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My Pharm > Asthma and COPD > Flashcards

Asthma and COPD Flashcards

1
Q

What are first line-maintenance treatments for COPD and asthma?

A

COPD - inhaled long-acting bronchodilators

Asthma - inhaled corticosteroids

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2
Q

Name the stepwise approach to managing asthma

A

step 1:

  • Mild intermittent disease - inhaled B2 agonist albuterol as needed

step 2:

  • mild persistent disease - low dose inhaled corticosteroids (ICS) daily plus abulterol as needed
  • or
  • ICS plus albuterol concomitantly only when symptoms occur

Step 3:

  • moderate persistent disease - low dose ICS/formoterol combo as needed, low dose ICS/formoterol as reliever (SMART)

Step 4:

  • Moderate to severe persistent disease - daily as needed medium dose of ICS/formoterol
  • or daily medium dose of ICS/LABA with prn albuterol
  • or daily daily medium dose ICS/LAMA with prn albuterol

step 5: severe persistent disease

  • daily medium to high dose ICS/LABA plus LAMA with albuterol prn

step 6: uncontrolled severe persistent disease

  • daily high dose ICS/LABA plus LAMA with albuterol prn plus systemic oral corticosteroids

step 5-6: consider adding asthma biologics (anti IgE anti IL5, anti IL5R, antiIL4/IL13)

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3
Q

Quick reliever medications for asthma?

A

B-agonists - albuterol, formoterol

Muscarinic antagonists - ipatropium

ED only - systemic corticosteroids (methlprednisone)

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4
Q

Long term controller medications for asthma?

A

Steroids -( prednisone systemic), fluticasone -ICS, budesonide ICS

Leukotriene antagonist - montelukast

LABA - salmeterol/formoterol

LAMA - tiotropium

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5
Q

Management of COPD meds: stop smoking meds

A

Varenicline, nicotine, buproprion

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6
Q

Management of COPD - mild, intermittent drugs?

A

SABA or SAMA for symptom relief (prn)

B agonists - albuterol or antimuscarinic (ipratroium)

Combination if not controlled (albuterol-ipratropium)

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7
Q

Management of COPD more severe or persistnet symptoms?

A

Long acting bronchodilators (scheduled)

Beta agonsits (laba) - salmeterol - formoterol or

antimuscarinics - lama - tiotropium

combination if not controlled -vilanterol-umeclindium

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8
Q

Management of COPD with frequent exacerbations?

A

Add inhaled glucocorticoid (scheduled)

Use with LA bronchodilator (ics not approved for monotherapy in COPD)

If not on a LABA - add as combination with ICS

Salmeterol-fluticasone

formoterol-budesonide

vilanterol-fluticasone

Triple therapy (LABA-LAMA-corticosteroid) may reduce exacerbations and mortality

vilanterol-umeclidinium-fluticasone

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9
Q

Management of EIB?

A

All patients with asthma will have a rapid acting b-agonist available - albuterol or formoterol inhaler

Well controlle dastham but frequent EIB symptoms - rapid acting b agonist -albuterol inhaler 10 min prior to prevent EIB for 2-4 hrs

If s/e occur - use cromolyn sodium inhaler 15-20 mins

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10
Q

Management of EIB - strenuous exercise or exercise in extreme conditions?

A

Combination of albuterol and cromolyn sodium are helpful

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11
Q

Frequent EIB in patients with poorly controlled asthma?

A

add inhaled glucocorticoids - most effective

Oral leukotriene inhibitors - decrease EIB within 2 hours - protection may last up to 24

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12
Q

Breakthrough EIB tx?

A

ONLY RABA effective - albuterol inhaler

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13
Q

Bronchodilators - beta 2 agonists MOA? Long and short?

A

Stimulation of B2 adrenergic receptor on bronchiol smooth muscle with increase in cAMP leading to bronchodilation

Rapid onset quick reliver - albuterol is drug of choice

long duration of action as long term controller - LABA - salmeterol - 2nd line add on to inhaled corticosteroids

Not approved as monotherapy for asthma

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14
Q

Side effects of Beta 2 agonists?

A

relation to target action - skeletal muscle tremor (b2 receptors), tachycardia, palpitations, anxiety, insomnia (b1 receptors)

dry mouth

Black box warning for salmeterol (LABA) - increased risk of asthma related deaths, should not be used without inhaled corticosteroid for asthma

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15
Q

How do muscarinic antagonists effect the lungs? Rapid onset drug? Long acting drug?

A

Block cholinergic bronchoconstrictor tone

SAMA - rapid onset, - ipratropium

alternatie quick reliever if B2 agonist is not tolerated

Generally have greated benefit in COPD patietns (tioproprium - lama - long duration)

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16
Q

Adverse effects of bronchodilating muscarinic antagonists?

A

Charged compoenents - minimal systemic side effects

drying of upper mouth and airways is possible, use with caution in comorbid glaucoma, symptomatic BPH, or bladder neck obstruction.

17
Q

Long-acting antimuscarinic agents (e.g., tiotropium) are indicated in which of the following clinical situations?

A.Alternative prn quick-reliever in asthma patients that can’t tolerate albuterol

B.Prn for relief of mild, intermittent symptoms of COPD

C.Scheduled administration with LABA for more severe or persistent symptoms of COPD

D.Alternative to albuterol for prevention of exercise-induced asthma

A

c) scheduled administration with LABA for more severe or persistent symptoms of COPD

18
Q

Theophylline MOA? Why is it not used?

A

Bronchodilator- not used as quick reliever

Adenosine antagonist - prolonged duration oral - rapid onset IV

Disadvantage - low safety margin - seizures, arrhythmias, insomnia, gi disturbances

Drug drug interactions - via effects on CYP450 metabolism

19
Q

Corticosteroids effect in asthma?

A

Block of pulmonary inflammation via

increased transcription of antiinflammatory factors (lipocrotin(inhibitor of phospholipase A2)

Suppression of COX-2 expression and subsequent synthesis of inflammatory mediators

Plus - widespread effects on immune cells and cytokine production

This enhances response to B2 agonists in acute exacerbations, drawback is delay in onset of action –> days to weeks - but may enhance response to b2 agonists in acute situations

20
Q

Inhaled corticosteroids are the long-term controller medication of choice in the treatment of asthma. This beneficial action can be attributed in part to:

A.Rapid onset of bronchodilator effect

B.Inhibition of cyclooxygenase 2 (COX-2) and prostaglandin synthesis

C.Inhibition of 5-lipoxygenase activity

D.Inhibition of phospholipase A2 and decreased leukotriene levels

A

d

21
Q

What are 3 corticosteroid aersol preperations?

A

Fluticasone

Budesonide

Flunisolide

COMBO meds: Salmeterol/fluticasone, Formoterol/budesonide

22
Q

oral corticosteroids used? Parenteral for asthma

A

Prednisone - oral

Parenteral - methylprednisolone

23
Q

s/e of corticosteroids with short course, high dose systemic use?

A

Short course, high dose systemic use for acute exacerbations

Hyperglycemia

sodium retention –> hypertension

Hypokalemia

GI bleeding

CNS disturbance, insomnia

24
Q

Corticosteroid side effects with long term use?

A

metabolic effects - cushings

immunosuppresion

osteoporosis

adrenal crisis

growth suppresion in children

muscle wasting

25
Q

side effects of inhaled corticosteroids?

A

reflex cough and bronchospasm

Candidal overgrwoth (thrush) - dysphonia (hoarseness to vocal cord weakness) - improper adminsitration technique

If taking high doses of ICS should monitor HPA axis plus bone density, cataracts-glaucoma.

26
Q

What is the MOA of cromolyn?

A

Prevention of Ag-induced release of mediators from sensitized mast cells (long term controller)

plus - inhibition of sensory afferents producing cough and bronchoconstriction.

Suppression of activating actions of cytokines

27
Q

Cromolyn sodium use in asthma?

A

Useful in exercise induced and antigen induced asthma, as well as nonspecific airways reactivity

advantages - minimal risk of systemic effects but may see bronchospasm/wheezing, cough –> need to adminster with a beta 2 agonist

disadvantage -limited as a prophylactic agent - must be given 15-60 mins before exercise - will not abort attack once initiated. limited efficacy in severe asthma.

My Pharm (6 decks)

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