Asthma And COPD Pharm 2: ICS, Luekotriene, And Monoclonals Flashcards
What are the most effective anti inflammatory agents used in asthma therapy?
ICS
What are the 3 Anti inflammatory effects of ICS for asthma patients?
Reduce eosinophils, T cells and mast cells.
What is the MOA for ICS for asthma? 3 things.
Switch off transcription of inflammatory cells and turn on anti inflammatory cells and increase expression of b2 receptors.
What are the indications for beclomethasone?
Maintenance treatment for asthma of 5 years of age and older.
What is a caution/warning for using beclomethasone?
Be careful transitioning someone from systemic corticosteroids to oral because of adrenal insufficiency.
What is budesonide indicated for?
Maintenance treatment of asthma 6 years and older.
What is the main route of metabolism for budesonide?
Cyp p450 3a4
What is the indication for ciclesonide?
Maintenance treatment of asthma for 12 years of age and older
What is a caution or warning for ccilesonide?
Don’t use in the presence of Candida albicans, TB or really any other infection.
Main indication for flunisolide?
Maintenance treatment of asthma of 6 years of age and older.
Main indication for fluticasone?
Maintenance treatment for asthma of 4 years of age and older.
What drug interaction is a no no with fluticasone?
Don’t use with cyp 3a4 inhibitors like ritonavir or ketoconazole.
What is the caution/warning for fluticasone?
At risk for Candida albicans infection.
What is the indication for mometasone?
Maintenance treatment for asthma of 4 years of age and older.
What is the clinical indication for triamcinolone?
Maintenance treatment of asthma.
Caution/Warning for use of triamcinolone?
Carefully watch if you use this medicine to transition an asthma patient from systemic corticosteroids to this ICSs.
What are three drug combos that can be used for maintenance of asthma? ICS + LABA.
Fluticasone and Salmeterol
Mometasone and formoterol
Budesonide and formoterol
How and why do we use oral corticosteroids?
We use them in conjunction with a short acting beta agonist to treat moderate to severe asthma flare ups.
What is prednisone indicated for?
Anti inflammatory or immunosuppressant for allergic asthma
What is the caution/warning for prednisone?
Monitor for Cushing syndrome and hyperglycemia. Make sure to taper off.
What is the MOA for leukotriene antagonists?
Bind to the CycLT receptor and block its activation which blocks all the inflammatory mess they can cause
What is the MOA of Montelukast?
Oral compound that binds and selectively inhibits CysLT1 and also blocks the action of LTD4.
What is a big time action that is being blocked when we block LTD4?
Bronchoconstriction.
What is the indication for montelukast?
Treat allergies and prevent asthma attacks.
What is montelukast not indicated for which means what?
Not indicated for acute attacks so have a beta 2 agonist on hand.
What is the MOA for zafirlukast?
Block D4 and E4, so blocking bronchoconstriction
What is the clinical indication for zafirlukast?
Treatment for chronic asthma.
What is the drug interaction we need to remember for zafirlukast?
Got to monitor PTT with patients on warfarin.
What is a warning/caution for zafirlukast?
Life threatening liver failure.
What is the MOA for zileuton?
Blocks 5 lipoxygenase which inhibits all luekotriene formation
Clinical indication for zileuton?
Treatment for chronic asthma
What is the drug interaction we need to be aware of with zileuton?
PTT levels need to be monitored because of interaction with warfarin.
Caution/warning for the use of zileuton?
Don’t use in patients with liver problems.
What is the MOA for omalizumab?
Anti IgE antibody
What are the two big clinical indications for omalizumab?
Moderate to severe asthma that isn’t being helped by corticosteroids and chronic idiopathic hives and rashes.
What is the BBW for omalizumab?
Anaphylaxis
What are 4 actions of omalizumab?
Anti IgE antibody, decreases high affinity receptors for IgE on mast cells, decreases mediator release from mast cells, anti inflammatory properties itself.
What drug family do we prescribe for mild intermittent asthma?
Beta 2 agonist
What 2 drug families do we prescribe for mild persistent asthma?
Beta 2 agonist and low dose ICS
What 3 drug families do we prescribe for moderate persistent asthma?
Beta 2 agonist, low dose ICS and LABA.
What 3 drug families do we prescribe for severe persistent asthma?
Beta 2 agonist, LABA, and high dose ICS
What 4 drug families do we prescribe for very severe persistent asthma?
Beta 2 agonist, LABA, ICS high dose and oral corticosteroid.
