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pharm > anti- inflammatory drugs > Flashcards

anti- inflammatory drugs Flashcards

1
Q

Leukotrienne antagonist

A

Montelukast (singulair)
categorized as a leukotrienne receptor antagonist
does not alter leukotrienne production
binds to a leukotrienne receptors and inhibits effect on bronchial smooth muscle
(called CystLT receptors)
PO- Pill form
once daily, when for routine maintenance.

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2
Q

clinical use for leukotrienne antagonist

A 
part of maintenance therapy for asthma 
add on therapy after on ICS 
an alter option during therapy escalation 
can lower use of B2 agents 
allow lower steroid levels 
Also effective for EIA
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3
Q

montelukast negatives

A

only inhibits one pathway of inflammation
must be use as part of a drug regimen
doesn’t stop leukotrienne production

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4
Q

side effect of montelukast

—– Leukotrienne antagonist——-

A

headache
neuro-psychiatic
eosinophilia
churg- strauss vasculitis (inflammation of the vessels)

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5
Q

Roflumilast (Daxas)

—- Phosphodiesterase 4 inhibitor ——–

A

Decreases inflammation by decreasing the ability of inflammatory cells to produce mediators
elevated cAMP inside immune
inhibition or prevents fibrotic changes
inhibition of airway infiltration of WBCs
use on mod to severe COPD
maintenance therapy

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6
Q

Daxas (phisphodiestarase 4 inhinitor) dosing

A

Once daily
Oral (PO)
Pill form
may take up 4-8 months before effects are seen

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7
Q

Roflumilast side effects

A 
significant incidence of neuro- Psychiatric changes 
Diarrhea (about 12% of patients ) 
weight loss (avg 10lbs)
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8
Q

monoclonal antibody drugs

A

Monoclonal Antibodies are lab created antibodies targeting specific human mediators
A significant area of Pharmacology for the treatment of:
Cancers
Autoimmune disorders (transplant rejection)
Inflammatory conditions (Crohn’s, Asthma)
COVID

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9
Q

Omalizumab (xoliar)

monoclonal antibody for asthma

A

produced by genetically modified chinese hamster ovary cells
binds to IgE and prevents it from binding to mast cells

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10
Q

Omazumab (xolair) dosing

A

given by SI
usually every 4 weeks (bur as frequent as 2 weeks)
circulatinf IgE starts to decrease within 1 hr after administration
cause 96% of IgE decrease

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11
Q

Omaxumab (xolair ) usage

A

use for the management of chronic asthma
After ICS, LABA and alternate therapies are inadequate
use less ICS
have less exacerbations

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12
Q

Omalizumab side effects

A

pain, redness around injection site

very infrequent incidence of anaphylaxis

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13
Q

Methylxanthines

A

older class of drug
found in coffer, tea and cocoa
added on later for the Tx of COPD and asthma

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14
Q

What are the two drugs in methulxanthines ?

A

– theophylline—
Used in COPD pts
Caffeine
— used in preterm infants with :apnea of prematurity ___

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15
Q

Theophylline

A

minimal bronchodilating properties
improves diaphragm strength from increase muscle contractility
mild cardiac improvement
CNS stimulation increase ventilatory drive
Mils diuresis

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16
Q

dosing of theophylline

A

PO
sustaines release tablet, serum
metabolized by the liver at different rates person to person
may use loading dose to reach serum level then adjust based on lab work

17
Q

theophyllines (negs)

A

changes from person to person
high serum variation with hepatic or renal dysfunction
wide range of drug interaction with a wide array of drugs

18
Q

theophylline side effects

A

CNS- headaches, anxiety, insomnia, seizures
CVS– dysrhythmias, palpitations
GI– nausea, vomiting, anorexia, diarrhea, GER

19
Q

Caffeine (methylxanthines )

A

used in neonates to streghtne drive to breath
apnea of prematurity
diffuses easier into CSF than theophylline
has potent CNS and respiratory stimulants effects

20
Q

Caffeine use and dosing

A

given orally or by IV
has a wide therapeutic range
dosing is based of weight

21
Q

Magnesium sulfate

A

used in sever asthma exacerbations when respiratory failure is impending

22
Q

use of MgSO4

A

Inhibits Calcium uptake into bronchial smooth muscle
Potentiating the effects of Beta2 Agonists
Inhibiting Histamine release from Mast cells
Blocking AcH release in cholinergic nerve endings

only use when other options have been tried

23
Q

administration of MgSO4

A

given via IV over 20 mins
dosage is weight based
usually just one dose is given

24
Q

Torsades de pointes (MgSO4)

A

a lethal heart rhythm—-may help in converting to stable rhythm

25
Q

preeclampsia

A

a syndrome characterized by hypertension in pregnant mothers.
preemclampsia decreases BP and seizure risk, used to prolong pregnancy by 1-2 days

26
Q

Asthma severity

A

based on two criteria
symptom control
risk of exacerbation
severity is establish after 1-2 months after drug regimen initiated

27
Q

assessment of asthma severity

A 
frequency of symptoms 
recue medication use 
frequency of exacerbations 
airflow  restriction 
airflow restriction on pulmonary function resting 
existing co- morbidities
28
Q

Reliever therapy

A

Low dose ICS-LABA

or SABA

29
Q

maintenance therapy

A

an increasing escalation of therapy involving multiple drugs

30
Q

MIld asthma

A 
symptoms less than 2 times a month 
low ICS-LABA PRN (50-100mg) 
no routine medication is required 
Fluticason and salmeterol 
budenoside/ formoterol 
mometasone/ formtorerol 
fluticasone/ vilanterol
31
Q

Mod Asthma

A 
for symptoms more frequent than twice a month, but not daily 
maintenance option- 
low dose ICS, with SABA relieve ( beclomethasone + salbutamol)  
or 
PRN ICS LABA combo 
futher add on 
daily LTRA (Montelukast 
reliever therapy 
PRN low dose ICS- LABA 
budesonide/ formoterol
32
Q

Severe Asthma

A 
symptoms most days or symptoms frequently causing night time waking 
preferred maintenance option 
Medium dose ICS-LABA combo ( 200-400mg)
further maintenance option 
high dose ICS (500-600)
add on : 
LAMA or LTRA 
reliever therapy 
ICS-LABA combo 
fluticasone/ salmeterol
33
Q

uncontrolled asthma

A

severe asthma with the inability to control symptoms
High dose ICS-LABA
momentasone/ formoterol (zenhale) 500-600 mg
add on
LAMA or Omalizumab Xolair
reliever therapy
ICS-LABA combo drug

34
Q

Gold guidelines

A

A.) minimal symptoms, low exacerbation risk (SAMA pm or SABA prn )

b. ) moderate symptoms, Low exacerbation risk (LAMA or LABA)
c. ) minimal symptoms, high exacerbation risk (ICS+LABA) or LAMA
d. ) frequent symptoms, high exacerbation risk ICS +LABA and or LAMA

pharm (11 decks)

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