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22. CPR Exam 2 > 1. Asthma and COPD Drugs > Flashcards

1. Asthma and COPD Drugs Flashcards

1
Q 
All of the following are what to an asthma patient?
Exercise
Endocrine Factors
Drugs
Cold air/weather changes
allergens
emotional expression
Food additives
environmental changes
Exposure to irritants and occupational chemicals
Vireal respiratory infections
A

Precipitating/Aggravating Factors

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2
Q 
All of the following are what associated with asthma?
Hormonal changes
upper airway dysfunction
hyperventilation
smoking/nicotine dependence
COPD
Respiratory infections
allergic conditions
respiratory conditions
Obstructive sleep apnea
Obesity
GERD
chronic sinusitus
Rhinitis either allergic or non allergic
A

Comorbid Conditions

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3
Q

Asthma management includes routine monitoring of symptoms and lung function, patient education to create partnership between pt and dr, controlling comorbid and environmental agents and providing pharmacologic therapy. What are the two main goals of tx?

A

Reduction in lung and airway impairment

reduction of any risk for an asthma attack

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4
Q

What are the two drug categories used for asthma?

A

Anti-inflammatory

Bronchodilators

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5
Q

What is the MOA for beta agonists (bronchodilators)?

A

Increase AC, increasing cAMP causing bronchodilation

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6
Q

What is the MOA for theophylline, which acts in two locations?

A

1) inhibits PDE causing an increase of cAMP and dilation

2) Inhibits adenosine, which would normally cause constriction

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7
Q

What is the MOA for muscarinic antagonists in asthma?

A

inhibit acetylcholine release, preventing constriction

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8
Q

There are two routes of deposition of inhaled drugs (corticosteroids/B2 agonists), what is the minor route, major effect of inhaled?

A

the amount that goes into the lungs (10-20%)

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9
Q

The major effect of inhaled b2/steroid medication (90%) is swallowed and goes into the gut, why does this have little effect on the symptoms?

A

First pass metabolism breaks down most of the drug before it can get to the circulation

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10
Q

B2 agonists act on smooth muscle to reverse bronchoconstriction, relaxing the smooth muscle cells of all airways, where they act as what type of antagonist?

A

functional antagonists (reverse/prevent contraction of all airways)

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11
Q

B2 agonists are most widley used for asthma and COPD. What is a short acting beta agonist (SABA) used in asthma, acute bronchitis, COPD, and bronchiolitis with adverse effects of HA, dizziness, insomnia, dry mouth and cough?

A

Albuterol

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12
Q

Albuterol is a beta agonists with certain side effects, including deterioration of asthma, CV effects, immediate HS and paradoxical?

A

bronchospasm

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13
Q

What B2 agonist is a short acting beta agonist SABA, which the the only B2 drug availible subcutaneously?

A

Terbutaline ***sulfur allergy dont give

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14
Q

Terbutaline (B2 agonist) approved from prophylaxis of broncho spasm w asthma, bronchitis, empysema in children over 12. Its not recommended for tocolysis (uterine contractions) and adverse effects include HA, nausea, tachycardia and?

A

palpitations

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15
Q

What B2 SABA is used for bronchial asthma and for reversible bronchspasm occuring in bronchitis and COPD, can see significant cardiovascular effects, and can produce a PARADOXICAL bronchospasm?

A

Metaproterenol

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16
Q

pirbuterol is a SABA used in prevention and reversal of bronchospasm in pts 12 and older, may be used with theophylline or corticosteroid therapy, can cause significant cardiovascular effect in some patients which are measured/monitored by what ?2

A

pulse rate and blood pressure

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17
Q

What B2 SABA is used in tx or prevention of bronchospasm in patients 4years and older with reversible obstruction, sometimes causing paradoxical bronchospasm?

A

Levalbuterol

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18
Q

What B2 long acting beta agonist LABA treats asthma in patients older than 5 years as an ADD ON to a long term inhaled corticosteroid, also used in matainence tx of bronchoconstriction in pts with COPD?

A

Fomoterol LABA

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19
Q

Fomoterol (LABA) CAN NOT BE USED WITHOUT a long term asthma control medication like inhaled corticosteroid, they increase the risk of asthma-related deaths and hospitalizations. These must be prescribed ONLY as a concomitant therapy with?

A

a long term control medication (inhaled corticosteroid)

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20
Q

Sumeterol a LABA is for tx of asthma in patients 4+, is a maintenance treatment of bronchospasm associated with COPD, and is used MOST commonly in preventing exercise?

A

induced bronchospasm (EIB) in patients 4+

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21
Q

What 2 B2 LABAs are used to treat breathing problems caused by COPD, including bronchitis and emphysema?

A

Indacaterol and Vilanterol

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22
Q

What B2 LABA is used long term, ONCE daily maintenance bronchodilator treatment of airflow obstruction in patients with COPD, chronic bronchitis and emphysema?

A

Olodaterol

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23
Q

LABAs increase risk of asthma-related deaths and hospitalizations and when being used should be a concomitant treatment for asthma/ anything with what?

A

inhaled corticosteroid (long term control medication)

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24
Q 
Match the following ICS (inhaled corticosteroids) with their LABAs
Fluticasone
Mometasone
Budesonide
Formoterol
Salmeterol
Formoterol
A

Fluticasone+ Salmeterol
Mometasone+Formoterol
Budesonide+Formoterol

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25
Q

Anticholinergics block acetylcholine from binding to its receptors and inhibit parasympathetic nerve impulses, they are most widely used in what two conditions?

A

Asthma

COPD

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26
Q

What muscarinic antagonist is indicated for temporary blockade of severe or life treatening muscarinic effects?

A

Atropine

27
Q

Atropine used recurrently in pts with CAD, the total dose should be restricted to what, to avoid detrimental effects of atropine induced tachycacrdia on myocardial O2 demand?

A

2 to 3mg

28
Q

What anticholinergic is used as a bronchodilator for maintenance treatment of bronchospasm associated with COPD (bronchitis/emphysema), and is JUST like atropine but is poorly absorbed after aerosol admin and therefore is FREE of systemic atropine like effects?

A

Ipratropium

29
Q

What anticholinergic is used LONG TERM, once daily, for maintenance tx of bronchospams in pts with COPD, and for reducing COPD exaccerabations?

A

Tiotropium (longer 1/2 life)

30
Q

What anticholinergic is used for LONG TERM tx of bronchospasm associated with COPD, chronic bronchitis and emphysema?

A

Aclidinium

31
Q

Methylxanthines are a unique class of drugs derived from purine base xanthine produced by plants and animals. Used in the tx of airway obstruction caused by conditions such as asthma, chronic bronchitis or emphysema, what are three examples?

A

Caffeine (COFFEE)
Theobromine in chocolate
Theophylline

32
Q

Methylxanthines are mostly used for asthma/COPD. Theophylline is used in tx of asthma and lung problems such as emphysema and chronic bronchitis, it has two distinct actions including suppression of response of airways to stimuli (block adenosine) and?

A

smooth muscle relaxation by inhibiting PDE increasing cAMP

33
Q

Due to the increased risk of exacerbation, methyxanthines should be used with EXTREME caution in pts with active peptic ulcer disease, seizure disorders and?

A

cardiac arrhythmias

34
Q

Inhaled corticosteroids (ICS) are the most effective controllers for asthma, the most effective anti inflam agents used in asthma therapy,they reduce eosinophils in airways/ sputum and the number of activated?

A

T cells and mast cells in airway mucosa

35
Q

ICS major effect is to switch off the transcription of multiple activated genes that incode?

A

inflammatory proteins such as cytokines, chemokines, adhesion molecules and inflammatory enzymes

36
Q

ICS are given twice a day, sometimes once daily, and rapidly improve symptoms, they are V good for exercise induce asthma and reduce AHR, which is?

A

airway hyperresponsiveness

37
Q

Tx with ICS appears to prevent irreversible changes in airway function (airway remodeling) and withdrawal of ICS results in slow deterioration of asthma control indicating that they suppress inflammation and sx but do not ?

A

cure the underlying condition

38
Q

ICS are first line therapy for patients with persistent asthma, but if they do not control symptoms at low doses, then it is usual to add?

A

LABAs

39
Q

What ICS is used for maintenance tx for asthma and as prophylactic therapy in pts 5+, Care is needed when transferred from systemic to this drug because DEATHS due to adrenal insufficiency have occurred in the past?

A

Beclomethasone

40
Q

Systemic Corticosteroids to inhaled Beclomethasome can cause adrenal insufficiency because when systemic are withdrawn, a number of months are required for recovery of what function?

A

the hypothalamic pituitary adrenal function (HPA)

41
Q

Budesonide (ICS) is used for maintenance treatment of asthma and as prophylactic in 6+, and it should not be used in status asthmaticus or acute episodes of asthma, a contraindication for use is if the patient has hypersensitivity to?

A

MILK proteins

42
Q

Cidesonide (ICS) is for maintenance of asthma as prophylactic therapy in adults and 12+, is it NOT indicateed for relief of acute bronchospasm, and is not recommended in the presence of what of the mouth and pharynx?

A

Candid albicans infection

43
Q

What is important to know about the effects of ICS?

A

THEY ARE NOT FOR IMMEDIATE SITUATIONS!!!

44
Q

What ICS is indicated for the maintenace treatment of asthma as prophylactic therapy in 6+, also for asthma patients requiring oral corticosteroids where adding this drug may reduce or eliminate the need for systemic CS?

A

Flunisolide

45
Q

Flunisolide is contraindicated in patients for primary treamtent of status asthmaticus or other acute episodes where ?

A

intensive measures are required

46
Q

What ICS is for maintenance tx of asthma as prophylactic therpay in pt 4+, NOT for acute bronchospasm, and have a contraindication associated with Candida Albicans infection of the mouth and pharynx?

A

Fluticasone

NOTE **Rinse mouth after inhalation

47
Q

What ICS is for tx of asthma as prophylactic therapy in pt 4+, contraindicated in pts with status asthmaticus and acute episodes also contraindicated in pts with MILK PROTEIN ALLERGY?

A

Mometasone

48
Q

What ICS is for maintenance treatment of asthmas as prophylactic therpay, also indicated for pts who require systemic CS, where adding this medication may reduce need for them?

A

Triamcinolone

49
Q

Triamcinolone is not indicated for relief of acute bronchospasm, should not be used in status asthmaticus or other acute episodes, patients transferred from oral to traimcinolone should be watch closely bc what is know to happen?

A

Deaths due to adrenal insufficiency

slowly ween off systemic CS

50
Q

Oral corticosteroids (OCS) are used in combo with short acting beta agonists SABA, to treat moderate to severe asthma flare ups, OCS are more likely to cause?

A

side effects than ICS

51
Q

What is the only OCS we need to know, which is an anti-inflammatory or immunosuppressive agent for MANY conditions and is also used for the tx of certain what, and for palliation of certain neoplastic conditions?

A

endocrine conditions

52
Q

Prednisone may lead to hypothalamic-pituitary-adrenal (HPA) axis suppression so one should monitor patients for hyperglycemia and what in chronic use?

A

Cushings syndrome

53
Q

Leukotrience receptor antagonists/ Lipoxygenase inhibitors are selective reversible antagonists of what receptor?

A

cysteinyl leukotriene receptors (CysLT1 receptors)

54
Q

Leukotrience receptor antagonists/ Lipoxygenase inhibitors are taken orally, are active bronchodilators, have some antiinflammatory action, have less effect than ICS and have what sparing effect?

A

Glucocorticoid sparing effect (no rise in glycemia like prednisone)

55
Q

Leukotriene antagonists are the most precribed drugs for management of asthma, used for treatment and prevention of ACUTE asthma attacks. The class of drugs bind CysLT1 receptors and block?

A

their activation and the subsequent inflammatory cascade

such as airway edema, SM contraction and altered cellular activity

56
Q

What leukotriene antagonist is orally active with high affinity to CysLT1 receptor, inhibiting physiologic actions of LTD4 and the CysLT1 receptor WITHOUT any agonist activity?

A

Montelukast

57
Q

Montelukast is used for allergies and prevents asthma attacks, not indicated for use in the reversal of bronchospams in acute asthma attacks including status asthmaticus, it can be continued during?

A

acute exacerbations of asthma

58
Q

What leukotriene antagonist is selective and competitive antagonist of LTD4/E4 which are the components of slow reacting substance of anaphylaxis (SRSA), and are prescribed for prophylaxis and chronic treatment of asthma in 5+?

A

Zafirlukast

59
Q

Zafirlukast can cause what, which is a case of life threatening hepatic failure which has been seen in some patients after taking normal amounts of the drug?

A

Hepatotoxicity

60
Q

What drug immediate release tablets have been withdrawn from US market but controlled release is still availbe, and is a 5lipoxygenase inhibitor (inhibits LTB4/C4/D4/E4)?

A

Zileuton

61
Q

Zileuton is used for prophylaxis and chronic treatment of asthma in adults and 12+, not used to treat acute asthma attack, and is NOT recommended in patients with active liver disease or?

A

with hepatic function enzyme elevations more than 3 times the upper limit
(High ALT/AST = STOP tx)

62
Q

What is a monoclonal antibody drug that

1) binds to free IgE, decreasing cell bound IgE
2) decreases expression of high affinity receptors
3) decreases mediator release
4) Decreases allergic inflam, prevents exacerbation of asthma and reduces symptoms

A

Omalizumab (very good!)

63
Q

Monoclonal antibody Omalizumab is an anti IgE Ab indicated for moderate to severe persistent asthma in pts 6+ with positive skintest or in vitro reactivity to a?

A

perennial aeroallergen

64
Q

Monoclonal antibody Omalizumab is indicated in tx for chronic idiopathic urticaria in 12+ who remain symptomatic despite antihistamine tx, COMMONLY see anaphylaxis, meaning this drug should be given?

A

ONLY in the hospital due to severe anaphylaxis, where would need more medications at hand

22. CPR Exam 2 (20 decks)

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