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CPR II Exam II > (1.1) Drugs used in Asthma and COPD (Izard) > Flashcards

(1.1) Drugs used in Asthma and COPD (Izard) Flashcards

1
Q

What are examples of aggravating factors for an asthma patient?

A

—Viral respiratory infections

—Exercise

—Endocrine factors

—Drugs: Aspirin, Beta blockers

—Weather changes : Cold Air

—Allergens

—Emotional expression: Anger, laughter

—Food additives: Sulfites

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2
Q

What are some examples of comorbid conditions associated with asthma?

A

—Rhinitis

—Hormonal changes

—Upper airway dysfunction

—Smoking nicotine dependence

—COPD

—Respiratory infections

—Sleep apnea

—Obesity

—GERD

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3
Q

What are the 2 categories of drugs used for treating asthma?

A

Anti-Inflammatory drugs

Bronchodilators

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4
Q

Bronchodilator Therapy : Mechanism of Action

Beta agonists?

A

Beta agonists stimulate adenylate cyclase to increase cAMP concentrations.

The higher concentration of cAMP leads to bronchodilation

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5
Q

Bronchodilator Therapy : Mechanism of Action

Theophylline?

A

Theophylline has 2 sites of action!

  1. Acts as a PDE inhibitor. By decreasing PDE activity, the drug is increasing cAMP concentration. The higher cAMP concentration leads to bronchodilation
  2. Inhibits Adenosine. This inhibits adenosine’s actions to bronchoconstrict, leading to bronchodilation.
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6
Q

Bronchodilator Therapy : Mechanism of Action

Muscarinic antagonists?

A

Muscarinic antagonists inhibit acetylcholine which will inhibit bronchoconstriction. This leads to bronchodilation

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7
Q

Where are the majority of inhaled drugs (corticosteroids/Beta2 agonists) absorbed?

A

80-90% swallowed and follow GI tract

“Major route/less effect”

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8
Q

Where do beta2 agonists primarily act?

A

Airway smooth muscle to reverse the bronchoconstriction of asthma

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9
Q

What is the primary action of beta2 agonists?

A

Relax airway smooth muscle cells of all airways

Act as functional antagonists, reversing and preventing contraction of airway smooth muscle cells by all known bronchoconstrictors

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10
Q

What class of drugs is the most widely used in treatment of asthma/COPD?

A

Beta2 receptor agonists

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11
Q

Albuterol

Indications:

Adverse effects:

Contraindications/warnings:

A

Indications: Asthma, acute bronchitis, COPD, bronchiolitis

Adverse effects: Headache, dizziness, insomnia, dry mouth, cough

Contraindications/warnings: Paradoxical bronchospasm, deterioration of asthma, CV effects, Immediate hypersensitivity reactions

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12
Q

Tertbutaline

Indications:

Adverse effects:

Contraindications/warnings:

A

Indications: Prophylaxis of bronchospasm associated with asthma, bronchitis and emphysema in pts. over 12 y/o

Adverse effects: Headache, nausea, tachycardia and palpitations

Contraindications/warnings: Not recommended as a med. for tocolysis

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13
Q

What is noteworthy about Terbutaline?

A

ONLY Beta2 drug available by subcutaneous injection

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14
Q

Metaproterenol

Indications:

Cautions/Warnings:

A

Indications: Bronchodilator for bronchial asthma and for reversible bronchospasm

Cautions/Warnings: Significant CV effect. Can produce paradoxical bronchospasm

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15
Q

Pirbuterol

Indications:

Cautions/Warnings:

A

Indications: Prevention of reversal of bronchospasm

Cautions/Warnings: CV warnings. Can produce a clinically significant CV effect in some patients.

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16
Q

Levalbuterol

Indications:

Cautions/Warnings:

A

Indications: Treatment or prevention of bronchospasm in pts >4yo with reversible obstructive airway disease

Cautions/Warnings: Life threatening paradoxical bronchospasm

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17
Q

Fomoterol-Long Acting Beta Agonist

Indications:

Contraindications/warnings:

Noteworthy:

A

Indications: Treatment of Asthma in pts greater than/equal to 5 y/o as an add-on to a long term asthma control medication such as an inhaled corticosteroid. Also, maintenance treatment of bronchoconstriction in pts with COPD

Contraindications/warnings: Use of LABA’s increases the risk of asthma-related deaths and asthma related hospitilizations

Noteworthy: Prescribe for asthma ONLY as concomitant therapy with a long-term control medication such as inhaled corticosteroid

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18
Q

What is a general rule to follow with prescribing LABAs?

A

LABA should be used in concomitant use of long-term asthma control medication such as an inhaled corticosteroid

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19
Q

Salmeterol

Indications:

A
  • Treatment of asthma in patients aged 4 years and older
  • Prevention of exercise induced bronchospasm (EIB) in patients aged 4 years and older
  • Maintenance treatment of bronchospasm with chronic COPD
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20
Q

Indacaterol and Vilanterol

Indications?

A

Used to treat breathing problems caused by COPD, including bronchitis and emphysema

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21
Q

Olodaterol

Indications?

A

-Used long term, once daily maintenance bronchodilator treatment of airflow obstruction in patients with chronic COPD

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22
Q

Describe the general guidelines for combination therpies associated with varying degrees of asthma severity:

A

Generally… Short acting Beta2 agonists are always required for symptom relief. When asthma becomes more severe, you have to consider adding another medication. Start with adding ICS, then ICS and LABA, then ICS + LABA + OCS.

23
Q

Atropine

MOA:

Indications:

Cautions/warnings:

A

MOA: muscarinic antagonist

Indications: Temporary blockade of severe/life threatening muscarinic effects

Cautions/warnings: Pts with coronary artery disease should have dose restricted to 2 to 3mg to avoid the detrimental effects of atropine-induced tachycardia

24
Q

What are the drugs that act here?

A
  • Atropine
  • Ipratropium
  • Tiotropium
  • Aclidinium
25
Q

Ipratropium

Uses?

Noteworthy?

A

Uses: Bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease

Noteworthy: Relatively free of systemic atropine-like effects

26
Q

Tiotropium

Uses?

A

Long term, once-daily, maintenance treatment of bronchospasm associated with COPD

27
Q

Aclidinium

Uses?

A

Long term maintenance treatment of bronchospasm associated with COPD

28
Q

What are methylxanthines?

A

Unique class of drug that are derived from the purine base XANTHINE

29
Q

What are the (3) drugs that are classified as Methylxanthines?

A

Theophylline

Theobromine

Caffeine

30
Q

What are the actions of Theophylline?

A

2 distinct actions!!!

  1. Smooth muscle relaxation (bronchodilation)
  2. Suppression of the response of the airways to stimuli (non-bronchodilator prophylactic effects)
31
Q

__________ are by far the most effective controllers for asthma, and their early use has revolutionized asthma therapy

A

Inhaled corticosteroids (ICS) are by far the most effective controllers for asthma, and their early use has revolutionized asthma therapy

32
Q

Inhaled corticosteroids are the _____________________, reducing inflammatory cell numbers and their activation in the airways

A

Inhaled corticosteroids are the most effective anti-inflammatory agents used in asthma therapy reducing inflammatory cell numbers and their activation in the airways

33
Q

ICS __________ in the airways and _____, and numbers of activated ____________ and surface ________ in the airway mucosa

A

ICS reduce eosinophils in the airways and sputum, and numbers of activated T lymphocytes and surface mast cells in the airway mucosa

34
Q

The molecular mechanism of action of corticosteroids involves _____________________________

A

The molecular mechanism of action of corticosteroids involves several effects on the inflammatory process

35
Q

The major effect of corticosteroids is to ________________________

A

The major effect of corticosteroids is to switch off the transcription of multiple activated genes that encode inflammatory proteins

36
Q

What is the first line therapy for patients with persistent asthma?

A

Inhaled corticosteroids (ICS)

37
Q

Beclomethasone

Drug class:

Indications:

Cautions/Warnings:

A

Drug class: Inhaled corticosteroids (ICS)

Indications: Maintenance treatment for asthma as a prophylactic therapy in patients 5 y/o and older

Cautions/Warnings: Need to SLOWLY withdraw pt.s from ICS therapy, can result in death due to adrenal insufficiency from abrupt transition

38
Q

Budesonide

Indications?

Cautions/warnings?

A

Indications = Maintenance treatment of asthma as prophylactic therapy

Cautions/warnings= This drug should NOT be used where primary treatment of status asthmaticus or other acute episodes of asthma are required. Severe hypersensitivity to MILK proteins are contradindicated

39
Q

Ciclesonide

Uses:

Cautions/warnings:

A

Uses: Maintenance treatment of asthma as prophylactic therapy in adult and adolescent pts 12 y/o and older

Cautions/warnings: Ciclesonide is not indicated for the relief of acute bronchospasm. Use is NOT RECOMMENDED in presence of candida albicans infection of the mouth and pharynx, TB, fungal, bacterial, viral or parasitic infection

40
Q

Flunisolide

Uses?

Contraindications?

A

Uses: Maintenance treatment of asthma as a prophylactic therapy in adult and pediatric patients 6 y/o and older. Also for asthma pts requiring oral corticosteroid therapy

Contraindicated: Pts w/ primary treatment of status asthmaticus or other episodes of acute asthma attacks

41
Q

Fluticasone

Uses:

Cautions/warnings:

A

Uses: Maintenance treatment of asthma as prophylactic therapy in pts aged 4 y/o and older

Cautions/warnings: Candida albicans infection of mouth and pharynx MAY OCCUR!!!

42
Q

Mometasone

Uses:

Cautions/warnings:

A

Uses: Maintenance treatment of asthma as prophylactic therapy

Cautions/warnings: Contraindicated in pt.s with status asthmaticus or other acute episodes of asthma and pts with known hypersensitivity to milk proteins

43
Q

Triamcinolone

Uses:

Cautions warnings:

A

Uses: Maintenance treatment of asthma as prophylactic therapy

Cautions/warnings: Contraindicated in the primary treatment of status asthmaticus or other acute episodes of asthma.

44
Q

Oral corticosteroids are ________________ than inhaled corticosteroids

A

Oral corticosteroids are more likely to cause side effects than inhaled corticosteroids

45
Q

Prednisone

Uses?

Cautions/warnings?

A

Uses: Anti-inflammatory or immunosuppresive agent, or treatment of certain endocrine conditions

Cautions/warnings: May lead to HPA axis suppression

46
Q

Leukotriene antagonists are the most prescribed drugs for….

A

Both the treatment and prevention of ACUTE ASTHMATIC ATTACKS

47
Q

What is the MOA of Leukotriene antagonists?

A

Binding to cysteinyl leukotriene (CysLT) receptors and blocking their activation and the subsequent inflammatory cascade

48
Q

Montelukast

MOA?

A

Inhibits physiologic actions of LTD4 at the CysLT1 receptor without any agonist activity

49
Q

Montelukast

Indications?

Cautions/warnings?

A

Indications: Treat allergies and prevent asthma attacks

Cautions/warnings: NOT INDICATED for use in the reversal of bronchospasm in acute asthma attacks

50
Q

Zafirlukast

MOA?

Indications?

Cautions/warnings?

A

MOA = Selective and competitive receptor antagonist of leukotriene D4 and E4 (LTD4 and LTE4) components of slow reacting substance of anaphylaxis

Indications = Prophylaxis and chronic treatment of asthma

Cautions/warnings = HEPATOTOXICITY

51
Q

Zileuton

Uses?

Cautions/warnings?

A

Uses = Prophylaxis and chronic treatment of asthma

Cautions/warnings = NOT RECOMMENDED in cases where active liver disease is present

52
Q

Omalizumab

Drug class?

Uses?

Cautions/warnings?

A

Drug class: Monoclonal antibody

Uses: Chronic idiopathic uticaria and asthma

Cautions/warnings: ANAPHYLAXIS

53
Q
A

CPR II Exam II (21 decks)

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