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Pharmacology Exam 2 > Asthma > Flashcards

Asthma Flashcards

1
Q

Albuterol (ProAir, Ventolin, Proventil)

A

Short acting Beta2-adrenergic Agonists (SABA)
Used extensively in infants & children
Absorption: bronchi, systemic concentration low
Metabolism & Excretion: Liver and urine

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2
Q

Levalbuterol (Xopenex)

A

Short acting Beta2-adrenergic Agonists (SABA)

In theory, this med may have less side effects because it is missing the S isomer that is associated with tachycardia. The R isomer causes bronchodilation. Albuterol is a mixture of R and S isomers and Levalbuterol only contains the R-isomer. However, the evidence is inconclusive whether there are fewer side effects with Levalbuterol. We prescribe this drug for older pts, but it costs $$ more than albuterol.

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3
Q

Metaproterenol (Alupent)

A

Short acting Beta2-adrenergic Agonists (SABA)

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4
Q

Terbutaline (Brethine, Brethaire)

A

Short acting Beta2-adrenergic Agonists (SABA)

Preg category B, others C

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5
Q

Bitolterol (Tornalate)

A

Short acting Beta2-adrenergic Agonists (SABA)

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6
Q

Pirbuterol (Maxair)

A

Short acting Beta2-adrenergic Agonists (SABA)

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7
Q

Multidose Inhaler (MDI)

A

MDI is the inhaler that contains a solution (what we usually see). The problem is that it can be challenging for patients who have difficulty with coordinating their hand/ breath- a spacer can help. These pts may miss getting in the drug.

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8
Q

Dry Powder Inhaler (DPI)

A

DPI contains solid particles and depends on the inspiratory effort of the patient. The nice thing is that the pt can breathe in again if they didn’t get the med in. If the pt can suck water through a straw, then s/he can use a DPI. Pts with severe lactose allergy may react to respiratory drugs in DPI form because the large particles are bound to lactose (e.g., Spiriva HandiHaler, etc.)

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9
Q

Short Acting Beta2-adrenergic Agonists (SABA)

A

MOA:
act on smooth muscle of bronchial tree to reverse bronchospasm
Adverse events:
tachycardia, palpitations, tremors, dizziness, restlessness, H/A
Drug Interactions:
Digitalis glycosides, beta blockers, TCA, MOIs
Cautions:
ischemic heart disease, CHF, stroke, hypertension, cardiac arrhythmias, seizure disorder, hyperthyroidism

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10
Q

Salmeterol (Serevent)

A

Long Acting Beta2-adrenergic Agonists (LABA)

Administered via inhaler: Absorption: bronchi, systemic concentration low

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11
Q

Formoterol (Foradil)

A

Long Acting Beta2-adrenergic Agonists (LABA)

Inhaled dry powder administered via aerolizer inhaler

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12
Q

Indacaterol (Arcapta Neohaler)

A

Long Acting Beta2-adrenergic Agonists (LABA)

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13
Q

Arformoterol (Brovana)

A

Long Acting Beta2-adrenergic Agonists (LABA)

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14
Q

Long Acting Beta2-adrenergic Agonists (LABA)

A

MOA:
Act on smooth muscle of bronchial tree to reverse bronchospasm
Adverse events:
tachycardia, palpitations, tremors, dizziness, restlessness, h/a
Drug Interactions:
Digitalis glycosides, beta blockers, TCA, MOIs
Cautions:
ischemic heart disease, CHF, stroke, hypertension, cardiac arrhythmias, seizure disorder, hyperthyroidism
Black Box warning (Salmeterol and Formoterol): Do not use as single agent
Contraindicated without use of other controller med (ICS)
Long term use only when other controllers have failed adequate control
Use shortest duration
Pediatrics: only use combination product (ICS + LABA)

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15
Q

Beclomethasone dipropionate (QVAR)

A

Inhaled Corticosteroids (ICS)

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16
Q

Triamcinolone acetonide (Azmacort)

A

Inhaled Corticosteroids (ICS)

17
Q

Budesonide (Pulmicort)

A

Inhaled Corticosteroids (ICS)

18
Q

Flunisolide (Aerobid)

A

Inhaled Corticosteroids (ICS)

19
Q

Mometasone furoate (Asmanex Twisthaler)

A

Inhaled Corticosteroids (ICS)

20
Q

Fluticasone (Flovent)

A

Inhaled Corticosteroids (ICS)

21
Q

Ciclesonide (Alvesco)

A

Inhaled Corticosteroids (ICS)

22
Q

Inhaled Corticosteroids (ICS)

A

MOA:
anti-inflammatory, inhibit the IgE and mast cell-mediated migration of inflammatory cells into bronchial tissue
Adverse events:
xerostomia, hoarseness, tongue/mouth irritation, oral candidiasis
Drug Interactions:
Ritonavir increases fluticasone, ketoconazole and fluticasone/budesonide
Cautions:
potential decrease in linear growth in children, ocular HSV, tuberculosis, oral or nasal surgery or trauma, healing nasal septal ulcers, untreated resp infection. Avoid in Cushing’s syndrome.
Please note that we advise patients to rinse their mouth after an ICS inhaler to avoid thrush in mouth and pharynx (oropharyngeal candidiasis and dysphonia).

23
Q

Zafirlukast (Accolate)

A

Leukotriene receptor antagonists (LTRA) (Leukotriene Modifiers)

24
Q

Montelukast (Singulair)

A

Leukotriene receptor antagonists (LTRA) (Leukotriene Modifiers)

25
Q

Leukotriene receptor antagonists (LTRA) (Leukotriene Modifiers)

A

MOA:
Block binding of leukotrienes to the receptor, prevent leukotriene-modulated bronchospasm; may also have anti-inflammatory properties
Cautions:
not for acute episodes, breast feeding, may need lower doses in liver disease
Adverse events:
elevated liver enzymes (zafirlukast), h/a, N/D, abd pain, insomnia
Drug interactions:
multiple with zafirlukast

26
Q

Zileutin (Zyflo)

A

Leukotriene Synthesis Inhibitor
MOA:
inhibits 5-lipoxygenase, interfering with leukotriene formation
Cautions:
Not recommended for children, over age 12 only; contraindicated in acute liver disease
Adverse events:
hepatotoxicity, behavioral disturbance, hypersensitivity
Drug interactions:
Many (CYP1A2 substrate, CYP3A4 substrate)
Evaluate liver function prior to initiating therapy and routinely

27
Q

Mast Cell Stabilizers

A

MOA:
inhibits mast cell degranulation, thus decreasing bronchial hyperactivity
Adverse events:
transient bronchospasm, cough, unpleasant taste, throat irritation
Cautions:
not used in acute episodes or status asthmaticus, caution if arrhythmias

28
Q

Cromolyn (Intal)

A

Mast Cell Stabilizer

29
Q

Neodocromil (Tilade)

A

Mast Cell Stabilizer

30
Q

Theophylline

A

Methylxanthines
MOA:
unknown mechanism
mediated by selective inhibition of PDEs; dilates pulmonary blood vessels
Adverse events:
Toxicity
Some pts with seizures 15 to 20 mcg/mL
CNS: Irritability, restlessness, seizures, insomnia
GI: reflux, heartburn
Cardiac: palpitations, tachycardia, hypotension, arrhythmias

31
Q

Theophylline Toxicity

A

Toxicity >20 mcg/mL: N/V/D, H/A, insomnia, & irritability

Toxicity > 35 mcg/mL: hyperglycemia, hypotension, arrhythmias, tachycardia, seizures, brain damage, death

32
Q

Theophylline Drug interactions

A

Many due to metabolism through CYP 450
Smoking increases clearance
Benzodiazepines are antagonized
Beta agonists may cause additive toxicity
Reduced lithium level
Low-carb/high protein diet increases clearance (ex: Atkins diet)
Charcoal-broiled foods accelerate metabolism

33
Q

Theophylline Contraindications/cautions:

A

Monitor pts: HTN, HD, CHF, h/o stroke and arrhythmia Monitor for toxicity
Prolonged clearance & half life with neonates and elderly

34
Q

Omalizumab (Xolair)

A

Immunomodulator
MOA:
Inhibits IgE binding to mast cells and basophils, decreasing mediator release
Adverse events:
Black box warning: anaphylaxis, cardiovascular & cerebrovascular event risk, injection site rxn, URI sx, migraine/ha
Cautions: acute bronchospasm, status asthmaticus, caution if anaphylaxis hx
Indicated for pts with moderate to severe persistent asthma with proven sensitivity to a perennial aeroallergen and symptoms that are inadequately controlled with inhaled corticosteroids

35
Q

Prednisone

A

Oral systemic Steroids
MOA: Inhibit release of inflammatory mediators, decrease mucous secretion, upregulate beta-adrenergic receptor numbers
Contraindications: untreated infection, chronic use in lactation, alcohol dependence; Caution: Diabetics
Adverse events: Psychosis, peptic ulcers, hyperglycemia, elevated BP, edema, bruising
Interactions: OCs may block metabolism, increased risk of tendon rupture with combined with fluoroquinolones, decreased effectiveness of phenytoin, phenobarbital, rifampin
Clinical use: Used for acute episodes not controlled with SABAs; More than 3 courses in a year indicates poor control of asthma (see dosage in exacerbation slide)

36
Q

Step Therapy for Asthma Pts 12 yrs and older

A

Step 1: SABA prn
Step 2: Low dose ICS (or cromolyn, LTRA, theophyline)
Consider desensitization
Step 3: Low dose ICS + LABA or Medium dose ICS or Low dose ICS + LTRA/ theophyline/zileutin
Step 4: Medium dose ICS + LABA or Medium dose ICS + LRTA/theophyline/zileutin
Step 5: Change to high dose ICS + other med
Consider omalizumab
Step 6: add oral steroid

37
Q

“Rule of Twos” to measure control

A

Rescue inhaler more than 2 times/week
Night time symptoms more then 2x/month
Refill rescue inhaler more than 2x/year
Peak flow over 20% less than baseline with symptoms

38
Q

Combivent

A

Ipratropium + albuterol (Combivent) is a second line quick relief medication in the treatment of asthma,

39
Q

Special populations: Pregnancy

A

Inhaled beta-agonists are drug of choice

Inhaled corticosteroids are the long-term DOC

Pharmacology Exam 2 (11 decks)

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