Asthma and COPD Drugs

Question 1

Albuterol

Answer 1

B2 Agonist

• Short acting B2 agonist (SABA)
• Indications: Asthma, COPD, Acute Bronchitis, Bronchiolitis
• Adverse Effects: Headache, Dizziness, Insomnia, Dry mouth, cough
• Contraindications/Warnings: Paradoxical Bronchospasm, Deterioration of asthma, CV effects, Immediate hypersensitivity

Emergency inhalers

Question 2

Terbutaline

Answer 2

B-Adrenergic agonist (Prefs B2 Receptors)

• SABA
• Indications: Treatment OR Prophylaxis of Bronchospasm in asthma, bronchitis, or Emphysema (In Pts. 12 or older!!!)
• Cautions/Warnings: Not recommended for pts with Tocolysis (Uterine contractions for premature labor!!) (can help but dont use)
• Adverse Effects: Headache, Nausea, Tachycardia, Palpitations
• ***** MOST IMPORTANT FACT = Only B2 Agonist available as a subcutaneous INJECTION!!!
• If pt has sulfur allergy DO NOT USE = comes as Terbutaline-sulfate

Question 3

Metaproterenol

Answer 3

B2 Agonist

• SABA
• Indications: Asthma, COPD, Bronchitis
• Cautions/Warnings: Can produce Significant CARDIAC EVENT in some pts, Paradoxical Bronchospasm

Question 4

Pirbuterol

Answer 4

B2 Agonist

• SABA
• Indications: Prevention and reversal of bronchospasm (In pts 12 or older!!!!)
• Warnings: can cause significant CARDIAC EVENT (like other B adrenergic agonists)

May be used with or without concurrent theophyline and or corticosteroids

Question 5

Levabuterol

Answer 5

B2 Agonist

• SABA
• Cautions: Paradoxical Bronchospasm

*** Used in pts 4 years or older to tx or prevent bronchospasm with REVERSIBLE OBSTRUCTIVE DZ!!!!

Question 6

Fomoterol

Answer 6

B2 Agonist
- Long Acting Beta Agonist (LABA)

• ** Tx of asthma in patients OVER 5 YEARS OLD as an ADD-ON to a Long-Term control med such as an inhaled corticosteroid
• ** Maintenance Tx of bronchoconstriction in pts with COPD!!!

***Contraindiations/Warnings: Do not use WITHOUT a long-term asthma control med such as corticosteroid when treating ASTHMA
- LABA’s increase rick of asthma- related deaths/ hospitalization!!!!
Goes for all LABAs………

Question 7

Salmeterol

Answer 7

B2 Agonist

• LABA
• Used to treat pts 4 years or older!!!
• *** - Used to treat Exercise Induced Bronchosmasm (EIB), COPD

***Contraindiations/Warnings: Do not use WITHOUT a long-term asthma control med such as corticosteroid when treating ASTHMA
- LABA’s increase rick of asthma- related deaths/ hospitalization!!!!
Goes for all LABAs………

Question 8

Indacaterol and Vilanterol

Answer 8

B2 Agonists

• LABAs
• ** - Used to Tx Breathing Problems caused by COPD!

***Contraindiations/Warnings: Do not use WITHOUT a long-term asthma control med such as corticosteroid when treating ASTHMA
- LABA’s increase rick of asthma- related deaths/ hospitalization!!!!
Goes for all LABAs………

Question 9

Olodaterol

Answer 9

B2 Agonist

• LABA
• *** - Used as a ONCE-DAILY Bronchodilator for tx of Airflow Obstruction in pts with: COPD

***Contraindiations/Warnings: Do not use WITHOUT a long-term asthma control med such as corticosteroid when treating ASTHMA
- LABA’s increase rick of asthma- related deaths/ hospitalization!!!!
Goes for all LABAs………

Question 10

Atropine

Answer 10

Anti-Muscarinic drug

• Blocks binding of Ach
• ** - Main drug for temporary blockage of severe/lifethreatening Muscarinic effects

*** Cautions: When used in pts with Coronary A. Disease, only 2-3mg should be used to avoid “ATROPINE INDUCE TACHYCARIDIA”

*** Used in emergencies!!!

Question 11

Ipratropium

Answer 11

Anticholinergic

• Potent analog of atropine
• ** Poorly absorbed after aerosol administration so has LESS ADVERSE EFFECTS!!! (Than Atropine!)

Question 12

Tiotropium

Answer 12

Anticholinergic

*** - Used as a Long-Term, Once-Daily tx for maintenance of Bronchospasm in COPD pts (Reduces COPD exacerbations)

Question 13

Aclindinium

Answer 13

Anticholinergic

*** - Used for Long-Term management of Bronchospasm in pts with COPD

Question 14

Theophylline

Answer 14

Methylxanthine

• ** Has 2 distinct actions
  
  1. Bronchodilation (Inhibits PDE so Increase of cAMP)
  2. Decrease reactivity of airways (Blocks Adenosine)
     
     • Used to help prevent asthma attacks (from like cold air etc…)
• Contraindications: Increases risk of exacerbation of: Peptpic ulcer dz, Seizures, Cardiac Arrhythmias

(Theobromine - in chocolate)
(Caffeine - Coffee)

Question 15

Beclomethasone

Answer 15

ICS

• prophylactic for asthma in pts 5 YEARS OR OLDER!
• ** - May help reduce need for Oral corticosteroids (systemic)
• ** - Cautions: CAREFUL CARE NEEDED when SWITCHING a patient from systemic corticosteroid to (less systemically available) Inhaled corticosterioid
  - Death may occur here due to Adrenal Insufficiency
  - Months are needed to recover the Hypothalamic - Pituitary - Adrenal (HPA) axis function!!!!!

Question 16

Budesonide

Answer 16

ICS

• Prophylactic for Asthma in pts 6 OR OLDER!!
• Caustions: Do not use for:
  
  • Primary tx of status asthmaticus (persistent asthma attacks)
  • tx of acute asthma attacks
• ***- CONTAINS MILK PROTEINS - Do not use in pts with MILK ALLERGY

Question 17

Ciclesonide

Answer 17

ICS
- Prophylactic for asthma
- Cautions:
- Not indicated for relief of acture bronchospasms
*** - INCREASES ORAL INFECTIONS - do not use if oral/pharynx infection present
(Rinse mouth after use)

Question 18

Flunisolide

Answer 18

ICS

• Prophylactic for asthma in pts 6 OR OLDER!!
• **- May help reduce need for Oral corticosteroids (systemic)
• Cautions: not a primary tx for status asthmaticus or severe acute sx

Question 19

Fluticasone

Answer 19

ICS
- Prophylactic for asthma in pts 4 YEARS OR OLDER!!
*** - INCREASES ORAL INFECTIONS - do not use if oral/pharynx infection present
(Rinse mouth after use)

Question 20

Triamcinolone

Answer 20

ICS

• Prophylactic for asthma
• ** - May reduce need for Oral Corticosteroids (systemic)
• Cautions:
  
  • Not indicated for relief of actute Sx*
  • ** CAREFUL CARE NEEDED when SWITCHING a patient from systemic corticosteroid to (less systemically available) Inhaled corticosterioid
    
    • Death may occur here due to Adrenal Insufficiency
    • Months are needed to recover the Hypothalamic - Pituitary - Adrenal (HPA) axis function!!!!!

Question 21

Prednisone

Answer 21

OCS

• systemic corticosteroid = anti-inflammatory / immunosupressive agent
• Used in a wide variety of conditions
• Cautions: Hypothalamus - Pituitary - Adrenal (HPA) SUPRESSION!!!!
  - Monitor patients for Cushing’s Syndrome and Hyperglycemia

Question 22

Montelukast

Answer 22

Leukotrine Receptor Antagonist (Inhibits LTD4 by inhibiting the CysLT1 Receptor) (No Agonist activity)

• Tx for Allergies and Asthma Attacks
• Cautions: Not used for relief of acute asthma attacks

Question 23

Zafirlukast

Answer 23

Leukotriene Receptor Antagonist (Inhibits LTD4 and LTE4) = components of Slow Reacting Substance Anaphylaxis (SRSA)

• Prophylactic for chronic asthma in pts 5 YEARS OR OLDER!!!
• *** Cautions: HEPATOTOXICITY = cases of hepatic failure reported with normal doses

Question 24

Zileuton

Answer 24

5 - Lipoxygenase Inhibitor (Inhibits Leukotrienes/Lipoxins (LTB4, LTC4, LTD4, LTE4)

• Prophylactic for asthma
• Not used for acture tx of asthma
• • Only controlled release available
• ** Not recommended for LIVER DISEASE pts (Stop use if persistent hepatic fxn enzymes are elevated more than 3x!!!)

Question 25

Omalizumab

Answer 25

Monoclonal Antibody against IgE

• for moderate to severe Asthma in pt 6 OR OLDER!!!
  
  • these pts NEED a Postive (+) skin test or in-vitro reactivity to perennial aeroallergen and have poorly controlled asthma
• Also can treat Chronic Idiopathic Uticaria (Itching)
• ** - Cautions: Can cause ANAPHYLAXIS!!!!
  - NEEDS to be administered in an HEALTHCARE SETTING to monitor pt!