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This Concept Map, created with IHMC CmapTools, has information related to: Respiratory Drugs, Respiratory Drugs beta2-agonists -only class for acute asthmatic attacks -first line for asthma Indications: oral and inhaled All rapid acting: abort attacks SALMETEROL: inhibit late phase of allergen-induced attacks -prevent exercise-induced -nocturnal attacks, Respiratory Drugs Expectorants ACETYLCYSTEINE-mucolytic -splits disulfide bonds ->lower viscosity, Respiratory Drugs IgE Antagonists OMALIZUMAB -monoclonal anti-IgE AB MOA-block region of IgE that binds to mast cells (Fc) Use- SubQ q2-4 wks ADRs- HA, viral infx, TCP?, allergic rxns, Respiratory Drugs beta2-agonists -only class for acute asthmatic attacks -first line for asthma Selective: ALBUTEROL - oral or aerosol -peak in 30-40min TERBUTALINE -parenteral for s. asthmaticus Slower, longer DOA: SALMETEROL +fluticasone=Advair formoterol -prevent nocturnal attacks, Respiratory Drugs beta2-agonists -only class for acute asthmatic attacks -first line for asthma EPINEPHRINE isoproterenol phenylephrine ephedrine, Respiratory Drugs Adrenocorticosteroids MOA: anti-inflammation via decreased: -Eos secretion, numbers -T cell cytokines -Mast cell numbers -Mac secretion, cytokines -Endoth leak channels -Mucus secretion Increased sm mm beta- receptors, Respiratory Drugs Adrenocorticosteroids Side Effects (daily use) Adrenal Supp** Growth retardation*** Osteoporosis** Cataracts*** Hema changes* Wt Gain*** HTN** -minimal ADRs w/ inhaled -thrush-oral candidiasis, Respiratory Drugs Anti-Histamines FEXOPHENADINE DIPHENHYDRAMINE, Respiratory Drugs Adrenocorticosteroids PREDNISONE(systemic) Inhaled: BECLOMETHASONE -minor HPA effects fluticasone (Advair) flunisolide triamcinolone, Respiratory Drugs Mast Cell, Eos Stabilizers CROMOLYN SODIUM-inhale nedocromil MOA- -block Cl- channel->inhibit activation 2. Airway nerves->inhibit cough Mast cells->inhibit inflam mediators Decrease Eos infiltration ADRs-pretty nontoxic -cough/bronchospasm in some pts -give beta agonist too May not see action for 4-6 wks, Respiratory Drugs Mast Cell, Eos Stabilizers Indications: prophylaxis Asthma (inhaled) -eg 1 hr before exercise Allergic Rhinitis (inh) Conjunctivitis (topical) Systemic Mastocytosis (oral) Food allergy, UC (oral), Respiratory Drugs Expectorants Oral Mucokinetic Agents: IODINE (KI), ammonium Cl- -historical Ipecac GUAIFENISIN (Mucinex)-oral OTC -reduce adhesiveness of secretions ->reduce coughing -Use: thick secretions, dry cough, sinusitis, Respiratory Drugs Methylxanthines -adenosine nucleosides Indications: mod-severe COPD, asthma (declining) -if severe, refractory recurrent apnea in premies Pharmacokinetics T1/2 shorter in smokers, កyo, BCP, Pregnancy Longer in liver dz, macrolides, viral infx, propranolol Absorb better in high protein, low CHO diet, Respiratory Drugs Adrenocorticosteroids Use: Asthma Allergic Rhinitis (<=8 wks for max response) Status Asthmaticus -IV admin, Respiratory Drugs Methylxanthines -adenosine nucleosides THEOPHYLLINE-fewer CNS ADRs aminophylline caffeine MOA: -inhibit PDE isozymes -inhibit cAMP degradation ->bronchodilation -antagonize adenosine R, mediators ->inc'd AV conduction->arrhythm -inhibit Ca++ influx -enhance catechol secretion ADRs: GI distress (take w/ food,H2O) CNS stim-nervousness, arrhythmias, convulsions Interactions: Cimetidine (1A2 inhib), Respiratory Drugs Expectorants dornase alfa (Pulmozyme) -for CF, chronic bronchitis -recombinant rhDNase ->cleave extracell DNA ->reduce viscosity ADRs-cough, wheeze, hemoptysis, pharyngitis, Respiratory Drugs Ca-Channel Blockers verapamil nifedipine MOA-relax bronchial sm mm -stabilize membranes, Respiratory Drugs Anti-Cholinergics -mostly COPD -oral inhalation IPRATROPIUM BROMIDE (Atrovent) tiotropium (Spiriva) -atropine derivatives -quaternary NH4 compound ->NO CNS EFFECTS MOA-block vagus bronchoconstriction -M3 musc receptor antagonists -slower than beta2-agonists, but longer-lasting, Respiratory Drugs Expectorants WATER-dilute, liquefy secretions -promote mucociliary action -SUPERIOR expectorant -inhaled as steam, vapor -rapid, Respiratory Drugs Inhibition of LTs Indications: ORAL -Mild-moderate asthma -max effect after wks-mos