Asthma Flashcards
Which class of drugs is best for the immediate-phase response of an asthma attack
bronchodilators
Which class of drugs is best for the late phase response of an asthma attack
anti-inflammatory drugs
Drugs that can trigger an asthma attack
cardioselective and nonselective beta blockers, calcium antagonists, dipyridamole, NSAIDs
Long term control asthma medications
corticosteroids LABA leuktriene modifiers methylxanthines cromolyn anti IgE
Quick relief for asthma
SABA
anticholinergics
systemic corticosteroids
This class of drug depresses the inflammatory response and edema in the respiratory tract and diminishes bronchial hyper-responsiveness
ICS
This class is the most effective long term control therapy for persistent asthma and is the only therapy shown to reduce the risk of death from asthma
ICS
CAUTION in growing children
ICS
Local ADRs include thrush , dysphonia, reflex cough and bronchospasm
ICS
Systemic effects could potentially include HPA axis suppression, impaired growth in children and dermal thinning (dose dependent)
ICS
ICS messes with BMD, cataracts, and glaucoma in kids. T or F
FALSE! ICS at low to moderate dose is safe!
This class is not a substitute for anti-inflam therapy and should not be used as monotherapy. Not for acute exacerbations
LABA
This class causes loss of protection with methacholine, histamine, and exercise
LABA
This class should not be used with CYP3A4 inhibitors- ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin
LABA
This class of drug competitively antagonizes leukotriene receptors D4 and E4 in the bronchiolar muscle, antagonizing endogenous molecules that cause bronchodilation
leukotriene receptor antagonists
this class is an alternative treatment of mild persistent asthma
LRA
CONTRAINDICATIONS in pregnancy, caution in elderly
LRA
These two LRAs are associated with liver toxicity, contraindicated in pts with liver disease
Zileuton and Zafirlukast
this class can cause GI disturbances, HA, respiratory infections
LRAs (zafirlukast and montelukast for resp infections)
this LRA interacts with warfarin, increasing prothrombin time
zafirlukast
this LRA doubles theophylline concentration, increases prothrombin time (warfarin), and doubles propranolol levels
zileuton
this class increases cAMP levels in the bronchial smooth muscle cells inhibiting phosphodiesterase- causes smooth muscle relaxation and bronchodilation
Methylxanthines
This class is indicated in refractory patients. It can be used as monotherapy or in combo with an ICS
methylxanthines
Dont use this class if you are a child under 4, have cardiac disease, HTN, or hepatic impairment
methylxanthines
This class has a narrow theraputic window, tons of drug-drug interactions, and safer alternatives
methylxanthines
This class interacts with cimetidine, macrolides, quinolones and is a CYP1A2 and 3A4 substrate
methylxanthines
this class can cause nausea, irritability, insomnia, HA, vomiting, tachyarrhythmias, ventricular arrhythmias, seizures
methylxanthines
this class stabilizes mast cells preventing the release of inflammatory mediators
mast cell stabilizers
indications for this class include patients less than 20 with severe allergic disease and moderate asthma OR pregnancy
mast cell stabilizers
ADRs for this class include cough, transient bronchospasm, throat irritation
mast cell stabilizer
this class is reserved for moderate to severe persistent asthma in patients 12 or older who are not controlled on other therapies (not first line therapy)
omalizumab
this drug works bc it is a recombinant monoclonal antibody that binds IgE on mast cells and basophils, so it limits the release of mediators of allergic response
omalizumab
this drug has a favorable safety profile, but a BBW for anaphylaxis
omalizumab
this class decreases inflammation by suppression of migration of leukocytes and reversal of increased capillary permeability
systemic corticosteroids
this class is used for control of chronic symptoms in people with severe asthma
systemic corticosteroids
this class stimulates b2 adrenoceptors, leading to a rise in intracellular cAMP- subsequent smooth muscle relaxation and bronchodilation
SABA
this class is indicated for relief of bronchospasm during acute exacerbations, and pretreatment for exercise induced bronchoconstriction
SABA
ADRs include fine tremor, tachycardia, hypokalemia
SABA
this class is indicated for relief of acute bronchospasm, can provide additive effects to B2 agonists in an acute setting
anticholinergics
treatment of choice for bronchospasm due to B blockers
anticholinergics
Contraindicated in glaucoma and pregnancy
anticholinergics
this class is important in the treatment of severe acute asthma exacerbations
systemic corticosteroids
mild intermittent asthma treatment
SABA
mild persistent asthma treatment
low dose ICS, SABA
moderate persistent asthma treatment
low dose ICS, LABA, SABA
severe persistent asthma treatment
medium or high dose ICS, LABA, oral glucocorticosteroid (SABA)
COPD pts get adequate relief from bronchodilators and anti-inflammatory agents. T or F
F
primary therapy for COPD
oxygen
Should I administer O2 to a pt with severe COPD who is retaining CO2
NOPE- depresses resp drive
DOC in COPD patients
anticholinergic agents (beta 2 agonists should be combined)
antibiotics can be used in a COPD patient when?
increased dyspnea, increased sputum volume, increased sputum purulence
