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Moonlighting guide ASTHMA Drugs Used in Asthma Subclass Mechanism of Action E ?ects Clinical Applications Pharmacokinetics Toxicities Beta agonists Albuterol Selective ? agonist Salbutamol Prompt e ?cacious bronchodilation Asthma chronic obstructive pulmo

ASTHMA Drugs Used in Asthma Subclass Mechanism of Action E ?ects Clinical Applications Pharmacokinetics Toxicities Beta agonists Albuterol Selective ? agonist Salbutamol Prompt e ?cacious bronchodilation Asthma chronic obstructive pulmonary disease COPD drug of choice in acute asthmatic bronchospasm Aerosol inhalation duration several hours also available for nebulizer and parenteral use Toxicity Tremor tachycardia overdose arrhythmias Salmeterol Selective ? agonist Slow onset primarily preventive action potentiates corticosteroid e ?ects Asthma prophylaxis Aerosol inhalation duration ?? h Toxicity Tremor tachycardia overdose arrhythmias Metaproterenol terbutaline Similar to albuterol terbutaline available as an oral drug Formoterol Similar to salmeterol Epinephrine Nonselective and agonist Bronchodilation plus all other sympathomimetic e ?ects on cardiovascular and other organ systems see Chapter Anaphylaxis asthma Aerosol nebulizer or parenteral others see Chapter see Chapter rarely used for asthma -selective agents preferred Isoproterenol and agonist Bronchodilation plus powerful cardiovascular e ?ects Asthma but -selective Aerosol nebulizer or parenteral agents preferred see Chapter Corticosteroids inhaled Fluticasone Alters gene expression Reduces mediators of in ammation powerful prophylaxis of exacerbations Asthma adjunct in COPD Beclomethasone budesonide unisolide others Similar to uticasone Corticosteroids systemic Prednisone Like uticasone Like uticasone Asthma adjunct in COPD Methylprednisolone Parenteral agent like prednisone Stabilizers of mast and other cells Cromolyn nedocromil Alters function of delayed Prevents acute chloride channels bronchospasm inhibits in ammatory cell activation Asthma other routes used for ocular nasal and gastrointestinal allergy Methylxanthines Theophylline Uncertain phosphodiesterase inhibition adenosine receptor antagonist Bronchodilation cardiac stimulation increased skeletal muscle strength diaphragm Asthma COPD Aerosol duration hours Toxicity Limited by aerosol application candidal infection vocal cord changes Oral duration ?? hours Toxicity Multiple see Chapter Aerosol duration ?? h Toxicity Cough not absorbed so other toxicities are minimal Oral duration ?? h but extended-release preparations often used Toxicity Multiple see text CSubclass Mechanism of Action E ?ects Leukotriene antagonists Montelukast Block leukotriene D za ?rlukast receptors Block airway response to exercise and antigen challenge Zileuton Inhibits lipoxygenase reduces synthesis of leukotrienes IgE antibody Omalizumab Humanized IgE antibody Reduces frequency of reduces circulating IgE asthma exacerbations Clinical Applications Pharmacokinetics Toxicities Prophylaxis of asthma especially in children and in aspirin-induced asthma Oral duration hours Toxicity Minimal Severe asthma Parenteral duration ?? d inadequately controlled Toxicity Injection site reactions by above agents CHRONIC ASTHMA Daytime symptom monthly Nocturnal awakening Rescue B use PEF or FEV Intermittent Weekly Less Than Mo Less Than Weekly Of Predicted GOALS Minimal or no sx Minimal attacks episodes or attack No emergency visits Minimal need for reliever No limits on physical activities and exercise Nearly normal lung fxn Minimal or no side e ?ects from meds Persistent Daily Monthly To Weekly To Nightly Wkly To Daily Several Times A Day - Of Predicted ANTIMICROBIAL FOR UTI AND PNEUMONIA CEPHALOSPHORINS Guidelines for Dosing of Some Commonly Used Cephalosporins and Other Cell-Wall Inhibitor Antibiotics Antibiotic Route of Adult Dose Pediatric Dose Administration Neonatal Dose Adjusted Dose as a Percentage of Normal Dose for Renal Failure Based on Creatinine Clearance Clcr First-generation cephalosporins Cefadroxil PO ?? g qd ??bid mg