Drugs

Leukotriene Inhibitors

Examples Singulair (montelukast) Zyflo (zileuton) Accolate (zafirilukast)

MOA

Uses Prophylaxis and chronic treatment of asthma

Side Effects

Contraindications Interactions Additional Info See additional chart

Mast Cell Stabilizers

Suppress the effects of leukotrienes; inhibit lipoxygenase (Zyflo); block leukotriene receptors (other) Cromolyn sodium Cromolyn (Intal) sodium- Nedocromil (Tilade) prevents mast cell release of histamine, leukotrienes

See additional See additional chart chart

SABA

LABA

Bad taste, Acute asthma cough, attack headache Sore throat, nausea Wheezing or bronchospasm from powder inhalation Albuterol Selective Relief of Minimal- None- (Provental/Ventolin) stimulus of ongoing acute skeletal Levalbuterol beta2 receptors attacks muscle (Xopenex) causing- tremor, Pirbuterol (Maxair) bronchodilation, shakiness, Terbutaline decreased hyperactivity, (Bricanyl mucus headache, turbuhaler) secretion, and nausea increased ciliary action Salmeterol Same Prophylaxis Headache, Salmeterol has (Servent) Not to be anxiety, throat milk proteins in Formoterol (Foradil) used in acute irritation, the formulation Brovana (a attack of tremor, asthma or thrush, COPD insomnia

Exercise induced asthma (EIB) Seasonal allergic rhinitis

None

Nedocromil no longer available in the US Do not use in acute attack Use with beta2 antagonists or ICSs Teach proper use of inhaler and spacer, use beta2s before inhaled steroids

With beta blockers, the full effects of albuterol may not be seen (especially the non- selective) Beta blockers may reduce its effect

Never to be used as monotherapy risk of asthma related deaths when used alone (black box warning)

Drugs LABA (oral)

Examples Albuterol (VoSpire ER) Terbutaline (Brethine)

MOA Same

Uses Long-term control, not for acute attack and should not be used alone

Side Effects May produce systemic effects; relative selectivity, esp. at high doses; beta1 stimulus can cause angina, tachycardia, dysrhythmias; beta2 stimulus can cause skeletal muscle tremor Uncommon at therapeutic levels (5-15 mcg/mL) At 20-25 mcg/mL- N/V, diarrhea, insomnia, restlessness > 30 mcg/mL- severe dysrhythmias (V-fib), convulsions, death from cardiac collapse

Contraindications Interactions Additional Info Cardiac dysrhythmias associated with tachycardia Non- selective beta- blockers; may increase the effects of MAOIs and tricyclic antidepress.

Methylxanthines Theophylline Caffeine

Relaxes smooth muscle of the bronchi Also causes CNS excitation, cardiac stimulation, vasodilation, diuresis

Maintenance therapy of asthma- better for those with nocturnal attacks

Children < 1 and elderly > 60 because of decreased clearance Any disease decreasing the theophylline clearance: CHF, acute pulmonary edema, cirrhosis, hepatic disease, fever, hypothyroidism, sepsis, shock May exacerbate seizure d/o, afib, PUD

Those taking theophylline should avoid caffeine Do not take with food (SR form) See notes for additional

Theophylline has very narrow therapeutic index - no antidote, only symptomatic control of toxicity

Drugs Muscarinic Antagonists

Examples Atrovent (ipatroprium bromide) [short-acting] Spiriva (tiotropium) [long-acting]

MOA

Uses

Side Effects

Contraindications Interactions Additional Info Atrovent HFA and Combivent (combination of ipatroprium and beta2 agonist) contain soy lecithin and should be avoided in those with a peanut allergy Not absorbed by lungs or GI tract so no interactions

Blocks the Bronchospasm Minimal- action of ACh at with COPD quarternary receptor sites in ammonium bronchial compounds smooth muscle= with little bronchodilation systemic effects Dry mouth and irritation of the pharynx