Term
BRONCHODILATORS
EFFECTS OF BETA AGONISTS |
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Definition
-Beta 2 stimulation
-bronchodilation
-Inhibition of histamine release
-Chronotropic Efects
-Vasodilation
-Increased neuromuscular transmission
-Uterine relaxation
-Hypokalemia |
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Term
Effects of Beta Agonists
Brhochodilation |
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Definition
-Beta Stimulation
-Increased adenyl cyclose
-Increased cAMP
-Smooth muscle relaxation, mast cell stabilization |
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Term
Effects of Beta Agonists
Cardiac Stimulation |
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Definition
-Beta-1 receptors found on the heart
-Beta-2 selective agents decrease cardiac efect
-Aerosol delivery
-Dose related |
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Term
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Definition
Aerosol
-Bronchoselective
-Rapid Response
-Protection against bronchospasm
-Higher doses
-Simple administration
-Short duration of activity |
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Term
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Definition
-Response
--intensity
--Duration
---Decreased with increased bronchconstricion
-Down regulation of receptors |
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Term
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Definition
INDCATIONS
-Bronchospasm
-Acute Asthma
-Chronic Lung Disease |
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Term
| Non-selective Beta Agonists |
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Definition
-Isoproterenol (isuprel)
-Metaproterenol (alupent)
-Isoetharine (bronkosol)
-Epinephrine |
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Term
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Definition
-Albuterol (ventolin, proventil)
-Bitolterol (tornalate)
-Pirbuterol (maxair)
-Terbutaline (brethine, brincanyl)
-Salmeterol (serevent) |
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Term
| ALBUTEROL (Ventolin, Proventil) |
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Definition
-Available as PO, MDI, aerosol
-very potent
-Bronchodilation
--begins in 5-15 minutes
--lasts 4-8 hours
-Oral dosing not recommended for acute attacks |
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Term
Albuterol (Ventolin, Proventil)
DOSING |
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Definition
AEROSOL 0.5% (5mg/ml): MAINTENANCE DOSE: 2.5-5mg; q4-8hrs ACUTE DOSE: 5-10mg; 5mg q20min x3 then q2-4hrs prn
MDI (0.09mg/puff) MAINENANCE DOSE: 2-3 puffs q 4-6hrs ACUTE DOSE: 3-4 puffs q20min x3 then q 1-2h prn |
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Term
| Terbutaline (Brethine, Bricanyl) |
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Definition
-Available as injection, PO, MDI
-Less potent than Albuterol
-Brohchodiltion
--ONSET: 5-30minutes by inhalation
--DURATION: 4-8hrs
-Oral dosing not recommended for acute attacks |
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Term
| Terbutaline (Brethine, Bricanyl) |
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Definition
INJECTABLE (1mg/ml): MAINTENANCE: NR ACUTE: 0.25-5mg q20min x3 then q2-6hrs prn
MDI (0.25mg/puff): MAINTENANCE: 2puffs q6h ACUTE: 3 puffs q20min x3, then q1h |
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Term
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Definition
Available as PO, MDI, aerosol
-Least potent
-Bronchodilation
--ONSET: 1 minute by inhalation
--DURATION: 3-4hrs
-Oral Dosing not recommended for acute attacks
-non-selective |
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Term
Metaproterenol (Alupent)
DOSING |
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Definition
AEROSOL 5%(15mg/2.5ml ud) MAINTENANCE: 15mg q4-6h ACUTE: 15mg q 1-2h
MDI (0.65mg/puff)MAINTENANCE: 2pufs q4h ACUTE: 2-4puffs q 1-2h |
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Term
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Definition
PHARMOCOLOGY
-Decreases degradation of cAMP
-Blocks the release of intracellular Calcium
-Result is bronchodilation |
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Term
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Definition
-Enhances mucociliary clearance
-Strengthens diaphragmatic contraction
-cerebral vasoconstriction
-Respiratory stimulant
-Lowers esophageal sphincter pressure
-Increases gastric acid secretion
-Inotropic and chronotropic cardiac effects |
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Term
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Definition
-Available in different salts
-Aminophylline 80% theophylline
-Intravenous form
-Narow therapeutic index
-Therapeutic range: 10-20mcg/ml
-Bronchodilation may occur at 5 mcg/ml
-Not effective in acute attacks |
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Term
Theophylline
ADVERSE EFFECTS |
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Definition
ADVERSE EFFECTS Serum Level(mcg/ml)
18% 15-20
60% 20-30
80% >30 |
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Term
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Definition
-Cytochrome p-450 microenzymes
-drug interactions
--secondary to enzyme induction and inhibition
-Saturable metabolism
--non linear pharmokinetics |
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Term
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Definition
-Acute Asthma
--no benefit over beta agonists
--contributes to toxicity
-Chronic Asthma
--reduces steroid and beta agonist requirements
-Chronic lung disease |
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Term
| Adverse Effects of Theophilline |
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Definition
-GI: n/v, anorexia, abdominal pain
-CNS: Headache, irritability, tremor, insomnia, seizures
-CARDIAC: arrhythmias, tachycardia |
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Term
| Drug interation of Theophylline |
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Definition
INCREASED LEVEL: Cimetidine(tagamet), Erythromycin, Quinolones, Propanolo (inderal), Fever, CHF, Liver Disease
DECREASED LEVEL: Rifampin (rimactine, Rifadin), Carbamazepine (tegretol), Phenytoin (dilantin), Phenobarbital, smoking, charcoal broiled meat, pediatrics |
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Term
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Definition
LOADING DOSE: 5mg/kg over 30minutes
-If no theophylline, get level
-1mg/kg for each increase of 2mcg/ml
-no faster than 20mg/min |
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Term
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Definition
Children 1-9yrs: 1mg/kg/hr
Healthy Smoking Adults: 0.8 mg/kg/hr
Non-smoking adults: 0.5 mg/kg/hr
CHF, liver disease: 0.25 mg/kg/hr |
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Term
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Definition
IV to oral conversion
-total daily IV dose
-Give in divided doses
-Aminophylline= 80% theophylline |
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Term
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Definition
-Produce bronchodilation in cholinergis mediated bronchoconstriction
-Compared to beta agonists
--less potent
--assitive benefits
--slower onset
--longer duration |
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Term
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Definition
ATROPINE 0.5%: MAINTANENCE DOSE: 5-10mg q6-8h ACUTE DOSE: 2.5-5mg q4-6h
ATROVENT(aerosol 0.025%) Maintenance Dose: 0.25-0.5mg q6h ACUTE DOSE: 0.5mg q 4-6h
MDI (18mcg/puff): MAINTENANCE: 2-3 puffs ACUTE: 4-6 puffs q4h |
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Term
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Definition
-Mainstay of therapy
-in acute setting |
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Term
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Definition
Pharmacology-*Valuable in acute cases
-relaxes smooth muscle
-Dilates airways
-Inhibits calcium uptake by cells and releases from sarcoplasmic reticulim
-only dangerous for people with ESRD |
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Term
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Definition
-smal numbers of trails
-used after failure of beta agonist
-dose: 1.2grams in 50ml over 20minutes |
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Term
| NOT EVERYTHING THAT WHEEZES IS ASTHMA |
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Definition
-CHF
-FBO
-UAO
-GERD
-Other things obstruct (CA, sarcoid)
-pulmonary embolism |
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