Not to be used in acute setting. Anti-inflammatory class - Cortiocosteroids - Leukotrinene modifiers - Anti-IgE antibody Bronchodilators - LABA's - Anti-cholinergic agents.

asthma and COPD Flashcards by Justin Armstrong

Montelukast

a LTC4 and LTD4 receptor inhibitor. prevents the bronco constriction caused by leukotrienes.

Used as alternative or additive to ICS + LABA in moderate persistent asthma

taken orally
1X DAILY

APPROVED FOR FOR CHILDREN >1 Y.O.

Can cause hypersensitivity and eosinophilia

How well did you know this?

Not at all

Perfectly

Zileuton

5-lipoxygenase inhibitor

Used as alternative for ICS in Milder persistent asthma

Used as alternative or additive to ICS + LABA in moderate persistent asthma

this prevents for the formation of leukotrienes

Taken orally
GIVEN 2X DAILY

APPROVED FOR CHILDREN >12 Y.O.

Can cause liver toxicity, and Flu like symptoms

How well did you know this?

Not at all

Perfectly

Zafirlukast

a LTC4 and LTD4 receptor inhibitor. prevents the bronco constriction caused by leukotrienes.

Used as alternative or additive to ICS + LABA in moderate persistent asthma

Taken orally
GIVEN 2X DAILY

APPROVED FOR CHILDREN >5 Y.O.

Can cause liver toxicity, hypersensitivity, eosinophilia

How well did you know this?

Not at all

Perfectly

Budesonide

Corticosteroid
high potency
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Fluticasone

Corticosteroid
high potency
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Beclomethasone

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Flunisolide

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Mometasone

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Prednisone

Systemic Corticosteroid

Used for severe asthma attacks and should be tapered off once control is established

Slow onset because they effect gene transcription

has a high first pass metabolism

suppress inflammatory genes and express anti-inflammatory genes

How well did you know this?

Not at all

Perfectly

Omalizumab

A anti-IgE antibody. used to prevent the sensitization of mast cells and basophils.

ONLY used when environmental or occupational allergens provoke asthma.

Block Box warning -> can produce anaphylaxis as easy as after first dose or up to a year later. (have EPI on hand)

How well did you know this?

Not at all

Perfectly

Asthma relievers

SABA’s

quick onset and last for a for a few hours

How well did you know this?

Not at all

Perfectly

Asthma controllers

Not to be used in acute setting.

Anti-inflammatory class

Cortiocosteroids
Leukotrinene modifiers
Anti-IgE antibody

Bronchodilators

LABA’s
Anti-cholinergic agents.

How well did you know this?

Not at all

Perfectly

Theophylline

this drug has both characteristics of a asthma reliever as well as a controller.

Given Orally

Has a very narrow therapeutic window. (10-20mg/L)

Inhibits PDE4 to increase cAMP as well as blocks adenosine receptors

Side effects can be like caffeine stimulated the CNS making nervousness and restlessness.

How well did you know this?

Not at all

Perfectly

SABA’s

should be used as soon as onset of symptoms or 10 min before exposure.

Albuterol -> inhaled
Levalbuterol -> inhaled
Metaproterenol -> oral
terbutaline -> oral

How well did you know this?

Not at all

Perfectly

LABA’s

used in long term therapy when you are using a SABA to much

Salmeterol
formoterol

Never given as mono therapy because a increased risk of death.

How well did you know this?

Not at all

Perfectly

contraindicated drugs

Any Beta antagonist

Suffix -lol

Contraindications in Corticosteroid therapy

Children -> inhibit grown

Adults -> can cause thrush because of immunosuppression (wash mouth out with water)

Post menopausal women systemic dosing -> can aggravate osteoporosis

Prednisolone

Systemic Corticosteroid

Used for severe asthma attacks and should be tapered off once control is established

Slow onset because they effect gene transcription

has a high first pass metabolism

suppress inflammatory genes and express anti-inflammatory genes

Dexamethasone

Systemic Corticosteroid

Used for severe asthma attacks and should be tapered off once control is established

Slow onset because they effect gene transcription

has a high first pass metabolism

suppress inflammatory genes and express anti-inflammatory genes

Moderate persistent asthma

a patient that has a daily attack

FEV1 -> 60-80%

give medium dose ICS plus LABA

use SABA for attacks

Mild persistent asthma

A patient that has a attack more than 2 times per week.

FEV1 is near normal

Give ICS as well as still using the SABA

Combination products

Budesonide/ formoterol
Fluticasone/ salmeterol

Used in moderate persistent asthma or sever persistent asthma.

Important to use combination drugs because monotherapy with a LABA has a increased risk of death.

Salmeterol

A LABA that you never want to use as montotherapy because it has a increased risk for death. give with another controller medication

formoterol

A LABA that you never want to use as montotherapy because it has a increased risk for death. give with another controller medication

peptide leukotrienes

LTC4, LTD4, LTE4

Aspirin-sensitive asthma

Associated with excessive leukotriene production. Give Zileuton, Montelukast, Zafirlukast.

Excercise induced asthma

leukotriene modifiers Zileuton, Montelukast, Zafirlukast all work to the same degree to prevent exercise induced bronchospasm.

Aminophylline

Inhibits PDE4 to increase cAMP as well as blocks adenosine receptors Given IV Side effects can be like caffeine stimulated the CNS making nervousness and restlessness.

COPD Patient characteristics

SMOKER Older than 35 Chronic Productive cough (caused by excessive vagal stimulation -> caused bronchioconstriction and mucus secretion) Breathlessness symptoms are often constant and don't vary.

Asthma patient characteristics

Some are smokers Often will be below 35 Y.O. Rarely have a cough Commonly have nocturnal breathlessness Commonly have a day to day variation in symptoms.

Ipratroprium

A Muscarinic receptor antagonist that is charged. this prevents it from entering the CNS. Short Acting with a quick onset (15 min) Inhaled Less selective and will bind to M1,2 and 3 Used in COPD to receive bronco constriction and mucus production Can be used in asthma in patients that don't tolerate or respond to beta-2 stimulation (SABA/LABA)

Tiotropium

A Muscarinic receptor antagonist that is charged. this prevents it from entering the CNS. Long lasting drug (24 hrs) that has a onset of 30 min Used in COPD to receive bronco constriction and mucus production Can be used in asthma in patients that don't tolerate or respond to beta-2 stimulation (SABA/LABA)

Muscarinic stimulation of the airway

Controlled via the Vagus nerve.

Methacholine

used in the methacoline challenge that stimulated the muscarinic receptors not the bronchiole smooth muscle and if constriction is more than normal at a lower dose they have asthma or hyper-reactive airway

Roflumilast

Oral PDE-4 inhibitor that is used in COPD patients.

Drugs contraindicated in COPD

Leukotriene modifiers -> no pathogenic role in COPD Systemic glucocorticosteroids because of a increased risk for infection.