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Pharm2 Mod 3: pulmonary > agents for respiratory illness > Flashcards

agents for respiratory illness Flashcards

1
Q

what is asthma

A

chronic inflammation of airways
contraction of bronchial smooth muscle
acute bronchospasm
increased secretion of mucus

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2
Q

what is the presentation of asthma

A

SOB
cough
chest tightness
wheezing

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3
Q

what is intermittent asthma

A

less than two days per week
near normal peak flow or spirometry
no daily medication
quick relief: short-acting B2 agonist

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4
Q

what is mild persistent asthma

A

more than 2 days per week, not daily
near normal peak flow or spirometry
long term: low dose inhaled corticosteroids
quick: short acting B2 agnoist

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5
Q

what is moderate persistent asthma

A

daily bronchoconstricitve episodes
60-80% or normal for peak flow or spirometry
long term: low to medium dose corticosteroids and long-acting B2 agonists
quick: short acting B2 agonist

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6
Q

what is severe persistent asthma

A

continual bronchoconstrictive episodes
less than 60% of normal peak flow or spirometry
high dose inhaled coricosteroids and long acting b2 agonist
quick: short acting B2 agonists

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7
Q

what is well controlled asthma

A

<2 days/week of symptoms/
< 2x/month nigh-time awakenings
no interference with ADL
short acting b2 agonist use <2 days/week
>80% of peak flow

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8
Q

what is not well controlled asthma

A

> 2 days/week of symptoms
1-3x/week of night time awakenings
some limitation with ADLs
2 days/week use of short acting b2 agonists
60-80% peak flow

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9
Q

what is very poorly controlled asthma

A

symptoms throughout the day
nighttime awakenings > 4x/week
extremely limited ADLs
short acting b2 antagonist used several times per day
< 60% peak flow

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10
Q

what determines normal values for peak expiratory flow (PEF)

A

age and height

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11
Q

what is the target of respiratory drugs

A

‘conducting zone’
Sympathetic innervation, parasympathetic innervation and mucous secreting and ciliated cells that remove inhaled particles

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12
Q

what is the sympathetic innervation of the respiratory system

A

sympathetic adrenergic neurons which activate B2 receptors -> bronchial dilation (B2 receptors activated by circulating epinephrine)

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13
Q

what is the the parasympathetic innervation of the respiratory system

A

parasympathetic cholinergic neurons which activate muscarinic receptors -> bronchial constriction

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14
Q

what is within the conducting zone

A

trachea
bronchi
bronchioles

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15
Q

what is within the respiraotry zone

A

respiratory bronchioles
alveolar ducts
alveolar sacs

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16
Q

what is albuterol

A

short acting beta 2 agonists - bronchodilators

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17
Q

what is the MOA for albuterol

A

activation of adenylate cyclase and increase in intracellular concentration of cAMP causing bronchodilation, relieves bronchospasm, increase mucous drainage

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18
Q

what is the indication for albuteral

A

management of acute bronchospasm in asthma and other chronic obstructive airway diseases

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19
Q

what are the adverse effects of albuterol

A

sympathomimetic effects: tachycardia, hyperglycemia, hypokalemia
tremor (common)

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20
Q

what is metaproterenol (orciprenaline)

A

moderately selective b2 agonist
inhaled or tablet forms available (only oral in USA)
not recommended for routine use given slow onset of action
known to exist but dont plan to prescribe

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21
Q

what is levalbuterol

A

another short-acting b2 agonists
inhaled (MDI and nebulizer forms)
deemed inferior to albuterol for management of acute asthma symptoms

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22
Q

what are leukotriene modifiers

A

zafirlukast and montelukast (leukotriene receptor antagonists)
zileuton (5-lipoxygenase inhibitors)

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23
Q

what are the properties of leukotrienes

A

chemoattractant for eosinophils and neutrophils
constrict bronchiolar smooth mm
increased endothelial permeability
promote mucus secretion

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24
Q

what are the indications for leukotriene modifiers

A

prophylaxis and treatment of asthma, allergic rhinitis, exercise-induced broncoconstriction

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25
Q

when are leukotriene modifiers contraindicated

A

pehnylketonuria
hepatic disease

26
Q

what is Zafirlukast

A

first FDA approved leukotriene receptor antagonist in US
2 doses - oral tablets
less effective than inhaled glucocorticoids for management of persistent asthma
preferred in asthma tx in children - not useful for treatment of acute asthma attacks

27
Q

what is montelukast

A

phophylaxis and maintenance of asthma and more commonly prescribed in US
can be used to treat chronic urticaria
usually added on after initiation of ICS in adults

28
Q

what is Zileuton

A

inhibits 5-liopoxygenase -> inhibits formation of leukotrienes
used for chronic asthma management only
common adverse effect = elevation of liver enzymes
infrequently used, 4x daily dosing
interferes with CYP metabolism

29
Q

what is the indication for methyxanthines

A

use for both orally and IV in treatment of asthma, bronchospasm and COPD (rarely); also in infant apnea
alternate treatment for asthma; not first line

30
Q

what is the MOA for methylxanthines

A

structurally similar to caffeiene
sympathomimetic -> increase HR, inotropy, BP
relaxes smooth muscle
anti-inflammatory and immunomodulatory effect

31
Q

what is theophylline

A

methylxanthine
competitive nonselective PDEi which increases intracellular cAMP, activates PKA, inhibits TNF-alpha, inhibits leukotriene synthesis
(reduce inflammation and innate immunity)
also nonselective adenosine receptor antagonists - cardiac effects

32
Q

whar are concerns with theophylline

A

narrow TRUTH IS
toxic side effects: N/D, Heart arrhythmias, CNS excitations, seizures
many drug-drug interactions (fluoroquinolone, erythromycin, some SSRIs)

33
Q

what needs to be monitored with theophylline

A

LFTs, PFTs and serum theophylline concentration

34
Q

what is aminophylline

A

only available outside the US
compound of theophylline with ethylenediamene
less potent and shorter acting
same MOA as theophylline

35
Q

what are the inidcations for inhaled corticosteroids

A

acute and or persistent asthma (mild to severe); COPD

36
Q

what is the MOA for inhaled corticosteroids

A

suppress inflammatory and immune response, and reduce edema and secretions by the following mechanisms;
controls the rate of protein synthesis
depresses the migration of polymorphonuclear leukocytes and fibroblasts
reverses capillary permeability and lysosomal stabilization at the cellular level to prevent or control inflammation

37
Q

what are the toxic effects of inhaled corticosteroids

A

cough
cataracts, thrush, hoarseness
HPA suppression
growth suppression
reduction in bone density

38
Q

what are the inhaled corticosteroids

A

budesonide (nebulized, MDI or Intranasal)
beclomethasone (nebulized or intransal)
fluticasone (propionate) (inhaled only; sub-type available for intranasal use)
mometasone (inhaled and intranasal)

39
Q

what are oral corticosteroids

A

methylprednisolone
prednisolone
prednisone

40
Q

what are long acting beta agnoists used for

A

maintenance of asthma and prevention of asthma attacks, exercise-inducted bronchoconstriction prevention and COPD management- not used in acute attack of COPD/asthma

41
Q

are long acting beta agonists monotherapy or combo therapy

A

CANNOT BE mono-therapy in asthma treatment
can be used as mono-therapy in COPD

42
Q

what is the difference from LABA and SABA medications

A

duration of action

43
Q

what are LABA drugs

A

Salmeterol
formoterol (in combo)

44
Q

what is salmeterol

A

LABA drug
available in combo with ICS and as mono-therapy (in a dry powder inhaler form)

45
Q

what is formoterol

A

only available as nebulized solution or in combo with LABA in the US
faster onset of action than salmeterol as a result of lower lipophilicity
more potent

46
Q

what are combonidation inhalers

A

LABA/ICS
SABA/anticholinergic

47
Q

what are LABA/ICS combination inhalers

A

advair (salmeterol/fluticasone)
symbicort (formoterol/budesonide)
Dulera (formoterol/mometasone)

48
Q

what is combivent

A

(albuterol/ipratropium)
SABA/anticholinergic combination inhaler

49
Q

what are mast cell stabilizers/modulators used for

A

to prevent or control certain allergic disorders
block mast cell degranulation, stabilizing the cell and thereby preventing release of histamine and related mediators

50
Q

what is Cromolyn

A

mast cell stabilizer
formerly non-steroid medication of choice for asthma tx prior to advent of LTRA
taken 4x/day
not seen to provide additive benefit with co-administered with steroids
infrequently used

51
Q

what is Omalizumab

A

recombinanat DNA-dervied humanized IgG1k monoclonal antibody that specifically binds to free human immunoglobulin E (IgE) in the blood and interstitial fluid
beings to membrane-bound for of IgE on surface of mlgE-expressing B lymphocytes

52
Q

what is omalizumab used for

A

to control severe allergic forms of asthma that are steroid resistant

53
Q

what are the AE of Omalizumab

A

anaphylaxis in 1-2/1000 cases; increase stroke and MI risk significantly (by 60%)

54
Q

what is COPD

A

chronic, irreversible obstruction to the airway
progressive
associated with decrease in FEV1.

55
Q

what are the severities of airflow limitation in COPD

A

GOLD 1 - mild (>80)
GOLD 2 - moderate (<80)
GOLD 3 - severe (<50)
COLD 4 - very severe (<30)

56
Q

what are the COPD GOLD guidelines

A

categorize -> initiate first line therapy - > follow up based on further DYSPNEA or EXACERBATIONS

57
Q

what are the indications for Ipratropium

A

COPD management, specifically to block cholinergic (vagal) mediated bronchospasm and mucus production

58
Q

what is the MOA for ipratropium

A

anti-muscarinic activity on the bronchial smooth muscle that results in decreased contractility of smooth muscle

59
Q

what are the toxic effects of ipratropium

A

local and systemic anticholinergic effects
xerostomia
urinary retention

overall well tolerated

60
Q

what is tiotropium

A

more costly alternative to ipratropium, with same indications
“long acting” anti-muscarinic medications, so only needed once daily
available in inhaled powder form

Pharm2 Mod 3: pulmonary (2 decks)

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