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PULMONARY MEDICATION - Coggle Diagram
PULMONARY MEDICATION
ASTHMA
defintion
chronic inflammatory of airways
bronchial hyperactivity
inflammation
reversible airflow obstruction
SX
wheeze
high pitch sound
upon exhalation
cough at night
sob / difficulty breathing
intermittent sx
reversible
drugs
BROCHODILATOR
MUSCARINIC ANTAGONIST
examples
ipratropium
tiotropium
aclidinium
umeclidiunium
glycopyrrolate
MOA
blockade of muscarinic receptors on bronchial smooth muscle = bronchoconstriction
blockade of muscarinic receptors on secretory glands = decrease secretion
PK
short acting:
ipratropium
t 1/2 = 2h
use in combo with albuterol
combivent
duoneb
may use as alternative for pt not tolerate SABA
long acting:
t 1/2 - 25h
tiotropium
AE
limited absorption = minimal antimuscarinic effects
dry
hot
red
confused
blind
urinary retention
constipation
tachycardia
methylxanthines
THEOPHYLLINE
MOA
inhibits PDE in bronchial SM
increase cAMP
increase bronchial SM relaxation
block adenosine receptors
decrease bronchoconstriction
AE
N/V
CNS
HA
nervousness
insomnia
cardiac
tachycardia
arrhythmia SVT
monitor
plasma levels
narrow therapeutic index
many DDI
BETA-2 AGONIST
examples
salmeterol
formoterol
indacaterol
olodaterol
albuterol
MOA
stimulate beta-2 receptors
bronchial SM dilation
selective
PK
short acting:
t 1/2 3-4 h
albuterol
long acting:
t 1/2 12h
must be used in combination with inhaled ICS
salmeterol + fluticasone (advair)
salmeterol
AE
tachycardia (not 100% selective)
arrhythmias over dose
tremor (SKM beta 2 stimulation)
hypokalemia (Na/K ATPase stimulation)
ANTI-INFLAMMATORY
CROMOLYNS
MOA
mast cell stabilizer
decrease release of mediators from mast cells
AE minimal
GLUCOCORTICOIDS
fluticasone
MOA
activate glucocorticoid receptor
effect on gene transcription
decrease transcri of inflammatory
cytokines
chemokines
increase trans of annexins
inhibit PLA2
decrease synthesis of eicosanoids
AE
oropharyngeal candidiasis
throat iritation
systemic effect / high dose
cushing syndrome
moon face
increase glucose = diabetes
thin skin
fat deposition
bruise
increase susceptibility to get infection
Na / fluid retention
osteoporosis
LEUKOTRIENES MODIFIERS
CysLT1 antagonist
ex
zafirlukast
montelukast
MOA
block leukotriene recetpor
AE
neuropsychiatric rare
LOX INHIBITORS
zileuton
MOA
inhibit 5-lipoxygenase LOX
AE
hepatotoxicity
monitor LFT q3 months
neuropsychiatric rare
ANTIBODIES
ANTI-IgE
omalizumab
MOA
monoclonal antibody against IgE
decrease fixation of IgE on mast cells
AE
injection site reactions
rare anaphylaxis
ANTI-IL 5
mepolizumab
reslizumab
benralizumab
COPD
definition
chronic inflammatory disorders of airway
characterized by
ariflow obstruction
mixture of
emphysema
destruction of alveolar wall
loss of alveolar tissue
chronic bronchitis
inflammation
increase in mucus
Sx
SOB
chronic cough
sputum production
risk factor: smoking
progressive sx
irreversible
drugs
beta-2 agonist
theophylline
muscarinic antagonist
glucocorticoids
PDE4 INHIBITORS
Roflumilast
MOA
inhibits PDE4 in inflammatory cells
increase cAMP
decrease inflammation
AE
GI
diarrhea
nausea
weight loss
psychiatric sx
insomnia
depression
anxiety
PAH
definition
mean pulmonary arterial pressure > 25mmHg at rest
disease of small pulmonary arteries
vasoconstriction/ vasodilation imbalance
vascular proliferation and remodeling
increase pulmonary vascular resistance
increase pulmonary artery pressure
right heart failure :broken_heart:
changes
pulmonary artery
increase vasoconstriction
due to endothelial dysfunction
increase SM proliferation
arterial remodeling =
DRUGS
INHIBITION OF VASOCONSTRICTION
CCB DHP
example
nifedipine
amlodipine
MOA
block L-type Ca channels
vasodilation
AE
hypotension
HA
AE of vasodilator
ENDOTHELIN RECEPTOR ANTAGONIST
example
macitentan
ambrisentan
bosentan
MOA
block ET receptor
vasodilation
AE
HA :dizzy_face:
hypotension
:forbidden: :pregnant_woman:
need to be on 2 types of birth control
STIMULATION OF VASODILATION
EICOSANOIDS / EICOSANOIDS RECEPTOR AGONIST
PGI2 ANALOGS
example
epoprostenol
treprostinil
treprostinil
MOA
stimulate IP receptor on vascular SM
vasodilation
AE
hypotension :dizzy_face:
HA
GI AE
jaw pain
pain in extremities
IP RECEPTOR AGONIST
selexIpag
sGC ACTIVATORS
NO
sGC activators
riociguat
MOA
activate sGC in VSM
increase cGMP
vasodilation
AE
hypotension
Headache
PDE5 INHIBITORS
example
sildenafil
tadalafil
vardenafil
avanafil
MOA
inhibit PDE5 in VSM
decrease degradation of cGMP
vasodilation
AE
headache
hypotension
contra :forbidden: organic nitrates
ALLERGY
drugs
H1 ANTIHISTAMINE
1ST GEN
diphenhydramine
chlorpheniramine
2nd GEN
desloratadine
cetirizine
loratadine
PATHOPHYSIOLOGY classified
vasodilation = increase capillary pressure
congestion
drug
alpha agonist
ex
phenylephrine
oxymetazoline
MOA
stimulate alpha 1 receptors on VSM in arterioles in the nasal mucosa
VSM contraction
1 more item...
AE
rebound congestion
receptor desensitization
damage to mucosa
indirect sympathomimetics
pseudoephedrine
MOA
displace stored catecholamines
uptake via NET and VMAT
displace NE in vessicles
2 more items...
AE
cardio
increase BP
increase HR
arrhythmia
CNS
paranoia
insomnia
HA
nervousness
increase secretion in nasal mucosa
rhinorrhea
drug
ipratropium
RUNNY NOSE ONLY
MOA:
inhibits M3
receptors
reduce secretion
AE
antimuscarinic effect
xerstomia
urinary retention
constipation
increase neuronal stimulation of sensory fibers
sneezing
MAST CELLS
corticosteroid
fluticasone
activate glucocorticoid receptor in mast cells
inhibit synthesis of inflammatory mediators
cromolyns
mast cell stabilizer
prevent cells from releasing
histamine
leukotrienes
montelukast
leukotriene receptor antagonist
block action of pro-inflammatory leukotriene
