Asthma & COPD Flashcards
what receptors excite & inhibit bronchial smooth muscle?
ß agonists -> excite (dilate)
Muscarinic antagonists -> inhibit (dilate)
what drug types inhibit bronchoconstriction?
Muscarinic antagonists & theophylline (block adenosine)
what class of drugs reverse bronchoconstriction in asthma?
ß2 agonists
relax airway smooth muscle
SABA & LABA
what are SABA?
Terbutaline, Metaproterenol, Levabuterol, Pirbuterol, Albuterol
A patient comes in with a complaint of adverse affects from her new SABA prescription for asthma. She notes she broke out in severe itchy rash and forgot to note at the initial meeting that she has an allergy to sulfa drugs. What SABA was she most likely presecribed?
subQ Terbutaline
A 6yo is recently diagnosed with intermediate asthma. What would be an appropriate SABA?
Levabuterol
patients > 4yo
What is a non-respiratory risk factor when prescribing SABA?
Cardiovascular symptoms:
elevated HR & BP
A G1P2 woman comes in with premature contractions at 24w. Her OB prescribes medication to delay these contractions (tocolysis). What SABA should her OB look for in the patients med list before performing tocolysis?
Terbutaline
Severe paradoxical bronchospams may occur with administration of what prescripsions
Metaproterenol, Albuterol, Levabuterol
“MAL”
In addition to asthma, SABA can be used for what other respiratory conditions?
reversible obstructive conditions
COPD, bronchitis, bronchiolitis
What is the most effective controller of asthma?
Inhaled Coticosteroids (ICS)
What is the MOA of ICS?
- Decrease pro-inflammatory TFs
- reduce eosinophils, T cells, Mast cells, & sputum
If a patient comes in on first-line Triamcinolone but has not seen any response in symptoms, what would be the next step in treatment?
Add to a LABA
What is one downside to using ICS?
Does not cure
only treats symptoms
How long after administering an ICS will patients see improvement?
Rapidly
full effect takes several days
A patient was recently taken off of systemic corticosteroids, how long should you wait before administering beclomethasone to a patient with asthma?
several months
if too soon can be fatal
wait for HPA axis to recover
What ICS should be used in patients older than 4y?
Fluticasone, Mometasone
What ICS should be used in patients older than 5y?
Beclomethasone
What ICS should be used in patients older than 6y?
Budesonide, Flunisolide
What ICS should be used in patients older than 12y?
Ciclesonide
What ICS should be administered for patients who need systemic corticosteroids?
Triamcinolone
All ICS are contraindcated for what purposes?
acute asthma or status asthmaticus,
A patient recently started on ICS for asthma and develops pharyngitis with white plaques that easily fall off. What medications was she most likely put on associated with this presentation?
Fluticasone or Ciclesonide
associated with oropharyngeal Candida albicans
A patient was recently transferred from systemic corticosteroids to a new ICS for asthma. What is the greatest risk in this situation?
Adrenal insufficiency & death
fatigue, muscle weakness, decreased appetite, and weight loss
A patient is known to have a severe allergy to milk. What ICS medication are contraindicated if needed for asthma?
budesonide & mometasone
A patient requires oral corticosteroids & ICS for asthma. What would be the most appropriate combination for this patient?
Beclomethasone & Prednisone
The use of ICS is indicated for what function in asthma treatment?
Maintanenance prophylaxis
If a patient comes in stating that they have had asthma attacks daily and were woken up about 4 nights a week and it gets in the way of going out and being with friends. These flare ups having been happening more frequently. What is a good course of treatment?
SABA & Oral corticosteroids
for moderate - severe asthma FLARE UPS
What differentiates the use of prednisone from ICS?
immunosuppressant, endocrine conditions, & anti-inflammatory
risk of HPA suppression
When puting a patient on prednisone, what are important signs to be looking for?
Cushings syndrome & hyperglycemia
fatty neck hump, moon face, striae…
What are the best drugs for maintenance of COPD?
LABA
(-terol)
When administering a LABA for asthma what else is required?
ICS
without -> increased fatality risk
What LABA should be used for asthma in a 4yo?
Salmeterol
otherwise use Fomoterol
Salmeterol is beneficial for what asthma?
maintenance & exercise induced bronchospasm
If you want to target the parasympathetic impulse to prevent smooth muscle constriction in patients with COPD, what class of drugs should be used?
anticholinergics
A 65yo patient diagnosed with COPD has been sent to you for presecription of a long term, maintenance treatment of bronchospasm. What drugs would be best to use?
Tiotropium, Ipratropium & Aclidinium
Block acetylcholine binding nerve terminal
long term maintenance drugs
What differentiates ipratropium from other anti-cholinergics for long term COPD?
free of systemic effects because of poor absorption
You want to put a patient that is responsive to methylcholine test on a new drug that bronchodilates & suppresses airway stimulation. What would be drug of choice?
Theophylline
same class as caffeine & theobromineb (chocolate)
Your patient that you put on theophylline tells you they are also on omeprazole. What is the problem with this situation?
Theophlline exacerbates PUD, seizures, & arrythmias
What class of drugs is preferred for managment of asthma?
Leukotriene Antagonists
What is the target of all leukotriene receptors ending in -lukast?
CysLT1 receptor
What is the target of Zileuton?
5-lipoxygenase
You are treating a patient for allergies & also to prevent asthma attacks. You do not want to use an ICS, what would be your best option that targets LTD4 specifically?
Monteluksat
inhibits LTD4 on CysLT1-R only
Your patient comes in for a visit and tells you they stopped carrying their Pirbuterol inhaler in their gym bag since they started taking their new medicine daily. Why is this a problem?
Leukotriene inhibitors are not for acute asthma attacks. SABA still required
If you want to target LTD4 & LTE4 on CysLT1 what drug should you use?
Zafirluksat
What are the contraindications of Zarilukast & Zileuton?
Hepatotoxicity
A patient tells you they are on a leukotriene inhibitor that starts with a Z but can’t remember which one. What would be a followup question you could ask to narrow down the which medication it is?
When did you start taking it?
If <12yo Zafirlukast
Zileuton is for patient older than 12yo.
What is the MOA of Zileuton?
inhibits 5-lipoxygenase
A patient with daily SABA use, 5 wakeful nights, an FEV1/FVC < 0.7 & stated daily-limitations from asthma comes in for a new prescription as their symptoms are unresponsive to ICS & prednisone. What is the mechanism of action of the most likely new drug?
anti-IgE -> decrease Fc on mast cell -> dec. mediators -> dec. inflammation & exacerbation
omalizumab is for patients unresponsive ICS, chronic urticaria
What is the age difference when prescribing omalizumab for asthma vs chronic idiopathic urticaria?
Asthma - older 6yo
Urticaria - older 12yo
what anticholinergics may apply to COPD treatment?
Ipratropium, Tiotropium, Aclidinium, & atropine (severe)
what ß2 agonists would be useful for treatment of COPD?
Oldaterol, Indacaterol, Vilanterol, Fometerol, & Salmeterol
Fometerol & Salmeterol are ALSO used in asthma
