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Advanced pharmacology > Asthma And COPD > Flashcards

Asthma And COPD Flashcards

1
Q

Asthma

A

A chronic condition that causes inflammation and narrowing of the bronchial tubes

2 types: allergic or non allergic

Symptoms: coughing, sob, chest tightness, wheezing

Triggers: outdoor/indoor allergens, smoke, colds,

Prevention of symptoms is the best strategy of long term manage

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2
Q

Asthma attacks

A

Chronic inflammation causes the build up of mucous, the tightening of bronchial muscles and swelling. triggers provoke this chronic inflammation to worsen during exposure and it becomes hard to breath

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3
Q

Categories of asthma severity / determining severity

A

Intermittent, mild persistent, moderate persistent, severe persistent

Determined by

  • reported symptoms over the las 2-4 weeks
  • current level of lung function ( peak flow)
  • # of exacerbations requiring systemic CS ( prednisone ) in the previous year
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4
Q

Components of asthma management

A

Routine monitoring of symptoms and lung function ( peak flow )

Pt education to create a partnership

Controlling environmental triggers and comorbid conditions

Want to control few nighttime awakenings and minimal need of SABA

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5
Q

Quick relief medication

A

Relieve asthma symptoms when they occur

  • SABA ( short acting beta agonist)
  • Anticholinergics
  • combination quick relief
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6
Q

Long term control medication for asthma

A

Prevent and control asthma symptoms

Take every day

  • inhaled corticosteroid
  • inhaled long acting beta agonist (LABA)
  • combination inhaled ( advair)
  • Omalizaumab
  • luekotriene midifiers
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7
Q

Anticholinergics

A

Quick relief
Alternative bronchodilators to or additive benefit to SABA

Ex. Ipratriopium

Adverse: dry mouth

Pearl: treatment of choice due for bronchospasm due to beta-blocker medication, does not modify reactions to antigens

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8
Q

SABA’s

A

Quick relief

  • relax smooth muscle
  • albuterol , levalbuterol ( better in the older pt)

Adverse: hypokalemia

Pearl: uses > 2 days a week = inadquate control

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9
Q

Systemic corticosteroids

A

Not entirely short-acting but used for moderate-severe exacerbations adjunctively to SABA’s to speed recovery and prevent recurrence of exacerbations

3-10 days

Prednisone

Adverse: hyperglycemia, growth suppression, fluid retention, watch for co-existing conditions

Pearl: use lowest effective dose for shortest period of time , if needed employ alternate -day AM dosing

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10
Q

LABA’s

A

Long term control

Not used as monotherapy

Used in combination with ICS in moderate or severe persistent asthma ( > 5 years old)

Not used for acute symptoms or exacerbations

Ex. Slameterol, Formoterol

Adverse: hypokalemia, QTc prolongation in overdose

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11
Q

Methylxanthines

A

Theophylline

Mild-moderate bronchodilator

Used as na adjunctive therapy to ICS

Pearls: maintain routine blood levels between 5-15 , GI upset

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12
Q

Leukotriene Modifers

A

Singulair
Mild-persistent, alt not preferred

Adverse: hepatic failure

Pearls: do NOT administer with food, watch for liver dysfunction

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13
Q

Corticosteroids

A

Most effect and potent agents available

Flovent

Decrease airway hyper-responsiveness and inhibits inflammation/black late -phase reactions to allergens

Pearls: rinse mouth after use

Adverse: cough, oral thrush

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14
Q

Mast cell stabilizers and immune modulators

A

MCS- not see that much

IM: very expensive done in allergist office

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15
Q

Seasonal allergies

A

Start long term control medication > 1 month before allergy season starts

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16
Q

Cough variant asthma

A

Trial bronchodilator

17
Q

Excerise induced asthma ( EIA)

A

Most asthmatics have EIA

Short-acting beta agonist 15 min before exercise ( 2-3)

Mask or scarf

Leukotriene Modifers may help ( singulair)

18
Q

Pediatrics - asthma

A

Treatment from 0-4 and 5-11 is different

LABA therapy given with ICS

Try not to dose during the school day

19
Q

Pregnancy - asthma

A

Inhaled beta -agonist - SABAS

Long term - ICS

20
Q

Geriatrics - asthma

A

Reversible symptoms = asthma

Irreversible = COPD

Increased risk of adverse drug reaction

21
Q

COPD

A

Common respiratory condition characterized by airflow limitation

Associated with high morbidity

Management : decrease symptoms, decrease frequency and severity and improve health status, exercise capacity and prolong survival

22
Q

COPD : Subtypes

Emphysema

Chronic Bronchitis

A

Emphysema: structural changes including abnormal and permanent enlargement fo the airspace along with destruction of the airspace walls

Chronic Bronchitis : chronic productive cough for three months in each of two successive in a patient

ACOS: asthma may eventually be considered COPD when symptoms are NOT fully reversible

23
Q

Clinical risks factors ( how to minimize them )

A

Smoking cessation, exposure avoidance , physical activity, anti-inflammatory pharmacotherapy

24
Q

Diagnosis and staging

A

Global Initiative for COPD : GOLD guidelines or CAT guideline - cheaper

  • combined assessment of airflow limitation with an assessment of symptoms and exacerbations to guide therapy

Airflow limitation = .70 for FEV / FVC

25
Q

Actions for risk reduction

A

Smoking cessation, annual influenza and pneumococcal vaccine
Long term O2 therapy
Pulmonary rehab

26
Q

Issues with compliance

A

Older age,
multiple devices ,
Lack of education
Inproper use inhaler ( always review)

27
Q

Pharm rule for COPD therapy

A

Used to reduce symptoms, reduce the frequency , severity of exacerbations and improve exercise tolerance / health status

28
Q

Bronchodilators

A

Increase FEV1

Given on a regular basis to prevent or reduce symptoms

29
Q

Combination bronchodilator therapy

A

Combining bronchodilators with different mechanisms and duration of action may increase bronchodilation with a lower risk of side effects

Combinations of SABA and SAMA = superior to monotherapy in improving FEV1 and symptoms

Combining LABA and LAMA’s significantly improves lung function ( FEV), dyspnea, health status and reduces exacerbations rates

30
Q

Inhaled corticosteroid + LABA

A

Advair

Increase lung function and decrease exacerbations ( moderate to severe COPD)

Increases risk of pneumonia

Adverse: oral candidiasis ( rinse and spit)

31
Q

Triple inhaled therapy

A

Trelegy Ellipta

ICS/LAMA/LABA

32
Q

PDE4 inhibitors

A

Daliresp

Used in patient with chronic bronchitis and severe COPD

33
Q

Antibiotics - COPD

A

Azithromycin/ erythromycin

Associated to decrease exacerbations over 1 year

May cause hearing resistance

34
Q

Formoterol and Salmetrerol

A

Beta agonist - improve FEV1, lung volume, number of hospitalizaitons , but NO effect or rate of decline of lung function

Adverse: tremors, higher doses of beta 2 agonist in older people

35
Q

LAMA + LABA

A

Relaxes bronchial smooth muscle causing bronchodilation

Best with GOLD category B w/ uncontrolled symptoms on 1 bronchodilator

Anoro Ellipta

Advanced pharmacology (12 decks)

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