Asthma + COPD Flashcards
How much medication is needed for effective delivery through inhalation vs swallowing
10-20% inhaled
80-90% swallowed
(inhalation is more effective)
______ is the preferred method of delivery of most medications used in asthma and COPD
inhalation.
medication are needed acutely so it can work quickly
Pressurized metered dose inhalers: drugs are ___ from a canister with aid of propellant. most need to be ____ before use
propelled
shaken
What do space chambers do?
reduce the volume of velocity of particles-> less swallowing and more inhaled.
Why does the inhaler need to be shaken?
Medication is a suspension. if it sits there, it clumps and not effective
Dry Powder inhalers: devices scatter a ____ _____ by air turbulence on inhalation. Need to take __________ inspiurations
fine powder
quick and deep (forceful)
Nebulizers: turn liquid to _____ and is driven by _____. Administration though _____. What population is this good for?
fine mist
stream of gas.
mask
cognitive impairment/altered mentation
Some differences between MDIs and DPIs?
liquid vs fine powder
propellant vs none
shake vs don’t shake
slow inhale vs quick + forceful
Soft mist inhalers (respimat): propels a ____ of medication without help of propellant. Contains ____ per use than MDI/DPI.
cloud
more particules
might be hard to use for cog impaired patients
up to ___ of patients cannot use their inhalers corrects
80%. counseling is crucial
Patients should wait ____ seconds between puffs
60 seconds
Which should be used first if Both are prescribed: bronchodilator + corticosteroid
bronchodilator first.
Combination inhalers combine __________ in one devide
multiple active ingredients. this is more convenient for patients and improves compliants
Short acting inhalers (rescue inhalers) active ingredients include:
short acting β agonists (SABA)- albuterol
short acting muscarinic antagonists (SAMA)- ipratropium
too much use- poorly controlled asthma/COPD
How fast do short acting inhalers work?
1-2 minutes- quickly reverse bronchoconstriction.
Long acting inhalers (maintenance inhalers) are taken _______ to prevent symptoms of asthma and COPD. They open airways and reduce swelling for ___ hours
daily or multiple times per day.
12 hours.
These are the LABAS, LAMAS, ICS
Mechansim of bronchodilators:
constrict airway smooth muscle, reverse symptoms, prevent bronchoconstriction.
What are the medication classes of bronchodilators
β 2 adrenergic agonists anticholinergic agents (muscarinic)
What are SABAs and LABAs that are on the market? (what do they end in)
“terol”
SABA: albuterol, levalbuterol
LABA: formoterol, salmeterol, vilanterol, indacaterol, olodaterol
What is the molecular structure difference between SABAs and LABAs?
large side chains on molecular structure. (more lipid-> retention in lipid layer of cell membrane)
What is the difference between albuterol and levalbuterol
albuterol is a racemic mix. leva is only R-albuterol.
IS leva better? clinical trial say unclear.
What are some side effects of Β2 agonists?
muscle tremor (B2 on skeletal- elderly) Tachycardia + heart palpitations (peripheral ZVD from atrial β2 receptors) hypokalemia (β2 stim K entry into skeletal muscle)
What are SAMA and LAMA that are on the market? (what do they end in)
“ium” (mostly)
SAMA: ipratropium
LAMA: tiotropium, umeclidinium, aclidinium, glycopyrrolate
Muscarinic antagonists have a higher selectivity for ___ receptors. These are in _____ and ____
M3 receptors
airway smooth muscle (Smooth muscle contraction) and submucosal cells (mucus secretion)
MOA of muscarinic antagonists
block the action of acetylcholine at parasympathetic sites in bronchial smooth muscle-> bronchodilation
Where are M1 muscarinic receptors?
epithelial cells + ganglia
Where are M2 muscarinic receptors?
neurons (augment acetylcholine release)
What are the effects of the muscarinic antagonists?
bronchodilator (at M3)
decreased mucus production (blockade of M3 receptor. M1 blockage will also help this)
What are muscarinic antagonist side effects?
anticholinergic: dry mouth (xerostomia), headache, dizziness
other: URIs, bitter taste, cough
What are inhaled corticosteroids that are on the market? (what do they end in)
“one” and “onide”
beclomthasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone
What is the mechanism of ICS?
inhibit the inflammatory response, depression migration of polymorphonuclear leukocytes, reverse capillary permeability
What is the downstream effects of inhaled corticosteroids?
increase β receptors on SM + improve them
reduce mucus + hyper secretion
reduce bronchial hyper responsiveness
reduce airway edema + exudation
_____ are more effective in asthma than COPD. Why?
Inhaled corticosteroids
eosinophilic is more sensitive than neutrophilic
What inflammatory cells do corticosteroids hit?
eosinophils, T cells, mast, Macs, DCs (everything)
cytokines are down as well as sheer numbers of inflammatory cells
what cells do corticosteroids hit?
epithelial, endothelial, airway SM, mucus
What are local side effects of ICS?
oral candidiasis, dysphonia (hoarse), cough
are there any short acting inhaled corticosteroids?
no
Systemic side effects of ICs includes?
pneumonia, growth suppression, osteoporosis, dermal thinning, adrenal insufficiency
(still less AEs than oral steroids)
Why should high does of ICS be avoided in COPD?
risk of pneumonia
How to prevent oral candidiasis in ICS?
rinse mouth and throat with warm water and spit out after inhaler use
Short acting agents (can/cannot) be used as long term controllers
some long acting agents need to be taken _____
cannot
multiple times a day
What are two leukotriene receptor antagonists? How are these delivered?
montelukast (Singulair) and safirlukast (accolade)
Tablets
What is the MOA of leukotriene receptor antagonists?
inhibit cysteine leukotriene receptor resulting in reduced intracellular calcium + inactive phosphokinase C
What are the results of leukotriene receptor antagonists?
decreased airway edema, SM relax, decreased inflammation
What is the FDA boxed warning with Singulair?
serious neuropsychiatric events
Severe asthma can use ____.
Monoclonal antibodies
MOA of Omalizumab? MOA for Mepolizumab and resilizumab? MOA for Dupilimumab? what type are each indicated for?
Omal: Anti IgE (uncontrolled asthma step 4-5 therapy)
Mepol + resil: Anti IL5/5R (eosinophilic asthma step 4-5)
Dupil: anti IL4 (type 2 asthma allergic or require OCS )
Why is Azithromycin used in late COPD?
anti-inflammatory properties.
reduce risk of exacerbation, but less effective in active smokers
Why is Roflumilast (Daliresp) used in late COPD?
Oral PDE4 inhibitor -> inhibit breakdown cAMP-> reduce inflammation
reduce exacerbations in chronic bronchitis, severe COPD, hx of exacerbations (hospitalizations)
What are the 4 intervention that all COPD patients will get?
smoking cessation
influenza, pneumonococcal + pertussis vaccines
physical activity
SABA (albuterol) and SAMA (ipratropium)
How to classify groups A-D in COPD?
A: 0-1 exacerbations, low symptoms
b: 0-1 exacerbation, high symptoms
C: >1 exacerbations, low symp
D: >1 exacerbations, high symptoms
Which treatment do each
