Asthma and COPD Medications Flashcards
Two categories of asthma meds and differences
Drugs used to treat asthma are classified as controllers (maintenance), or relievers (rescue). Controllers are taken on a daily basis, chronically, to keep asthma symptoms under control, primarily by reducing inflammation. Rescue or reliever meds are used as needed to quickly reverse bronchoconstriction or preventatively for exercise-induced bronchospasm.
Which asthma medications are generally classified as “controller” medications?
Long-acting medications and antiiflammatory medications
Which asthma/COPD medications are classified as “rescue” medications?
Short-acting medications (beta-agonist bronchodilators and anticholinergics) and systemic steroids
How do the goals of treatment differ in asthma vs COPD?
Asthma treatment seeks to primarily to normalize lung function and decrease the inflammation that causes attacks. COPD treatment cannot restore lung function as irreversible loss has occurred, so seeks to decrease symptoms.
Glucocorticoids MOA
Block the cleavage of arachidonic acid from the plasma membrane which results in lower T cell activation and cytokine production
Cromolyn sodium MOA
Stabilize mast cell membranes by blocking calcium influx, so no degranulation
Leukotriene inhibitors examples
Montileukast and zafirleukast
Leukotriene inhibitors MOA
Block the D4 leukotriene receptor, blocks major stimulus oh type 1 hypersensitivities. Downstream effects are lower Ca and increased cAMP, both leading to bronchial muscle relaxation
What are SABAs and MOA
Short Acting Inhaled Beta 2 Agonists
Side effects of SABAs
Tremor, lightheadedness, palpitations, hypokalemia, tachycardia, hyperglycemia.
When given in high doses or systemically, can cause arrythmias or cardiac muscle ischemia, and troponins (cardiac muscle proteins released in cardiac damage) are monitored while on high dose ihlaed or systemic continuous therapy in higher-risk patients.
When to increase from a SABA to a new medication
If using SABA greater than two days per week
Examples of SABAs
Albuterol, Levalbuterol (Levalbuterol is the L-isomer of albuterol and is indicated ONLY for patients who have a documented ventricular arrhythmia with standard albuterol.)
Terbutaline is an IV beta-2 agonist that is given to relax smooth muscle in severe asthma but can also be given in premature labor to relax uterine contractions.
When are LABAs indicated
LABA should only be used in asthma patients as an adjunctive therapy in patients who are currently receiving but are not adequately controlled on an inhaled corticosteroid). Once asthma control is achieved and maintained for 3 months, assess the patient at regular intervals and step down therapy (discontinue LABA) if possible without loss of asthma control.
Contraindications for LABAs
active coronary artery disease.
LABA example
Salmeterol
Anticholinergic MOA
They block the action of acetylcholine and decrease cGMP at parasympathetic sites in the bronchial smooth muscle causing bronchodilation and decreased mucus production.
SAAB example
Short Acting Anticholinergic Bronchodilators (SAABs)
Ipratropium bromide: This is one of the most common meds you will see used for symptom control in COPD.
Long acting anticholinergic example
Tiotropium
Theopylline MOA
Mechanism: theophylline blocks phosphodiesterase causing increase cAMP which promotes release of epinephrine from adrenal medulla cells as well as bronchial smooth muscle relaxation. This results in bronchodilation, diuresis, CNS and cardiac stimulation and gastric acid secretion.
Theophyline contraindications
Warnings: caution in patients with cardiovascular disease, hyperthyroidism, peptic ulcer disease and seizure disorder since use may exacerbate these conditions.
Theophyline side effects
Side effects: same as caffeine: nausea, loose stools, headache, tachycardia, insomnia, tremor, and nervousness.
Signs of theophylline toxicity
Signs of toxicity - persisted and repetitive vomiting, ventricular tachycardia, seizures.
Magnesium MOA and admin
Magnesium Sulfate IV
It functions as a calcium channel blocker due to competitive inhibition for divalent cationic binding sites in smooth muscle, cardiac muscle, and membranes of electrical conduction systems throughout the body
Magnesium side effects
. Side effects of this therapy are related to its effects on smooth muscle as well as membrane depolarization: nausea, vomiting, hypotension (we bolus patients with normal saline prior to giving magnesium to prevent this), and as patients get into the toxic range, decreased deep tendon reflexes and the rapid development of pulmonary edema.
Inhaled corticosteroids examples
beclomethasone, budesonide, fluticasone
First line treatment for asthma
Inhaled corticosteroids
Inhaled corticosteroids contraindications
primary treatment of status asthmaticus or acute episodes of asthma or COPD. Inhaled corticosteroids are not for the relief of acute bronchospasm and oral steroids should be used if patients are in an asthma exacerbation.
Side effects of inhaled corticosteroids
dysphonia (voice changes), oral candidiasis, hyperglycemia, increased risk of fractures and pneumonia (with high doses and long term)
Patients on high dose inhaled steroids are at increased risk for severe outcomes with which viral infection?
Varicella, all should be vaccinated
MOA of zileuton
Zileuton is 5-lipoxygenase inhibitor which inhibits leukotriene formation in the first place
Uses for leukotriene modifiers
All agents help decrease airway edema, constriction and inflammation caused by leukotrienes. Based on their mechanism of action, they are also useful for co-suppression of allergic rhinitis!
Side effects/warnings for leukotriene inhibitors
Warnings: psychiatric events, monitor for signs of aggressive behavior, hostility, agitation depression and suicidal thinking. Depression and suicide are a black box warning for this group of drugs and all patients should be warned at the time of prescribing.
Systemic eosinophilia, sometimes presenting the clinical features of vasculitis, can also occur.
What monitoring must be done for zileuton
monitoring of LFTs every month for first three months, every 2-3 months for the rest of the first year of therapy.
Cromolym sodium MOA
This drug is a nonsteroidal compound that stabilizes the plasma membranes of mast cells and eosinophils, preventing the degranulation and release of histamine, leukotrienes and other substances that cause airway inflammation.
Cromolym sodium administration
The oral bioavailability is only 1%, but when administered by inhalation is major effect is exerted on the respiratory tract and very little is absorbed into the circulation
Cromolym toxicities
Does not interact with other drugs and has a very low toxicities profile
MOA of omalizumab
Omalizumab is an IgG monoclonal antibody that inhibits IgE binding to the IgE receptor on mast cells and basophils
Major side effect with omalizumab
Anaphylaxis has occurred after the first dose but also has occurred beyond one year after beginning treatment. This means it is one of the few drugs you can anaphylax to THE FIRST TIME YOU TAKE IT
Mepolizumab MOA
By blocking IL-5, This monoclonal antibody blocks major stimuli for the maturation, proliferation, recruitment, and activation of eosinophils.
Roflumilast MOA
Roflumilast and its active metabolite are selective inhibitors of type four phosphodiesterase (PDE4) in lung tissue, thereby increasing intracellular levels of cAMP
Used only in COPD
Indications of uncontrolled asthma
using albuterol > twice a week, any nighttime cough, daytime coughing spells more than twice a week, FEV1 <80% predicted
All COPD patients should:
be counseled about quitting smoking at every visit and offered medication to assist with stopping smoking,
should be vaccinated annually in October against influenza,
should also be given the 23-valent pneumococcal polysaccharide vaccine against Strep pneumoniae at the time of diagnosis, regardless of season.
