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respiratory med > asthma and COPD > Flashcards

asthma and COPD Flashcards

1
Q

Montelukast

A

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

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2
Q

Zileuton

A

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

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3
Q

Zafirlukast

A

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

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4
Q

Budesonide

A

Corticosteroid
high potency
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

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5
Q

Fluticasone

A

Corticosteroid
high potency
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

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6
Q

Beclomethasone

A

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

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7
Q

Flunisolide

A

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

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8
Q

Mometasone

A

Corticosteroid
Slow onset because they effect gene transcription

suppress inflammatory genes and express anti-inflammatory genes

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9
Q

Prednisone

A

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

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10
Q

Omalizumab

A

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)

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11
Q

Asthma relievers

A

SABA’s

quick onset and last for a for a few hours

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12
Q

Asthma controllers

A

Not to be used in acute setting.

Anti-inflammatory class

  • Cortiocosteroids
  • Leukotrinene modifiers
  • Anti-IgE antibody

Bronchodilators

  • LABA’s
  • Anti-cholinergic agents.
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13
Q

Theophylline

A

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.

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14
Q

SABA’s

A

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

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

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15
Q

LABA’s

A

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.

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16
Q

contraindicated drugs

A

Any Beta antagonist

Suffix -lol

17
Q

Contraindications in Corticosteroid therapy

A

Children -> inhibit grown

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

Post menopausal women systemic dosing -> can aggravate osteoporosis

18
Q

Prednisolone

A

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

19
Q

Dexamethasone

A

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

20
Q

Moderate persistent asthma

A

a patient that has a daily attack

FEV1 -> 60-80%

give medium dose ICS plus LABA

use SABA for attacks

21
Q

Mild persistent asthma

A

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

22
Q

Combination products

A

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.

23
Q

Salmeterol

A

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

24
Q

formoterol

A

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

25
Q

peptide leukotrienes

A

LTC4, LTD4, LTE4

26
Q

Aspirin-sensitive asthma

A

Associated with excessive leukotriene production.

Give Zileuton, Montelukast, Zafirlukast.

27
Q

Excercise induced asthma

A

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

28
Q

Aminophylline

A

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.

29
Q

COPD Patient characteristics

A

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.

30
Q

Asthma patient characteristics

A

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.

31
Q

Ipratroprium

A

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)

32
Q

Tiotropium

A

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)

33
Q

Muscarinic stimulation of the airway

A

Controlled via the Vagus nerve.

34
Q

Methacholine

A

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

35
Q

Roflumilast

A

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

36
Q

Drugs contraindicated in COPD

A

Leukotriene modifiers -> no pathogenic role in COPD

Systemic glucocorticosteroids because of a increased risk for infection.

respiratory med (3 decks)

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