-------------+-------------+-------------+-------------+-------------+ | Leukotriens | | | | | | Inhibitors | | | | | +-------------+-------------+-------------+-------------+-------------+ | Montekulast | Selective | Prophylaxis | | -not used | | | leukotirene | and | | for primary | | | receptor | treamtent | | tx of acute | | | agonist | of chronic | | asthma | | | that | asthma | | attack | | | inhibits | | | | | | the | | | -Contraindi | | | cysteinyl | | | cated | | | leukotriene | | | in Pts with | | | receptor by | | | PKU | | | by binding | | | | | | to it. | | | -interact | | | | | | with | | | | | | Rifampin | | | | | | and | | | | | | Phenobarb. | +-------------+-------------+-------------+-------------+-------------+ | Antihistami | | | | | | nes | | | | | +-------------+-------------+-------------+-------------+-------------+ | Diphenhydra | H1 receptor | Upper | -Drowsiness | -contraindi | | mine | agonist, | Respiratory | | cated | | | compete | Allergies | -Excitabili | in | | 1st gen | with | | ty | narrow-angl | | | histamine | | in children | e | | | for h1 | | | glaucoma, | | | receptor | | -sedation | Lower resp. | | | sites on | | | Infections, | | | the | | -dizziness | stenosing | | | effector | | | peptic | | | cells. They | | -tinnitus | ulcer, | | | do not | | | symptomatic | | | prevent | | -Lassitude | BPH, | | | histamine | | | bladder | | | release or | | -disturbed | neck | | | bind with | | coordinatio | obstruction | | | histamine | | n | , | | | that has | | | pyloroduode | | | already | | -N/V | nal | | | been | | | obstruction | | | released | | -Irritabili | , | | | | | ty | and MAOI | | | First gen | | | use | | | antihistami | | -Blurry | | | | nes | | vision | -cannot use | | | are | | | in newborns | | | primarily | | -Tremors | and | | | metabolized | | | premature | | | by the | | -Appetite | infants | | | liver | | changes | | | | | | | -cannot | | | | | -Constipati | take while | | | | | on | breastfeedi | | | | | | ng | | | | | -Dry mouth | | | | | | | -Beers | | | | | -Dysuria | criteria | | | | | | med | | | | | -Urinary | | | | | | -retention | | +-------------+-------------+-------------+-------------+-------------+ | Bromphenira | First | Allergic | -CNS | Same as | | mine | generation | and | stimulation | above | | | bind | vasomotor | and | | | 1st gen | non-selecti | Rhinitis | depression | | | | vely | | | | | | to the | Pruritus | -Same as | | | | central H1 | | above | | | | receptors | conjunctivi | | | | | | tis | | | +-------------+-------------+-------------+-------------+-------------+ | Cetirizine | Second | Seasonal or | | -less CI | | | generation | perennial | | than first | | 2nd gen | antihistami | rhinitis | | gen | | | nes | | | | | | are | Chronic | | -cannot | | | selective | urticaria | | take during | | | for | and | | 3rd | | | peripheral | pruritus | | trimesters- | | | H1 | | | risk for | | | receptors | | | fetal sz's | | | and are | | | | | | therefore | | | | | | less | | | | | | sedating. | | | | | | They do not | | | | | | cross the | | | | | | BBB in | | | | | | appreciable | | | | | | amounts | | | | +-------------+-------------+-------------+-------------+-------------+ | Fexofenadin | | Allergic | | | | e | | Rhinitis | | | | | | | | | | 2nd gen | | | | | +-------------+-------------+-------------+-------------+-------------+ | Azelastine | Antihistami | Allergic | | | | | ne | Rhinitis | | | | 2nd gen | | | | | | | | Nasal | | | | inhaled/int | | antihistami | | | | anasal | | ne | | | +-------------+-------------+-------------+-------------+-------------+ | Decongestan | Activate | | -CNS Stim | -should not | | ts | Aplha 1 | | | use for | | | adrenegic | | -CV effects | more that 5 | | | recpetos on | | | days | | | nasal blood | | -CVA | | | | vessels to | | | -do not | | | reduce | | -Abuse | exceed | | | nasal | | | recommended | | | congestion | | -Transient | dose | | | | | stinging | | | | (do not | | | -Contraindi | | | reduce | | -Burning | cated | | | rhinorrhea, | | | in MAOI's, | | | sneezing or | | -sneezing | HTN, and | | | itching) | | | CAD | | | | | -dryness | | | | Produce | | | -Topical | | | vasocontric | | -local | safer than | | | tion | | irritation | oral | | | by | | | | | | stimulating | | -reboung | | | | alpha | | conngestion | | | | receptors | | | | | | within the | | | | | | respiratory | | | | | | tract | | | | | | mucosa | | | | +-------------+-------------+-------------+-------------+-------------+ | Phenylephri | Oral and | -Nasal | | | | ne | topical | congestion | | | | | | | | | | | | -Eustachian | | | | | | tube | | | | | | congestion | | | +-------------+-------------+-------------+-------------+-------------+ | Pseudoephed | oral | Systemic | Mild CNS | | | rine | | decongestan | stimulant | | | | | t | effects | | | | | | | | | | | Nasal | | | | | | decongestio | | | | | | n | | | +-------------+-------------+-------------+-------------+-------------+ | Oxymetazoli | topical | Nasal | | | | ne | | decogestion | | | | | | s | | | +-------------+-------------+-------------+-------------+-------------+ | Cough | | | | -do not use | | Preparation | | | | for chronic | | s | | | | cough | | | | | | caused by | | (Antitussiv | | | | smoking, | | es) | | | | asthma, or | | | | | | emphysema | | | | | | | | | | | | -do not use | | | | | | if | | | | | | excessive | | | | | | respiratory | | | | | | secretions | | | | | | | | | | | | -do not | | | | | | self | | | | | | medicate | | | | | | cough \>7 | | | | | | days | +-------------+-------------+-------------+-------------+-------------+ | Dextrometho | D-isomer of | Cough | Drowsiness | -caution in | | rphan | the codeine | suppressant | | hepatic | | | analogue | | Dizzy | impairmenta | | | Levorphanol | | | void | | | , | | Nausea | in use with | | | acts | | | MAOIs | | | centrally | | Gi upset | | | | in the | | | | | | cough | | | | | | center of | | | | | | the medulla | | | | | | to elevate | | | | | | the | | | | | | threshold | | | | | | for | | | | | | coughing | | | | +-------------+-------------+-------------+-------------+-------------+ | Guafienesin | Expectorant | Cough | GI upset | | | | that | expectorant | | | | | increases | due to | | | | | output of | common cold | | | | | the | and URI | | | | | respiratory | | | | | | tract by | | | | | | decreasing | | | | | | adhesivenes | | | | | | s | | | | | | and surface | | | | | | tension | | | | +-------------+-------------+-------------+-------------+-------------+ Intranasal steroid is first line for allergic rhinitis then add oral antihistamine if not effective SABA -stage 1 asthma and COPD At least twice a day using prn SABA before ICS for the first week while getting controlled then when maintained the SABA doesn\'t have to be used **[ON Target VERSUS OFF Target:]** ON-TARGET: The side effect acts on the same receptor as the desired effect of the drug OFF-TARGET: The side effect acts on a different receptor as the receptor used to achieve the desired effect of the drug **[4. Determine clinically relevant treatment guidelines, patient/family education and monitoring parameters for asthma and COPD.]** -princess **Goals of Asthma treatment \[GINA (Asthma Guidelines)\]:** 1. - - - 2. - - - -  \  Goals of treatment for Stable COPD 1. - - - 2. - - - GOLD COPD ARTICLE IMPORTANT DOCS Etiotypes of COPD  clincial indicators of diagnosis of COPD  Spirometry cCACCC CT Scan  Vaccinations for Stable COPD Bronchodilators Anti-inflammatory therapy GOLD - MANAGEMENT OF COPD - ICS/Bronchodilators  GOLD \-- Goals for Tmnt of Stable COPD GOLD \-- Inhalation Device Choice  Key Points for Use of Bronchodilators Key Points for Use of Anti-inflammatories  Key Points for Use of Other Pharm Tmnts       **[CPG Allergic Rhinitis ]** Definition: AR is an IgE-mediated inflammatory disease characterized by nasal congestion, rhinorrhea, sneezing, and/or nasal itching when a person inhales an allergen they\'re sensitive to. Classification: AR can be classified by: - - - Prevalence: AR is a common global health problem affecting both adults and children. In the US, it may affect 1 in 6 people. Economic Impact: - - Quality of Life: AR significantly impacts patients\' quality of life, cognitive function, work productivity, and school performance. Guideline Development: The document describes the process of developing clinical practice guidelines for AR, including literature searches, evidence classification, and the use of a multidisciplinary panel. Purpose: The guideline aims to address quality improvement opportunities for clinicians managing AR patients, optimize patient care, and reduce harmful or unnecessary variations in care. Scope: The guideline is applicable to both pediatric (over 2 years old) and adult patients with AR, but is not intended to be a comprehensive reference for diagnosing and managing AR.  ADULT \-- CDC Viral Infections/Common Colds Tmnt +-----------------------+-----------------------+-----------------------+ | Condition | Epidemiology/Diagnosi | Management/Treatment | | | s | | +=======================+=======================+=======================+ | Acute rhinosinusitis | \*90-98% of | - - - | | | rhinosinusitis cases | | | | are viral and | | | | antibiotics may not | | | | help even if | | | | causative agent is | | | | viral | | | | | | | | -Severe (3-4d), fever | | | | \>102 F, purulent | | | | nasal drainage or | | | | facial pain | | | | | | | | -Persistent (\>10d) | | | | wo improvement, nasal | | | | drainage or daytime | | | | cough | | | | | | | | -Worsening (3-4d) | | | | such as worsening or | | | | new onset fever, | | | | daytime cough, or | | | | nasal discharge after | | | | initial improvement | | | | of viral URI lasting | | | | 5-6d | | +-----------------------+-----------------------+-----------------------+ | Acute uncomplicated | -Cough is most common | Antibiotics not | | bronchitis | s/s and acute | recommended | | | bronchitis is most | regardless of cough | | | common dx for these | duration | | | pts | | | | | Recommend: | | | -Eval focus on ruling | | | | out pneumonia (PNA) | - - - | | | which is rare among | | | | healthy adults in | | | | absence of abnormal | | | | VS (HR\>100, RR\>24, | | | | T\>38 ) & abnormal | | | | lung findings | | | | | | | | -Colored sputum | | | | doesn't indicate | | | | bacterial infection; | | | | most cases | | | | radiography not | | | | indicated | | +-----------------------+-----------------------+-----------------------+ | Common cold or | \*Common cold is 3rd | - - - | | non-specific upper | most frequent dx; | | | respiratory tract | atleast 200 viruses | | | infection (URI) | cause common cold | | | | | | | | Prominent s/s: fever, | | | | cough, rhinorrhea | | | | (nasal drainage), | | | | nasal congestion, | | | | postnasal drip, sore | | | | throat, headache, | | | | myalgias | | +-----------------------+-----------------------+-----------------------+ | Pharyngitis \[Strep | -Group A | \*DO NOT recommend | | Throat\] | beta-hemolytic | antibiotics for pts | | | streptococcal (GAS) | w/ negative RADT | | | infection is the only | results | | | common indication for | | | | antibiotic therapy | - - - - - | | | for sore throat | | | | cases; GAS causes | | | | only 5-10% of adult | | | | sore throat cases | | +-----------------------+-----------------------+-----------------------+ PEDIATRIC \-- CDC Viral Infections/Common Cold Tmnt Pediatric PEDIATRIC +-----------------------+-----------------------+-----------------------+ | Condition | Epidemiology/Diagnosi | Management/Treatment | | | s | | +=======================+=======================+=======================+ | Acute rhinosinusitis | \*90-98% of | \*Watchful waiting up | | (acute sinusitis) | rhinosinusitis cases | to 3d for children w/ | | | are viral and | acute bacterial | | | antibiotics may not | sinusitis w/ | | | help even if | persistent s/s | | | causative agent is | | | | viral | \*Prescribe | | | | antibiotics for | | | -Severe (3-4d), fever | children w/ acute | | | \>102 F, purulent | bacterial sinusitis | | | nasal drainage or | w/ severe or | | | facial pain | worsening disease | | | | | | | -Persistent (\>10d) | \*Tmnt for children | | | wo improvement, nasal | w/ Hx of Type I | | | drainage or daytime | hypersensitivity to | | | cough | PCN vary | | | | | | | -Worsening (3-4d) | \*In children who | | | such as worsening or | vomiting/cannot tol | | | new onset fever, | PO: single dose | | | daytime cough, or | ceftriaxone can be | | | nasal discharge after | used then switch to | | | initial improvement | PO antibiotics if | | | of viral URI lasting | improving | | | 5-6d | | | | | Recommendation: | | | | | | | | - | +-----------------------+-----------------------+-----------------------+ | Acute Otitis Media | \*most common | -Mild case w/ | | (AOM) | childhood infection | unilateral s/s in | | | w/ antibiotics | children 6-23 mos or | | | prescribed | unilateral or bilat | | | | s/s in children \>2 | | | Definitive Dx | yrs watchful waiting | | | Requires: | based on shared | | | | decision-making | | | -Mod-Sev bulging of | | | | tympanic membrane | -Amoxicillin 1st line | | | (TM) or new onset | for children who | | | otorrhea not dt | didn't receive it | | | otitis external | within past 30d | | | | | | | -Mild building of TM | -Amoxicillin/clavulan | | | and recent (\