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CPR Exam 2 > Allergies and COPD Drugs > Flashcards

Allergies and COPD Drugs Flashcards

1
Q

What are the 2 categories of drugs used to treat asthma?

A
  1. Anti-inflammatory drugs
  2. Bronchodilators
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2
Q

What type of anti-inflammatory drugs are used to treat asthma?

A
    1. Corticosteriods (inhaled and oral)
    1. Antibodies
    1. Drugs that modify leukotriene receptor (DO NOT CONTAIN HORMONES)
      * ​lipoxygenase inhibitors
      * leukotriene receptor blockers
      • —DO NOT CONTAIN HORMONES—-
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3
Q

What types of bronchodilators are used to treat asthma?

A
  1. B-agonists (most effective)
  2. Anti-cholinergics
  3. Methylxanthines
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4
Q

Name the SABA

A
  • 1. Albuterol
  • 2. Terbutaline
  • 3. Metaproterenol
  • 4. Pirbuterol
  • 5. Levalbuterol
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5
Q

Name the LA-BA

A
  1. Fomoterol
  2. Salmeterol
  3. Indacaterol
  4. Vilanterol
  5. Oldaterol
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6
Q

Name anti-cholinergic drug

A
  • 1. Atropine
  • 2. Ipatropium
  • 3. Tiotripium
  • 4. Aclidinium
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7
Q

Name the methylxanthines

A
  1. Theophylline
  2. Theobromine
  3. Caffeine
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8
Q

Name the inhaled corticosteroids

A
  1. Beclamethasone
  2. Budesonide
  3. Ciclesonide
  4. Flunisolide
  5. Fluticasone
  6. Mometasone
  7. Triamcinolone
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9
Q

Oral and Parenteral Corticosteroids (OCS)

A

1. Prednisone

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10
Q

Monoclonal Ab drugs

A

1. Omalizumab

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11
Q

Leukotriene receptor ANT

A
  • 1. Zafirlukast
  • 2. Montelukast
  • 3. Pranulukast

Both are reversible

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12
Q

Lipooxygenase inhibitor

A

1. Zileuton

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13
Q

MOA of B2-AGO?

A

+ AC => ↑ cAMP => bronchodilation.

  • relax airway smooth muscle, where they act as functional ANT and reverse constriction.
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14
Q

MOA of theophylline

A

2 mechanisms on airways with reversible obstruction:

    1. Inhibit PDE, preventing the breakdown in cAMP => ↑ in CAMP => bronchodilate
    1. Inhibits adenosine, which is a bronchoconstricts => suppresses response of airway to stimumi (prophlactic)
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15
Q

MOA of muscarinic ANT (anticholinergics)

A
  1. Prevent binding of ACh, which usually bronchoconstricts => inhibit parasympathetic inpulse => prevent bronchoconstriction
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16
Q

What is the major route of inhaled corticosteroids and B2-agonists, and what type of effect does it have?

What is the minor route?

A
  • Major route (80%): swallow, but produces a minor effect
  • Minor route: inhaled, but produces a MAJOR effect.
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17
Q

For inhaled drugs, why is swallowing the major route, but the effect is less?

A

Absorbed from GI tract => liver, where it undergoes 1st pass metabolism.

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18
Q

Bronchodilators act on airway smooth muscle to do what?

A

reverse bronchoconstriction

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19
Q

What is the most commmonly used drug to treat asthma/COPD?

A

B2-AGO

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20
Q

What is the only β2 drug available for SQ injection?

A

Terbutaline

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21
Q

What are the indications for use of Terbutaline?

A

Ppl over 12 YO to treat and prophalax against bronchospams in [asthma, bronchitis and emphysema]

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22
Q

What is the black-box warning for Terbutaline?

A

Not recommended as a medication for tocolysis (utermine contractions/preterm labor)

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23
Q

Which β2-agonist for asthma is not recommended for pt’s with sulfa allergies?

A

Terbutaline

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24
Q

What are side effects of Terbutaline?

A
  • 1. HA
  • 2. N
  • 3. Palpitations
  • 4. Tachycardia
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25
Q

What are indications for Albuterol?

A

1. Asthma

2. Acute bronchitis

3. Bronchilitis

4. COPD

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26
Q

Which life-threatening AE can occur after tx w/ Albuterol?

A
  1. Paradoxical bronchospasm
  2. make asthma worse
  3. CV
  4. immediate hypersensitivity reactions
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27
Q

AE of Albuterol

A
  • 1. HA
  • 2. Dizziness
  • 3. Insomnia
  • 4. Dry mouth
  • 5. Cough
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28
Q

What are 2 indications for the use of the β2-agonist Metaproterenol?

A
  • Bronchodilator for bronchial asthma
  • Reversible bronchospasm which may occur in assoc. w/ bronchitis and COPD

–

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29
Q

What are 2 cautions/warnings associated with the use of Metaproterenol?

A
  • Can produce significant cardiovascular effect in some pt’s, as measured by pulse, BP, sx’s and/or ECG changes
  • Can produce paradoxical bronchospasm(can be life threatening) bc aersol
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30
Q

Which drug class should not be used concomitantly with Metaproterenol?

A

Beta-adrenergic aerosol bronchodilators due to additive effects

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31
Q

Which β2-agonist may be used with or without concurrent theophylline and/or corticosteroid therapy?

A

Pirbuterol

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32
Q

What are the indications for Pirbuterol?

A
  • Pts 12 YO or older to prevent and reverse bronchospasms with reversible bronchospasms (inc asthma)
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33
Q

What are significant AE of Pirbuterol?

A

CV affects, like other inhaled B adrenergic AGO

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34
Q

What are the indications for the use of the β2-agonist, Levalbuterol?

A
  • 4 YO or older to treat or prevent bronchospams in reversible obstructive airways disease
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35
Q

Signifiant AE of Levalbuterol?

A

Life-threatening paradoxical bronchospasms

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36
Q

What are the 4 long-acting β2-agonists?

A
  • 1. Fomoterol
  • 2. Salmeterol
  • 3. Indacterol
  • 4. Vilanterol
  • 5. Oldaterol
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37
Q

What are the 3 indications for use of the LABA, Fomoterol?

A
  1. Asthma
    * Pts over 5 YO as an add on with a med that contorls asthma long-term (inhaled corticosteroids)
  2. Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥5 y/o
  3. COPD: Maintain/prevent bronchoconstriction
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38
Q

What are cautions/warnings for the use of LABA’s in asthma?

A
  • ↑ risk of asthma-related death and asthma-related hospitlizations
  • MUST be used concomitantly with an inhaled corticosteroid for asthma (fomoterol and salmeterol)
39
Q

What are the 3 indications for use of the LABA, Salmeterol?

A
  1. Asthma
    * Pts over 4 YO as an add on with a med that contorls asthma long-term (inhaled corticosteroids)
  2. Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥4 y/o
  3. COPD
    * Maintenance tx of bronchosapsm in pt’s with COPD

SAME THING AS FOMOTEROL, BUT CAN BE USED IN 4 YO OR YOUNGER

40
Q

What is the indication for the use of the LABA, Indacaterol and Vilanterol?

A

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

41
Q

What is the indication for use of the LABA, Olodaterol?

A

Used as LONG-term, 1x/daily to help bronchodilate in pt’s with COPD(chronic bronchitis and emphysema)

42
Q

What 4 [ICS +LABA} combination inhalers can we have?

A
  1. ICS + LABA
  2. Fluticasone + Salmeterol
  3. Formoterol + Mometasone
  4. Formoterol + Budensonide
43
Q

If pt has mild intermittant breathing problems, what do you prescribe?

What about mild persistant?

Very severe persistant?

A
  • SABA
  • SABA + Low dose ICS
  • SABA + High dose ICS + LABA + OCS
44
Q

Which anticholinergic drug is indicated for use as a bronchodilator for maintenance tx of bronchospasm associated with COPD, including chronic bronchitis and emphysema?

A

Ipatropium

45
Q

Which anticholinergic drug is given 1/day for long-term maintenance tx of bronchospasm associated with COPD, and for reducing COPD exacerbations?

A

Tiotroprium

46
Q

What is the indication for use of the anticholinergic drug, Aclidinium?

A

LONG-term, maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema

47
Q

Which anti-cholinergic drug is a potent ATROPINE ANALOG that is poorly absorbed, thus, does not have all of the systemic effects of atropine?

A

Ipratropium

48
Q

Anti-cholinergic drugs are used mainly to treat what?

A

COPD

Ipratropium + Aclidinium treats COPD + chronic bronchitis + emphysema

49
Q

What are the Methylxanthines (Theobromine, Theophylline) used to treat for?

What is theobromine present in?

A
  • Airway obstruction caused by
  • asthma
  • chronic bronchitis
  • emphysema

Chocholate

50
Q

What methylxanthine is used to in a lot of prophylactic measures?

A

Theophylline

51
Q

Theophylline should be used with extreme caution in pt’s with what 3 underlying clinical conditions?

A
  1. - Active peptic ulcer disease
    • Seizures
    • Cardiac arrhythmias (NOT including bradyarrhythmias)
52
Q

What is given as the first-line therapy for persistent asthma; if sx’s are not controlled at low doses you may add what?

A

Inhaled corticosteroids (ICS); can add LABA as next step

53
Q

How do corticosteroids work as anti-inflammatory meds?

A

Stop transcription of genes that encode inflammatory cells

54
Q

What are the BEST controllers/supressors for asthma but do NOT correct the problem?

55
Q

How does ICSs work as anti-inflammatory meds?

A
    1. Reduce eosinophils in airway and sputum
    1. Reduce activated T cells and mast cells in mucosa.
56
Q
  • How often is ICS administered?
  • How quickly do they work in improving asthma symptoms?
  • What are 3 other effects of ICS?
A
  1. 2x/day
  2. Improve asthma symptoms and lung function in DAYS
  3. Other effects
    1. Prevent excericse-induced asthma and nocturnal exacerbations
    2. Reduce AHR (airway hyperresponsiveness) over months
    3. If given early, can prevent irreversible damage to airways that occur in chronic asthma.
57
Q

Withdrawal of ICS results in what and what does this imply?

A

Control of asthma slowly deteriorates, thus, implying that they SUPRESS inflammation and symptoms, but do NOT cure,

58
Q

Are ICS for immediate/MRGNT use?

59
Q

What are the 2 indications for the use of the ICS, Beclomethasone?

A
  • Pts 5YO or older to maintain and prophylact against asthma
  • Tx of asthma in pt’s who require ORAL corticosteroid therapy to reduce or eliminate the need for systemic corticosteroids
60
Q

Which 2 ICS’s require special care if used in pt’s who are transferred from systemically active drugs to less systemically available inhaled drugs which can cause death d/t adrenal insufficiency?

A

- Beclomethasone

- Triamcinolone

61
Q

What happens after the withdrawal for systemic corticosteroids?

A

It takes months for HPA to recover function

62
Q

What is the indication for use of the ICS, Budesonide?

A

Pediatric and adults 6YO older to maintenance tx of asthma prophylactic

63
Q

Which pt’s should the ICS, Budesonide not be used in?

A

For primary tx of status asthmaticus or other acute episodes of asthma, where intensive measures are needed

  • Pts with severe hypersenitivity to milk proteins
64
Q

What is the indication for use of the ICS, Ciclesonide?

A

Adolescents and adults 12YO older to maintain tx of asthma prophylactic

65
Q

When is the ICS, Ciclesonide not indicated for use and should be avoided in the presence of what infection?

A
  • Not indicated for the relief of acute bronchospasm
  • Not recommended in presence of Candida albicans infection of the mouth and pharynx, tuberculosis, fungal, bacterial, or parasitic infections
66
Q

What are the 2 indication for use of the ICS, Flunisolide?

A
  • Maintenance and prophylactic tx of asthma in adults and pt’s ≥6 y/o
  • Asthma pt’s needed oral corticosteroid therapy. Adding flunisolide may ↓ or eliminate the need for other oral corticosteroids
67
Q

Use of the ICS, Flunisolide is contraindicated for use in which pt’s?

A

Primary tx of status asthmaticus or other acute episodes of asthma where intensive measures are required

  • like Budesonide
68
Q

Indications for Flutacisone

A
  • Maintain and prophylact against asmtha in pts 4 YO or older
  • not indicated for
69
Q

Fluticasone is not indicated for whom?

Can cause what?

A
  • Acute bronchospasms
  • Candida albican infection, so monitor pt and tell to wash mouth
70
Q

ICS are used to maintain asthma and prophalyx in patients ____ old.

  • 1. Beclamethosone
  • 2. Budesonide
  • 3. Ciclesonide
  • 4. Flunisolide
  • 5. Flutacasone
  • 6. Mometasone
  • 7. Triamcinolone

Mark which ones have another use

A
  • 1. Beclamethosone: 5 YO and older *
    1. Budesonide: 6 YO and older
    1. Ciclesonide: 12 YO and older
  • 4. Flunisolide: 6 YO and older *
    1. Flutacasone: 4 YO and older
    1. Mometasone: 4 YO and older
  • 7. Triamcinolone: ____. *
71
Q

Which ICS is also used in patients who are require a systemic corticosteroid, where adding could reduce the need for the systemic corticosteroid?

A

Triamcinelone

72
Q

Which ICS is also used in patients who are require a oral corticosteroid, where adding could reduce the need for the oral corticosteroid?

A

Flunisolide

73
Q

Which ICS is also used in patients who are require a oral corticosteroid, where adding could reduce the need for a systemic corticosteroid?

A

Beclamethasone

74
Q

Which 2 ICS used for asthma are contraindicated in pt’s with:

  • status asthmaticus or other acute episodes of asthma where intensive measures are required
    • pt’s with a known hypersensitivity to milk proteins?
A
  • -Budesonide
  • -Mometasone
75
Q

What systemically less available drugs need to be watched when they are switched to from a systemically available, because the patient can die from adrenal insuffiency?

A

1. Beclamethosone

2. Triamcinolone

76
Q

When are oral corticosteroids used for asthma and in conjunction with what other drug class?

A

With SABA for moderate-severe asthma flare-ups

77
Q

Which is most lilkely to cause sxs: oral or inhaled corticosteroids?

78
Q

What is the oral corticosteroid which may be used for moderate to severe asthma flare ups in combo with a short acting beta-agonist?

A

Prednisone

  • -Anti-inflamm/immunosupressive agent
  • -Tx endocrine conditions
79
Q

What should patients of Prednisone be monitored for?

A

HPA axis supressions

  • -Cushings
  • -Hyperglycemia
  • If sx come about, taper off
80
Q

What are the 3 leukotriene antagonists used for asthma?

A
  • Montelukast
  • Zafirlukast
  • Pranulukase
81
Q

Leukotrient ANT are taken through which hole?

Are ______ and have ________ action.

More or less effective than ICS?

WHAT IS KEY TO THEIR USE?

A
  • Oral
  • Bronchodilate and anti-inflammatory action
  • Less
  • Glucocorticoid sparing; meaning that they potentiate the actions of corticosteroids
    *
82
Q

Why are Leukotriene receptor ANT prescribed for?

how

A

TREATMENT and PREVENTION of

acute asthmatic attacks

bind to receptor and prevent inflammatory cascade.

83
Q

What is the MOA of Montelukast?

A

Binds w/ high affinity and selectivity to the CysLT1 receptor; INHIBITING the physiologic actions of LTD4

84
Q

Montelukast is primarily prescribed for what?

A

Treat allergies and prevent asthma attacks

85
Q

Which leukotriene receptor antagonist used for asthma is associated with hepatotoxicity as an AE?

A

Zafirlukast

86
Q

What is Zafirlukast prescribed for?

A

Prophylaxis and chronic tx of asthma in pts ≥5 y/o

87
Q

What is Zafirlukast MOA?

A

Selective and COMPETITIVE leukotriene receptor ANT to LD4 and LE4, components of SRSA (slow-reacting substance anaphalayxis)

88
Q

What is the MOA of Zileuton?

A

Inhibitor of 5-lipoxygenase and thus inhibits leukotriene (LTB4, LTC4, LTD4, and LTE4) formation

89
Q

What is the indication for the use of Zileuton?

A

Prophylaxis and chronic tx of asthma in pt’s ≥12 y/o; NOT acute asthmatic attacks

90
Q

Zileuton is not indicated for use in pt’s with what underlying disease/abnormalities?

A

- Active liver disease

or

  • Persistent hepatic function enzymes ≥3x upper limit of norma
91
Q

What is the MOA of Omalizumab, a monoclonal AB?

A
  • Binds to free IgE, decreasing binding to cell
  • Blocks binding to FCεRI, decreases exporesson of these receptors
    • Causes ↓ release of mediators from mast cells, basophils, and eosinophils
  • Decrease allergic inflammationa and prevents exacerbation of asthma and reduces symptoms
92
Q

What are the 2 indications for the use of Omalizumab?

A
  • Moderate to severe persistent asthma in pt’s ≥6 y/o w/ (+) skin test or invitro reactivity to perennial aeroallergen and sx’s inadequately controlled w/ ICS
  • Chronic idiopathic urticaria in pt’s ≥12 y/o who who dont respond to H1 antihistamine tx
93
Q

What is a black box warning for Omalizumab?

A

Administer only in a healthcare setting prepared to manage anaphylaxis that can be life threatening

94
Q

Pt’s w/ features of both asthma + COPD may benefit from what treatment?

A

ICS + LABA + LAMA?

CPR Exam 2 (29 decks)

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