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2-Adrenergic Agonists
Selectively activate 2 receptors resulting in bronchodilation: bronchospasm is relieved, histamine release is inhibited, and ciliary motility is
Therapeutic Uses: Adverse Effects:
Albuterol: Inhaled, short-acting and oral, long-acting Terbutaline: Oral, L-A Inhaled: Minimal adverse effects (C) CI: tachydysrhythmias
-blockers like propanolol negate effects of both TCAs and MAOIs risk of tachycardia and angina
Education:
Inhale 3-5 sec, hold 10 sec, wait 60 sec for next dose
Methylxanthines
Expected Action:
Long-term control of asthma Mild toxicityGI distress & restlessness. Severe reactions
Severe reactions can occur at therapeutic levels and include dysrhythmias and seizures. Effects unlikely @ <20 mcg/mL. Activated charcoal absorption, lidocaine for dysrhythmias and diazepam for seizures.
Contraindications/Precautions: Interactions:
(C)
Inhaled Anticholinergics
Expected Action:
Contraindications/Precautions:
Glucocorticoids
Proto: beclomethasone (QVAR) Others: budesonide (Pulmicort), fluticasone (Flovent), triamcinolone (Azmacort), prednisone (Deltasone) Prevent inflammation, suppress airway mucous production, and promote responsiveness of 2-receptors in bronchial tree. Therapeutic Uses: Inhaled: Long-term asthma prophylaxis S-T, oral: Treat symptoms following acute asthma. L-T, oral: Treat chronic asthma 1 adrenocortical insufficiency Promote lung maturity and RDS in fetuses at risk for preterm birth. Adverse Effects: Inhaled: Dysphasia, candidiasis, bone loss Oral (10d): adrenal gland function / bone loss / hyperglycemia / glucosuria / / infection / peptic ulcer disease / myopathy / fluid & electrolyte disturbances. (?) CI: Live virus / systemic fungal infect. Contraindications/Precautions: Interactions: Diuretics: hypokalemia NSAIDs: GI ulceration Glucocorticoids counteract effects of insulin and oral hypoglycemics. Education: Oral are for short-term use, 3-10 days following acute attack Expected Action:
Expected Action:
Anti-inflammatory: Stabilize mast cells, inhibiting histamine release. Suppress inflammatory cells (e.g. eosinophils, macrophages)
Therapeutic Uses:
Prophylaxis of exercise-induced and allergen-induced asthma attacks Allergic rhinitis by intranasal route
Adverse Effects:
Contraindications/Precautions:
Leukotriene Modifiers
zafirlukast (Accolate)
Prevent effects of leukotrienes thus suppressing inflammation, airway edema, bronchoconstriction, and mucus production.
Therapeutic Uses: Adverse Effects:
Long-term asthma therapy in folks 12 YO Liver injury zileuton and zafirlukast. (nausea, anorexia, abdominal pain) (?)
Contraindications/Precautions: Interactions:
Zileuton / zafirlukast inhibit warfarin metabolism [warfarin] Zileuton / zafirlukast inhibit theophylline metabolism theophylline toxicity
Education:
Antitussive Opioids
Expected Action:
CNS sedation effects: Respiratory depression (<12/min) naloxone Potential for abuse, schedule II.
Contraindications/Precautions:
(C)
Mucolytics
Expected Action:
Acute & chronic pulmonary disease secretions Acetylcysteine is the antidote for acetaminophen poisoning Aspiration and bronchospasm (B) CI: GI bleeding
Cystic fibrosis
Adverse Effects:
Contraindications/Precautions:
IV: Loading dose, next dose over 4h, last dose over 16h.
Decongestants
Expected Action:
Allergic rhinitis, sinusitis, and common cold Rebound congestion (Max 3-5 days, taper down use) Vasoconstriction CI: Chronic rhinitis
(?)