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Pharmacology > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

Drug type?

“-terol”

A

Short-acting Beta Agonists (SABA)

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2
Q

Drug type?

“-terol”

A

Long-acting Beta Agonists (LABA)

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3
Q

Drug type?

“-sone/ide”

A

Inhaled Corticosteroids (ICS)

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4
Q

Drug type?

A

Corticosteroids

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5
Q

Drug type?

Montelukast (Singulair)
Zafirlukast (Accolate)

A

Leukotriene Receptor Antagonists (LTRAs)

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6
Q

Drug type?

Tiotropium (Spiriva)
Umeclidinium (Incruse Ellipta)
Aclidinium (Tudorza)

A

Long-acting Muscarinic Antagonists (LAMA)

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7
Q

Drug type?

Cromolyn (inhaled)
Nedocromil (opth)

A

Mast Cell Stabilizer

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8
Q

Drug type?

Ipratropium (Atrovent HFA)

A

SAMA

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9
Q

Drug type?

Roflumilast (Daliresp)

A

PDE4-I

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10
Q

Drug type?

A

Monoclonal Antibodies

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11
Q

Drug type?

Etomidate (Amidate)
Ketamine (Ketalar)
Propofol (Diprivan)

A

Sedatives

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12
Q

Drug type?

Succinylcholine (Quelicin)
Rocuronium (Zemuron)
Vecuronium (Norcuron)

A

Paralytics

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13
Q

Chronic lung disease characterized by reversible airflow obstruction, airway inflammation, and airway hyper-responsiveness

A

Asthma

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14
Q

Asthma or COPD?

like inhaling through straw

A

Asthma

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15
Q

Asthma or COPD

like exhaling through a straw

A

COPD

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16
Q

Is asthma more common in children or adults?

A

children

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17
Q

Asthma Etiology

A

Airway inflammation
Mobilization of neutrophils, eosinophils, lymphocytes
Mast cell activation

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18
Q

What are the drug targets of asthma?

A

IgE, IL4, IL5, IL13

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19
Q

Non-Pharmacologic trmnts of Asthma?

A

1) Limit exposure to triggers: allergens, smoke, cold air, influenza
2) manage co-morbidities (GERD, anxiety, sleep apnea, allergic rhinitis)
3) Ensure proper inhaler technique

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20
Q

Are bronchodilators or Anti-inflammatories 1st line in Asthma?

A

Anti-inflammatory!

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21
Q

____ should be the backbone of asthma regimen

A

Inhaled corticosteroids (ICS)

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22
Q

LTRA and LAMA are Asthma trmnts starting at step ____

A

3
I know LAMA isnt on this chart but the statement is in our Asthma Pharm Lecture

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23
Q

Monoclonal Antibodies are considered in step ____

A

5/6

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24
Q

What is the one super cool ICS-LABA combo?

A

Budesonide/Formoterol (Symbicort) combo is great for short exacerbation, but still functions as a longterm corticosteroid

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25
Q

Are SABAs & LABAs agonists or antagonists?

A

Agonists
They want Beta 2 receptors to do a better job

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26
Q

Are SAMAs & LAMAs agonists or antagonists?

A

Antagonists
They want to inhibit muscarinic receptors & dry everything out

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27
Q

Do SABAs increase or decrease HR?

A

increase = tachycardia SE
SABAs agonize B2 receptors (relax lungs), but there may be some B1 overlap (excite heart)
Caution in pts with heart dz, hyperthyroidism (may stim it even more), glaucoma (may incr IOP), and DM

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28
Q

LABAS should always be given with ____ for Asthma

A

ICS
Gotta treat underlying inflamm cause

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29
Q

What makes a LABA last longer than a SABA?

A

They bind to B2 receptors AND an exoreceptor

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30
Q

Rx for acute asthma attack?

A

SABA (Albuterol or Levalbuterol)
OR
ICS-LABA (Budesonide/Formoterol)

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31
Q

We are out of ICS. Can you give only LABA for asthma attack?

A

HELL NOOOOOOOOO
They will die and you will be sued

32
Q

ICS MOA

A

glucocorticoid receptor inhibitors.
Inhibits mobilization of certain cell lines (mast cells, eosinophils, basophils, macrophages, neutrophils) & inflammatory mediators (histamine, leukotrienes, cytokines, eicosanoids)

33
Q

Do ICS have a quick OOA?

A

Not really (5hrs). Peak: 1-2wks. Systemic absorption ~14%

Mobilizing cell lines takes time

34
Q

Systemic Corticosteroids MOA

A

Adrenalcorticoid steroid is a synthetic glucocorticoid analog.
Anti-inflammatory

35
Q

Can you give pt with liver failure prednisone?

A

NO, prednisone is a prodrug that must be metab in the liver to its active metabolite.
Prednisone -> prednisolone (ACTIVE)

36
Q

Do peds get prednisone or prednisolone?

A

prednisolone bc its the active metabolite and its effects are more predictable.

Recall: Prednisone is a pro drug!

37
Q

Why do systemic corticosteroids need to be tapered?

A

HPA axis suppression → systemic corticosteroids have similar effects on body as cortisol. In 2 wks, you become dependent on systemic corticosteroids and the adrenals stop producing cortisol.

38
Q

Short term vs long term SE of systemic corticosteroids

A

Short: hyperglycemia, irritability, incr appetite, insomnia, HTN
Long: HPA axis suppress, osteoporosis (elderly), growth retardation (kids), thin skin, edema “moon face”, central obesity, immunosuppress

39
Q

Med examples, MOA

Leukotriene Receptor Antagonists (LTRAs)

A
40
Q

SE?

Leukotriene Receptor Antagonists (LTRAs)

A
41
Q

Should a 3yo take Montelukast or Zafirlukast?

A

Montelukast

42
Q

Why would you consider a LeukoTriene Receptor Antagonist (LTRA) for asthma?

A

As an alternative daily maintenance medication

43
Q

Why do inhaled corticosteroids cause far less systemic SE than oral corticosteroids?

A

ICS are systemically absorbed less than oral
- ICS: Systemic Absorption ~14%
- Oral Corticosteroids: Systemic Absorption ~90%

44
Q

“You should only be taking this Oral Systemic Corticosteroid for _____ days MAX to prevent dependance and other systemic SE.”

A

3-10

45
Q

A last-line asthma option that is structurally similar to caffeine, has a wide array of mechanisms, SLOW OOA, is a Toxicity risk, has a narrow therapeutic window (can hurt just as quickly as it can help), and crosses the placenta

Billman said to never Rx it and if you’re at the point where you’re considering this, you should’ve already referred them!!

A
46
Q

Can Mast Cell Stabilizers be given for acute asthma attack? Why?

A

NOOOOO they can take up to 4wks for full effect

47
Q

Monoclonal Antibodies MOA

A

Omalizumab MOA: recombinant humanized monoclonal antibody binds to free IgE -> inhibits that free IgE from binding to its receptor on basophils and mast cells -> prevents inflammatory response

48
Q

Worst case scenario SE of Monoclonal Antibodies

A

Body sees them as foreign -> hypersensitivity -> ANAPHYLAXIS

49
Q

Monoclonal Antibodies

Dupilumab target

A

IL-4

Only one w/o a Z in its name & 4 comes before 5

50
Q

Monoclonal Antibodies

Omalizumab target

A
51
Q

Monoclonal Antibodies

Mepolizumab, Reslizumab, Benralizumab targets

A

IL-5

52
Q

Do SABAs, LABAs, and SAMAs produce bronchodilator or anti-inflammatory effects?

A

bronchodilator

53
Q

Do Corticosteroids and Mast Cell Steroids produce bronchodilator or anti-inflammatory effects?

A

anti-inflammatory

54
Q

Do LTRAs and Methylxanthines produce bronchodilator or anti-inflammatory effects?

A

BOTH

55
Q

COPD Dx is based on

A

cough, sputum production, PFT

56
Q

Progressive,partially reversible pulmonary disorder marked by airflow limitation
Think: any toxin harming lungs

A

COPD

57
Q

COPD

Chronic tissue injury and remodeling leads to…

A

Obstructive broncholitis and parenchymal destruction (emphysema)

58
Q

COPD trmnt goals?

A
  • control symptoms, prevent/limit progression, decrease exacerbations
  • Short term = open airways
  • Long term = decr sputum
59
Q

LABA monotherapy is only okay for
A. Asthma
B. COPD

A

COPD

60
Q

Criteria for “more risk” in COPD?

A

at least 2 exacerbations in past year OR 1 requiring hosp

61
Q

COPD symp are assessed using which tools?

name the criteria scales

A

mMRC
CAT
CCQ

62
Q

SAMA MOA

A

Short-acting muscarinic antagonists
Inhib cholinergic receptors -> bronchodilation, decr sputum prod

63
Q

SE, BBW

SAMA

A
64
Q

Rx for COPD Exacerbation

A

SAMA or SABA PRN

65
Q

Using Gold Criteria, classify COPD pt with FEV1/FVC <70% AND FEV1 = 70%

A

Gold II Moderate

66
Q

What do SAMA & LAMAs do to your HR?

A

slows it down (bradycardia)

67
Q

Caution when Rx Tioropiu (LAMA) to pts with ______ allx

A

milk protein allx

68
Q

MOA, OOA slow or fast?

Phosphodiesterase-4 (PDE-4) Inhibitor

A
69
Q

Phosphodiesterase-4 (PDE-4) Inhibitor is metabolized by what?

A

CYP1A2 & CYP3A4 substrate
SCREEN FOR DRUG INTERXNS

70
Q

Should a pink puffer (underwt & depressed pt) be Rx Roflumilast (PDE-4 inhibitor)

A

No, that drug has wt loss and psychiatric SE

71
Q

When should you consider a PDE-4 inhibitor (Roflumilast) for COPD?

A

VERY LAST OPTION

72
Q

Roflumilast (PDE-4 inhibitor) should always be used with _____ for COPD

A

maintenance bronchodilator

73
Q

Inhaler spacers should only be used with
A. Metered dose inhalers (MDI)
B. Powdered dose inhalers (DPI)

A

Metered dose inhalers (MDI)

74
Q

HFA, Respimat, QVAR are
A. Metered dose inhalers (MDI)
B. Dry Powder inhalers (DPI)

A

MDI

75
Q

Ellipta, Diskus, Pressair, Handihaler, Neohaler, and Respiclick are
A. Metered dose inhalers (MDI)
B. Dryer powder inhalers (DPI)

A

DPI

76
Q

Metered dose inhalers (MDI) should be inhaled
A. Slowly and deeply
B. Quickly and forcefully

A

Slowly and deeply

77
Q

Dryer powder inhalers (DPI) should be inhaled
A. Slowly and deeply
B. Quickly and forcefully

A

Quickly and forcefully

Pharmacology (14 decks)

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