Asthma And COPD Pharm 2: ICS, Luekotriene, And Monoclonals

Question 1

What are the most effective anti inflammatory agents used in asthma therapy?

Answer 1

ICS

Question 2

What are the 3 Anti inflammatory effects of ICS for asthma patients?

Answer 2

Reduce eosinophils, T cells and mast cells.

Question 3

What is the MOA for ICS for asthma? 3 things.

Answer 3

Switch off transcription of inflammatory cells and turn on anti inflammatory cells and increase expression of b2 receptors.

Question 4

What are the indications for beclomethasone?

Answer 4

Maintenance treatment for asthma of 5 years of age and older.

Question 5

What is a caution/warning for using beclomethasone?

Answer 5

Be careful transitioning someone from systemic corticosteroids to oral because of adrenal insufficiency.

Question 6

What is budesonide indicated for?

Answer 6

Maintenance treatment of asthma 6 years and older.

Question 7

What is the main route of metabolism for budesonide?

Answer 7

Cyp p450 3a4

Question 8

What is the indication for ciclesonide?

Answer 8

Maintenance treatment of asthma for 12 years of age and older

Question 9

What is a caution or warning for ccilesonide?

Answer 9

Don’t use in the presence of Candida albicans, TB or really any other infection.

Question 10

Main indication for flunisolide?

Answer 10

Maintenance treatment of asthma of 6 years of age and older.

Question 11

Main indication for fluticasone?

Answer 11

Maintenance treatment for asthma of 4 years of age and older.

Question 12

What drug interaction is a no no with fluticasone?

Answer 12

Don’t use with cyp 3a4 inhibitors like ritonavir or ketoconazole.

Question 13

What is the caution/warning for fluticasone?

Answer 13

At risk for Candida albicans infection.

Question 14

What is the indication for mometasone?

Answer 14

Maintenance treatment for asthma of 4 years of age and older.

Question 15

What is the clinical indication for triamcinolone?

Answer 15

Maintenance treatment of asthma.

Question 16

Caution/Warning for use of triamcinolone?

Answer 16

Carefully watch if you use this medicine to transition an asthma patient from systemic corticosteroids to this ICSs.

Question 17

What are three drug combos that can be used for maintenance of asthma? ICS + LABA.

Answer 17

Fluticasone and Salmeterol
Mometasone and formoterol
Budesonide and formoterol

Question 18

How and why do we use oral corticosteroids?

Answer 18

We use them in conjunction with a short acting beta agonist to treat moderate to severe asthma flare ups.

Question 19

What is prednisone indicated for?

Answer 19

Anti inflammatory or immunosuppressant for allergic asthma

Question 20

What is the caution/warning for prednisone?

Answer 20

Monitor for Cushing syndrome and hyperglycemia. Make sure to taper off.

Question 21

What is the MOA for leukotriene antagonists?

Answer 21

Bind to the CycLT receptor and block its activation which blocks all the inflammatory mess they can cause

Question 22

What is the MOA of Montelukast?

Answer 22

Oral compound that binds and selectively inhibits CysLT1 and also blocks the action of LTD4.

Question 23

What is a big time action that is being blocked when we block LTD4?

Answer 23

Bronchoconstriction.

Question 24

What is the indication for montelukast?

Answer 24

Treat allergies and prevent asthma attacks.

Question 25

What is montelukast not indicated for which means what?

Answer 25

Not indicated for acute attacks so have a beta 2 agonist on hand.

Question 26

What is the MOA for zafirlukast?

Answer 26

Block D4 and E4, so blocking bronchoconstriction

Question 27

What is the clinical indication for zafirlukast?

Answer 27

Treatment for chronic asthma.

Question 28

What is the drug interaction we need to remember for zafirlukast?

Answer 28

Got to monitor PTT with patients on warfarin.

Question 29

What is a warning/caution for zafirlukast?

Answer 29

Life threatening liver failure.

Question 30

What is the MOA for zileuton?

Answer 30

Blocks 5 lipoxygenase which inhibits all luekotriene formation

Question 31

Clinical indication for zileuton?

Answer 31

Treatment for chronic asthma

Question 32

What is the drug interaction we need to be aware of with zileuton?

Answer 32

PTT levels need to be monitored because of interaction with warfarin.

Question 33

Caution/warning for the use of zileuton?

Answer 33

Don’t use in patients with liver problems.

Question 34

What is the MOA for omalizumab?

Answer 34

Anti IgE antibody

Question 35

What are the two big clinical indications for omalizumab?

Answer 35

Moderate to severe asthma that isn’t being helped by corticosteroids and chronic idiopathic hives and rashes.

Question 36

What is the BBW for omalizumab?

Answer 36

Anaphylaxis

Question 37

What are 4 actions of omalizumab?

Answer 37

Anti IgE antibody, decreases high affinity receptors for IgE on mast cells, decreases mediator release from mast cells, anti inflammatory properties itself.

Question 38

What drug family do we prescribe for mild intermittent asthma?

Answer 38

Beta 2 agonist

Question 39

What 2 drug families do we prescribe for mild persistent asthma?

Answer 39

Beta 2 agonist and low dose ICS

Question 40

What 3 drug families do we prescribe for moderate persistent asthma?

Answer 40

Beta 2 agonist, low dose ICS and LABA.

Question 41

What 3 drug families do we prescribe for severe persistent asthma?

Answer 41

Beta 2 agonist, LABA, and high dose ICS

Question 42

What 4 drug families do we prescribe for very severe persistent asthma?

Answer 42

Beta 2 agonist, LABA, ICS high dose and oral corticosteroid.