Asthma and COPD Drugs (cont.) Flashcards
MOA for Beta 2 Agonists?
Active Beta 2 receptors to relax smooth muscle and cause bronchildation
What are some possible adverse effects with the use of Albuterol?
Insomnia, dry mouth, cough
Which SABA is the only one available by Subcutaneous Injection?
Terbutaline
How is Terbutaline given?
SubQ injection
Patient with what allergy should not use Terbutaline (SABA)?
Sulfur allergy patients
What are the main adverse effects seen with the use of Terbutaline?
Tachycardia and palpitations
What are the main system effects of Pirbuterol (SABA)?
CV effects
Which 3 SABA have the risk of causing paradoxical bronchospasm and CV effects?
Albuterol
Metaproterenol
Levalbuterol
Which 3 SABA have the risk of causing paradoxical bronchospasm?
Albuterol
Metaproterenol
Levalbuterol
LABA are more often used in the treatment of COPD. If they are used in patients with asthma, what must that patient be using too?
Asthmatic patients must also be using an ICS!!
In order for LABAs to be used with Asthma patients, what must they also be using?
ICS
Why must patients with asthma be using an ICS in order to use a LABA?
Increases the risk of asthma related deaths if not using an ICS as well
MOA for Anticholinergic drugs?
Block Acetylcholine from binding its receptors => bronchodilation by (-) parasympathetics
Which Anticholinergic drug is used for a TEMPORARY blockade of muscarinic effects?
Atropine
In patients with CAD, what must the Atropine dose be less than and why?
Less than 2-3 mg to avoid an increased HR and myocardial oxygen demand
Which Anticholinergic drug is used for the maintenance treatment of Bronchospasm?
Ipratropium
What is unique about Ipratropium?
It is poorly absorbed so it is relatively free of systemic atropine-like side effects!!
Which 2 Anticholinergic drugs are used for the LONG-term maintenance of bronchospasm?
Tiotropium
Aclidinium
Which 2 Anticholinergic drugs are used for the long-term maintenance of bronchospasm?
Tiotropium
Aclidinium
What are the 2 MOAs for Theophylline (methylxanthine)?
- Bronchodilation
2. Suppresses airway response to stimuli
What conditions can Methylxanthines possible exacerbate?
PUD
Seizure disorders
Cardiac arrhythmias
Which Methylxanthine can bronchodilate and suppress airway response to stimuli?
Theophylline
What class of drugs is the most effective controller of Asthma?
ICS
ICS decrease what cells?
Eosinophils
Mast cells
T lymphocytes
MOA for ICS?
Turn off transcription of genes that encode inflammatory proteins
MOA for ICS?
Turn off transcription of genes that encode inflammatory proteins
For patients with persistent asthma, what is the 1st line therapy and what can you add after that?
ICS
+/- LABA
With what 2 drugs must you be careful when switching them off a systemically active corticosteroid to the ICS?
Beclomethasone
Triamcinolone
Why must you be careful when switching patients off a systemically active corticosteroid to either Beclomethasone or Triamcinolone?
Deaths due to adrenal insufficiency have occurred
What 2 ICS drugs should patients who have a hypersensitivity to milk proteins avoid?
Budesonide
Mometasone
What 2 ICS drugs should patients with a hypersensitivity to milk proteins avoid?
Budesonide
Mometasone
Ciclesonide is a ____ that is (+) by _____
Prodrug
(+) bronchial esterases
Since Ciclesonide is a prodrug, what does that decrease the risk of?
Candidiasis
Flunisolide may reduce the need for what drug?
ORAL corticosteroids
Triamcinolone may reduce the need for what drug?
Systemic corticosteroids
What is a possible adverse effect of Fluticasone and what should patients do after drug use?
Candida Albicans infection of mouth/pharynx
– have patients rinse mouth after use
ICS drugs are NOT to be used in what conditions?
Status asthmaticus or severe acute asthma
ICS drugs are NOT to be used in what conditions?
Status asthmaticus or severe acute asthma
Oral corticosteroids are more likely to cause what compared to ICS?
Side effects
To treat asthma flare-ups, what can be added to a SABA?
Oral corticosteroid
Prednisone adverse effect?
Hypothalamic-Pituitary-Adrenal axis suppression
Patients on prednisone should be monitored for what?
Cushings Syndrome and hyperglycemia
MOA of Leukotriene Antagonists?
Block CysLT receptors and their subsequent inflammatory cascade
Montelukast blocks what receptor and what specific Leukotriene from performing its actions?
CysLT1 receptor
– LTD4
Zafirlukast blocks the actions of what leukotrienes?
LTD4 and E4
What is an adverse effect of Zafirlukast?
Hepatotoxcity
Zileuton is a lipoxygenase (-) which means it blocks for the formation of?
All leukotrienes - LTB4, C4, D4, E4
In what condition is Zileuton controlled release form NOT recommended?
Liver disease and elevated liver enzymes 3X ULN
What type of Antibody is Omalizumab and what does a patient have to have in order to be placed on it?
Anti-IgE antibody
- (+) skin test OR
- reactivity to perennial aeroallergen
Adverse effect of Omalizumab?
Anaphylaxis
