asthma and COPD Flashcards
Isoproterenol (Isuprel®)
B- Adrenergic Agonists
MOA Albuterol (Ventolin®; Proventil®)
- Selective B2 agonists
-
Short Acting
- rescue
MOA of Ipratropium (Atrovent®)
Muscarinic antagonist : Bronchodilator
MOA Theophylline (Theo-Dur®)
- increases cAMP - Phosphodiesterase inhibitor
- blocks adenosine receptor
- effect: relaxes smooth muscle, stimulates CNS and heart
Fluticasone (Flovent®)
inhaled corticosteroid
Montelukast (Singulair®)
Leukotriene Inhibitors
MOA of Salmeterol (Serevent®)? use
- long acting B2 agonist
- prevention and prophylaxis
Formoterol/mometasone (Dulera)
long acting bronchodilators
MOA of Omalizumab (Xolair)
- monoclonal antibody to IgE
- prevents binding of IgE to cells associated with allergic response
list treatment strategies for asthma
- dilate airways
- decrease inflammation
- prevention
bronchioles are constricted by and relaxed by receptors
- contstricted: cholinergic innervation
- relaxed: beta- 2 receptors
typical symptoms of asthma
- wheeze (not all asthmatics wheeze)
- tightness, burning feeling, SOB
- mucous
MOA of Theophylline (Theo-Dur®)
-
inhibits PDE which breaks down cAMP
- cAMP needed for bronchodilation
what is going on to the airways in COPD
- chronic bronchitis
- cilia immobilized- particles not kept out -> susceptible to infection
- airways narrowed
- increased mucous -> chronic cough
what is going on to the airways in emphysema
- walls of alveoli break down
- less surface area available for transfer of gas
- fibrosis, loss of elasticity
what are the most widely used treatment for asthma? MOA?
- B2 selective receptor agonists
- increase cAMP -> relax airway smooth muscle and inhibit histamine release
B2 selective receptor agonists take how long to have an effect? effects generally last?
- act immediately
- generally last 4-6 hours
Salmeterol should always be combined with what
- a steroid
- Salmeterol/fluticasone (Advair)
- to help reduce tolerance
effect of Salmeterol/fluticasone takes
- 20-30 min
side effects of short acting B2 agonists
- tachycardia
- nervousness
- dizziness
- tremor
route of administration of Ipratropium (Atrovent®)? when is it used
- inhaled
- useful for patients intolerant of B2 agonists
- first line: COPD
Ipratropium (Atrovent®) is often combined with
- albuterol -> combivent
when is Theophylline (Theo-Dur®) used
- for asthma or COPD not controlled by B agonists or muscarinic antagonists
- generally long acting form used
therapeutic index of Theophylline (Theo-Dur®)
- low
- blood level important
- may differ with generics
side effects of Theophylline (Theo-Dur®)
- tachycardia, arrhythmias
- seizures
List the three anti-inflammatory drug classes
- corticosteroids
- leukotriene inhibitors
- Cromolyn sodium
Effects of inhaled corticosteoids
- decrease inflammation
- reduce bronchial reactivity
- improve response to B agonists
when do inhaled corticosteroids come into tx of asthma
- first line of treatment
- combined with SABA, before a LABA is brought on board
side effects of inhaled corticosteriods
- oral candidiasis (thrush)
- hoarseness
when is Omalizumab (Xolair) used
- moderate to severe allergic asthma
side effects of Omalizumab (Xolair)
- rash
- injection site reaction
- small decrease in platelets
when are the “Lukast”s like Montelukast used
- usually given as add on if corticosteroids aren’t enough
- no effect on attack in progress
MOA of Zileuton (Zyflo®)
Leukotriene Inhibitors
unique use of Zileuton (Zyflo®)
may decrease aspirin sensitive asthma
List the asthma step therapy
- short acting beta agonist: as needed
-
inhaled corticosteroid
- or Cromolyn sodium
- or leukotriene inhibitor
- long acting beta agonist or bronchodilator
- add oral steroid when needed
MOA of Cromolyn sodium
- inhibits release of histamine from mast cells- not a bronchodilator
- used mainly in children
- taken 4 x /day for prevention
first line drug for COPD
Ipratropium (atrovent): muscarinic antagonist
