MOA

2
adrenergi
c
agonists

Relaxes
smooth
muscles,
bronchodilati
on

Rescue
treatment -can be used
for exercise
induced
asthma
Long
Relaxes
acting B2 smooth
Agonists
muscles,
(LABA)
bronchodilati
on. Same as
Maintena SABA but
nce of
slower onset
COPD
can be used
and
for night
asthma
cough
Inhaled
Corticost
eroids
(ICS)

Inhibits
cytokines,
adhesions
protein
activation,
Mainstay inflammator
for
y cell
persistent migration
asthma
(stops entire
and
inflame.
COPD
process)

Anticholin Decreases
ergic
contractility
Agents
of smooth
muscles,
First line
relaxes
therapy
airways,
in COPD
reduces
mild
mucous
stable pts production

Side
Effects
Tachycar
dia,
palpitati
ons,
anxiety,
nervous
ness

Medications

H/A,
pharyngi
tis, URI
sxs,
cough,
mild
cardiac
stimulati
on

Formoterol,
Salmeterol,
Arformoterol

Dry
mouth,
Oral
Thrush
dyspepsi
a, vocal
hoarsen
ess, sore
throat

Beclomethasone,
Budesonide,
Pulmicort
capsules,
Fluticasone,
Mometasone,
Ciclesonide

MUST
RINSE
AFTER
USE
Bronchiti
s,
dyspnea
, cough,
dry
mouth,
hoarsen
ess

Contraindicat
ions

Albuterol,
Pirbuterol,
Levabuterol.
Can use nebulizer
or hand held
inhaler

Preg Cat C

Not for
monotherapy
for Asthma
Milk Protein
hypersensitiv
ity
Black box for
asthma
related
deaths

All preg C except

Pulmicort Cat B

Asthma &COPD:
Ipratropium
Bromide
+Albuterol
COPD only:
Tiotropium
Bromide (Spiriva)
Aclidinium

Caution in
glaucoma
and unrinary
retention
probs
Never
monotherapy
in asthma

Bromide
Used in
adjunct
for
Asthma &
COPD

Combo
LABA/ ICS
Used for
Asthma and
COPD

Methylxanth
ines

Steroid
dose
fluctuates
Steroid/LA
BA
Must rinse
after use
Idiopathic Anxiety,
: broncho- palpitation
protective s, tremor,
, antidysrhythm
inflam.,
ias,
smooth
hypotensi
muscle
on
relaxer

Advair
Preg Cat C
(fluticasone/salme
terol)
Symbicort
(budesonide/formo
terol)
Dulera
(Mometasone/for
moterol)
Theophyline
Must
monitor
Do not exceed
therapeuti
900mg/daily
c range
(toxicity:
Preg Cat C
seizures)
CYP450
interaction
s:
allopurinol,
cimetidine,
fluoroquino
lones,
macrolides

phenytoin,
rifampin,
lithium

Asthma only Drugs:

Mast Cell
Stabilizers

Block mast
cells
response

Leukotriene
Inhibitors

Potent and
selective
antagonist
of
leukotriene
receptor:
reduces
eosinophils
attraction,
inflam,
edema,
smooth
muscle
contraction,
mucous

Adjunct for
inadequatel
y controlled
mildmoderate
persistent
asthma (w/
ICS)
Help
asthmatics
that:
ASA
sensitive,
seasonal
allergies,
excercised
induced
asthma
Anti-IgE
therapy
Must have
positive
RAST
testing: IgE
at least 30700

Omalizuma
b binds to
Fc receptor
on IgE,
preventing
IgE from
binding to
mast cells

Hoarseness,
irritation,
cough, bitter
taste
Very well
tolerated
Rare: ab. Pain,
h/a, pharyngitis
May cause
Churg-Strauss
Syndrome
(vasculitis)
Depression/
Suicide so
monitor pt

Risk of
anaphylaxsis,
neoplasms,
injection site
reactions, may
have
cardiovascular/
CVS events

TAKEN OFF
Preg Cat B
MARKET
Cromolyn
(Intal)
Montelukast
(Singular)
Preg B
Zafirukast
(Accolate)
Preg C
Zileuton
(Zyflo)
Preg C
must
monitor
LFTs

Omalizuma
b (Xolair)
SQ
injections

Used for
moderatesevere
persistent
asthama

Phosphodieste
rase-4
Inhibitors
Used with
LABA in
severe-very
severe COPD
Systemic
Corticosteroid
s
Adjunct in
sever,
uncontrolled
asthma and
COPD
Short courses
can be used in
moderate to
severe
exacerbations

Affects
cAMP and
decreases
inflammatio
n

Psychiatric:
insomnia,
anxiety,
depression,
mood
changes
Weight loss
GI sxs: D/N
Growth
suppression
, cataracts,
osteoporosi
s, adrenal
suppression
, decreased
glucose
tolerance,
Cushings
syndrome,
acne, poor
wound
healing,
thinning of
skin,
bruising,
weight gain

Roflumilast
(Daliresp)

Not
approved
for children
and
adolescents

Prednisone

Must taper!
Just to
stabilize