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Pharmacology 2 > Asthma + COPD > Flashcards

Asthma + COPD Flashcards

1
Q

Pathophysiology
Asthma

A

Asthma is a chronic inflammatory disorder of the airways. The pathophysiology of asthma involves the following components: airway inflammation, intermittent airflow obstruction and bronchial hyperresponsiveness.

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2
Q

Signs and symptoms
Asthma

A

SOB
Chest tightness or pain
Wheezing when exhaling

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3
Q

Rationale for drug use
Asthma

A

Symptom control and relief.

Prevention of exacerbations, acute asthma and death.

Improve and maintain lung function and quality of life

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4
Q

Step 1 asthma treatment criteria and drugs

A

Symptoms <2 times / month
SABA reliever puffer (salbutamol)

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5
Q

Step 2 asthma management criteria and drugs

A

Suitable for most new pts
ICS (low maintenance dose) + SABA (reliever as needed)

Budesonide + Salbutamol

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6
Q

Step 3 asthma criteria and treatment

A

Low dose ICS (budenoside) + fomoterol (LABA) + SABA (salbutamol)
Used for frequent use of inhaler (more than 2 times a week

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7
Q

Suffix
Beta2 agonist

A

LABA
terol

SABA
Salbutamol
terbutaline

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8
Q

Two kinds of Beta2 agonists

A

Short acting SABA
Long acting LABA

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9
Q

Generic names
Beta2 agonists

A

SABA
Salbutamol
Terbutaline
LABA
Formoterol
Indacaterol
Salmeterol

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10
Q

MOA
Beta 2 agonists

A

Relax bronchial smooth muscle by stimulating beta2 adrenoreceptors.

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11
Q

Indication
SABA

A

Symptom relief of asthma and COPD
Prevention of exercise-induced bronchoconstriction

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12
Q

Indication
LABA

A
  • Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids (except olodaterol)
  • COPD
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13
Q

Precautions
Beta 2 agonists

A

Cardiovascular disorders (including hypertension, ischaemic heart disease, heart failure, arrhythmias)—risk of cardiovascular adverse effects.

Diabetes—risk of hyperglycaemia with high doses.

Treatment with other sympathomimetic amines—may increase adverse effects (tremor, tachycardia, headache); avoid combination or adjust dose as necessary.

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14
Q

Adverse effects
Beta2 agonists

A

tremor, palpitations, headache
Hyperglycemia in high doses

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15
Q

Practice points
Beta2 agonists

A
  • high or increasing** usage of SABAs** indicates poorly controlled asthma and requires review of management
  • check inhaler technique and compliance regularly, especially when asthma control is poor
  • withhold LABA (24–36 hours) and SABA (4 hours if possible) before diagnostic spirometry; see details in the Spirometry Quick Reference Guide at the National Asthma Council Australia website
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16
Q

Drug class and indication

Formoterol

A

Beta2 agonist - LABA
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* Symptom relief of asthma in patients receiving inhaled corticosteroids and regular formoterol
* COPD

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17
Q

Drug class and indication

Indacaterol

A

Beta2 agonist - LABA
COPD

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18
Q

Drug class and indication

Indacaterol with glycopyrronium

A

Beta2 agonist (LABA) + Anticholinergics
COPD

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19
Q

Drug class and indication

Indacaterol with glycopyrronium and mometasone

A

Beta2 agonist (LABA) + Anticholinergic + corticosteroids

Maintenance treatment of severe asthma inadequately controlled with a combination inhaled corticosteroid and long-acting beta2 agonist

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20
Q

Drug class and indication

Indacaterol with mometasone

A

Beta2 agonist (LABA) + corticosteroids
Maintenance treatment of asthma when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate

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21
Q

Drug class and indication

Salbutamol

A

Beta2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

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22
Q

Drug class and indication

Salmeterol

A

Beta2 agonist (LABA)
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* COPD

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23
Q

Drug class and indication

Terbutaline

A

Beta 2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

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24
Q

Drug interactions
Beta2 agonists

A

beta-blockers + beta2 agonists
Beta-blockers antagonise the therapeutic effects of beta2 agonists and may precipitate asthma; seek specialist advice if the combination is felt necessary as a selective beta-blocker may be suitable.

theophylline + beta2 agonists
Theophylline can potentiate hypokalaemia induced by high doses of beta2 agonists; monitor patients with severe asthma closely for hypokalaemia.

Combination with other sympathomimetic amines may overload sympathetic nervous system = tremors, tachycardia

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25
Q

Suffix
Corticosteroids

A

“asone” or “sonide”

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26
Q

Generic drug names
Corticosteroids

A

Beclometasone (inhaled)
Budesonide (inhaled)
Ciclesonide (inhaled)
Fluticasone furoate (inhaled)

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27
Q

Indication
Corticosteroids

A

Maintenance treatment of asthma and COPD

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28
Q

MOA
Corticosteroids

A

Reduce airway inflammation and bronchial hyper-reactivity.

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29
Q

Precautions
Corticosteroids

A

COPD—inhaled corticosteroids may increase the risk of pneumonia.

Smoking—asthma patients who smoke may respond less well to inhaled corticosteroids than non-smokers and may require higher doses.

30
Q

Adverse effects
Corticosteroids

A

dysphonia, oropharyngeal candidiasis, bruising, facial skin irritation following nebulisation
Systemic adverse effects
Bone density loss
Pneumonia: risk may be increased in COPD patients.

31
Q

Counselling
Corticosteroids

A

Use spacer
rinse mouth with water after use

32
Q

Practice points
Corticosteroids

A
  • check inhaler technique and compliance regularly
  • inhaled corticosteroids may be a useful add-on treatment for COPD inadequately controlled with long-acting beta2 agonists
33
Q

Drug class and indication

Beclometasone (inhaled)

A

Corticosteroid
Maintenance treatment of asthma

34
Q

Drug class and indication

Beclometasone with formoterol

A

Corticosteroid + Beta2 agonist (LABA)
* Maintenance treatment of asthma (including additional symptom relief) when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with long-acting bronchodilators

35
Q

Drug class and indication

Beclometasone with formoterol and glycopyrronium

A

Corticosteroid + beta2 agonist (LABA) + anticholinergic (LAMA)
COPD with FEV1 <50% and recurrent exacerbations requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS)

36
Q

ICS aka…

A

Inhaled coricosteroid

37
Q

Drug class and indication

Budesonide (inhaled)

A

Corticosteroid
Maintenance treatment of asthma
Croup

38
Q

Drug class and indication

Budesonide with formoterol

A

ICS + LABA
* Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular budesonide and formoterol
* Maintenance and symptom relief of asthma
* Symptom relief (mild asthma)
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist

Inhaled corticosteroid + LABA beta2 agonist

39
Q

Drug class and indication

Budesonide with glycopyrronium and formoterol

A

ICS + LAMA + LABA
Moderate-to-severe COPD with frequent or severe exacerbations requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS)

Inhaled corticosteroid + LAMA Anticholinergic + LABA Beta2 agonist

40
Q

Drug class and indication

Ciclesonide (inhaled)

A

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

41
Q

Drug class and indication

Fluticasone furoate (inhaled)

A

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

42
Q

Drug class and indication

Fluticasone furoate with umeclidinium and vilanterol

A

ICS + LAMA + LABA
* Maintenance treatment of severe asthma inadequately controlled with a combination inhaled corticosteroid (ICS) and long-acting beta2 agonist (LABA)
* Moderate-to-severe COPD with frequent or severe exacerbations requiring treatment with a long-acting anticholinergic, a LABA and an ICS

Inhaled corticosteroid + inhaled anticholinergic + beta2 agonist

43
Q

Drug class and indication

Fluticasone furoate with vilanterol

A

ICS + LABA
* Maintenance treatment of asthma in patients who require a medium-to-high dose of inhaled corticosteroid (ICS) with a long-acting beta2 agonist (LABA)
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a LABA

Inhaled corticosteroid + Beta2 agonist

44
Q

Drug class and indication

Fluticasone propionate (inhaled)

A

ICS
Maintenance treatment of asthma

Inhaled corticosteroid

45
Q

Drug class and indication

Fluticasone propionate with formoterol

A

ICS + LABA
Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular fluticasone propionate and formoterol

Inhaled corticosteroid + beta2 agonist

46
Q

Drug class and indication

Fluticasone propionate with salmeterol

A

ICS + LABA
* Maintenance treatment of asthma inadequately controlled with inhaled corticosteroids or when stabilised on regular fluticasone propionate and salmeterol
* COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist

Inhaled corticosteroid + beta 2 agonist

47
Q

Drug interactions
Corticosteroids

A
  • metabolised by CYP3A4, consequently combinations with CYP3A4 inhibitors may increase their concentrations and the risk of adverse effects, while combinations with CYP3A4 inducers may decrease their efficacy.
  • corticosteroids + NSAIDs
    Oral corticosteroids increase risk of gastric ulceration with NSAIDs; consider need for an NSAID carefully; if an NSAID cannot be avoided use lowest effective dose for shortest period of time
48
Q

Generic names of Anticholinergics (inhaled)

A

Short acting
Ipratropium
Long acting
Aclidinium
Glycopyrronium (inhaled)
Tiotropium
Umeclidinium

49
Q

Suffix
Anticholinergics (inhaled)

50
Q

MOA
Anticholinergics (Inhaled)

A

Promote bronchodilation by inhibiting cholinergic bronchomotor tone. They block muscarinic actions of acetylcholine.

51
Q

Precautions
Anticolinergics (inhaled)

A

Cardiovascular disorders—anticholinergics may increase risk of cardiovascular adverse effects; patients with pre-existing cardiac conditions were often excluded from randomised, controlled trials.

52
Q

Adverse effects
Anticholinergics (inhaled)

A

dry mouth, throat irritation

53
Q

Anticholinergics (inhaled) aka …

A

antimuscarinics or muscarinic antagonists

54
Q

SAMAs VS LAMAs

Anticholinergics (inhaled) aka antimuscarinics

A

Short acting (SAMA)
Ipratropium is short acting; it is also known as a short-acting muscarinic antagonist (SAMA). It is an alternative to short-acting beta2 agonists (SABAs) in the initial management of symptoms such as breathlessness in mild COPD. In asthma, its use is mainly limited to treatment of severe acute attacks when SABA therapy is inadequate.

Long acting (LAMA)
Aclidinium, glycopyrronium, tiotropium and umeclidinium are long acting; they are also known as long-acting muscarinic antagonists (LAMAs).

All LAMAs are marketed for use in COPD

In asthma, tiotropium (Spiriva Respimat®) is marketed as an add-on inhaler to regular inhaled corticosteroid (ICS) with or without a long-acting beta2 agonist (LABA) for patients >6 years.

55
Q

Counselling
Anticholinergics (inhaled)

A

Ensure correct use of inhaler / use of spacer.

56
Q

Practice points
Anticholinergics (inhaled)

A
  • stop ipratropium if treatment with a long-acting anticholinergic is required for COPD
  • before diagnostic spirometry, withhold ipratropium for 12 hours and LAMAs for 36 hours
57
Q

Drug class and indication

Aclidinium

A

LAMA
COPD

Anticholinergic (inhaled)

58
Q

Drug class and indication

Aclidinium with formoterol

A

LAMA + LABA
COPD

long acting anticholinergic (inhaled) + long acting beta2 agonist

59
Q

Drug class and indication

Glycopyrronium (inhaled)

A

Anticholinergic (LAMA)
COPD

60
Q

Drug class and indication

Ipratropium

A

Anticholinergic (LAMA)
Symptom relief of asthma and COPD

61
Q

Drug class and indication

Tiotropium

A

Anticholinergic - inhaled (LAMA)
* COPD
* Maintenance treatment of moderate-to-severe asthma as adjunct to standard treatment including an inhaled corticosteroid (ICS)

62
Q

Drug class and indication

Tiotropium with olodaterol

A

Anticholinergic (inhaled) LAMA + Beta2 agonist (LABA)
COPD

63
Q

Drug class and indication

Umeclidinium

A

Anticholinergic (inhaled) LAMA
COPD

64
Q

Drug class and indication

Umeclidinium with vilanterol

A

Anticholinergic (inhaled) LAMA + beta2 agonist (LABA)
COPD

65
Q

Pathophysiology
COPD

A

Chronic obstructive pulmonary disease is characterised by poorly reversible airflow obstruction and an abnormal inflammatory response in the lungs. The latter represents the innate and adaptive immune responses to long term exposure to noxious particles and gases, particularly cigarette smoke.

66
Q

Signs and symptoms
COPD

A
  • Increasing breathlessness
  • Persistent chesty cough
  • Frequent chest infections
  • Persistent wheezing
67
Q

Drug rationale
COPD

A

Symptom relief.

Improvement of exercise tolerance and quality of life.

Prevention or treatment of exacerbations and complications of COPD.

68
Q

Step 1 COPD treatment

A

start with a SABA (albuterol) or ipratropium when required for symptom relief

69
Q

Step 2 COPD treatment

A

add or switch to a LABA or long-acting anticholinergic1 for persistent symptoms

70
Q

Practice points for inhaled medications

A

Use a spacer to maximise medication effectiveness and correct use of medication

71
Q

Similarities between COPD and Asthma management

A

1st line treatment SABA
Use of inhaled medications
both experience cough and SOB

72
Q

Differences between Asthma and COPD management

A

Asthma:
* not progressive disease
* Broad inflamatory response
* treated with beta 2 agonists and ICS
* Treatable / curable esp. in children
* often diagnosed <20yrs

COPD:
* Progressively worsens
* Common in >40yrs develop
* Commonly a Smoker
* irreversible
* Emphysema
* Sputum

Pharmacology 2 (41 decks)

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