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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
Are SABAs & LABAs agonists or antagonists?
Agonists They want Beta 2 receptors to do a better job
26
Are SAMAs & LAMAs agonists or antagonists?
Antagonists They want to inhibit muscarinic receptors & dry everything out
27
Do SABAs increase or decrease HR?
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
28
LABAS should always be given with ____ for Asthma
ICS Gotta treat underlying inflamm cause
29
What makes a LABA last longer than a SABA?
They bind to B2 receptors AND an exoreceptor
30
Rx for acute asthma attack?
SABA (Albuterol or Levalbuterol) OR ICS-LABA (Budesonide/Formoterol)
31
We are out of ICS. Can you give only LABA for asthma attack?
HELL NOOOOOOOOO They will die and you will be sued
32
ICS MOA
glucocorticoid receptor inhibitors. Inhibits mobilization of certain cell lines (mast cells, eosinophils, basophils, macrophages, neutrophils) & inflammatory mediators (histamine, leukotrienes, cytokines, eicosanoids)
33
Do ICS have a quick OOA?
Not really (5hrs). Peak: 1-2wks. Systemic absorption ~14% Mobilizing cell lines takes time
34
Systemic Corticosteroids MOA
Adrenalcorticoid steroid is a synthetic glucocorticoid analog. Anti-inflammatory
35
Can you give pt with liver failure prednisone?
NO, prednisone is a prodrug that must be metab in the liver to its active metabolite. Prednisone -> prednisolone (ACTIVE)
36
Do peds get prednisone or prednisolone?
prednisolone bc its the active metabolite and its effects are more predictable. Recall: Prednisone is a pro drug!
37
Why do systemic corticosteroids need to be tapered?
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
Short term vs long term SE of systemic corticosteroids
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
# Med examples, MOA Leukotriene Receptor Antagonists (LTRAs)
40
# SE? Leukotriene Receptor Antagonists (LTRAs)
41
Should a 3yo take Montelukast or Zafirlukast?
Montelukast
42
Why would you consider a LeukoTriene Receptor Antagonist (LTRA) for asthma?
As an alternative daily maintenance medication
43
Why do inhaled corticosteroids cause far less systemic SE than oral corticosteroids?
ICS are systemically absorbed less than oral - ICS: Systemic Absorption ~14% - Oral Corticosteroids: Systemic Absorption ~90%
44
"You should only be taking this Oral Systemic Corticosteroid for _____ days MAX to prevent dependance and other systemic SE."
3-10
45
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 ## Footnote Billman said to never Rx it and if you're at the point where you're considering this, you should've already referred them!!
46
Can Mast Cell Stabilizers be given for acute asthma attack? Why?
NOOOOO they can take up to 4wks for full effect
47
Monoclonal Antibodies MOA
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
Worst case scenario SE of Monoclonal Antibodies
Body sees them as foreign -> hypersensitivity -> **ANAPHYLAXIS**
49
# Monoclonal Antibodies Dupilumab target
IL-4 ## Footnote Only one w/o a Z in its name & 4 comes before 5
50
# Monoclonal Antibodies Omalizumab target
51
# Monoclonal Antibodies Mepolizumab, Reslizumab, Benralizumab targets
IL-5
52
Do SABAs, LABAs, and SAMAs produce bronchodilator or anti-inflammatory effects?
bronchodilator
53
Do Corticosteroids and Mast Cell Steroids produce bronchodilator or anti-inflammatory effects?
anti-inflammatory
54
Do LTRAs and Methylxanthines produce bronchodilator or anti-inflammatory effects?
BOTH
55
COPD Dx is based on
cough, sputum production, PFT
56
Progressive,**partially reversible** pulmonary disorder marked by **airflow limitation** Think: any toxin harming lungs
COPD
57
# COPD Chronic tissue injury and remodeling leads to...
Obstructive broncholitis and parenchymal destruction (emphysema)
58
COPD trmnt goals?
- control symptoms, prevent/limit progression, decrease exacerbations - Short term = open airways - Long term = decr sputum
59
LABA monotherapy is only okay for A. Asthma B. COPD
COPD
60
Criteria for "more risk" in COPD?
at least 2 exacerbations in past year OR 1 requiring hosp
61
COPD symp are assessed using which tools? | name the criteria scales
mMRC CAT CCQ
62
SAMA MOA
Short-acting muscarinic antagonists Inhib cholinergic receptors -> bronchodilation, decr sputum prod
63
# SE, BBW SAMA
64
Rx for COPD Exacerbation
SAMA or SABA PRN
65
Using Gold Criteria, classify COPD pt with FEV1/FVC <70% AND FEV1 = 70%
Gold II Moderate
66
What do SAMA & LAMAs do to your HR?
slows it down (bradycardia)
67
Caution when Rx Tioropiu (LAMA) to pts with ______ allx
milk protein allx
68
# MOA, OOA slow or fast? Phosphodiesterase-4 (PDE-4) Inhibitor
69
Phosphodiesterase-4 (PDE-4) Inhibitor is metabolized by what?
CYP1A2 & CYP3A4 substrate SCREEN FOR DRUG INTERXNS
70
Should a pink puffer (underwt & depressed pt) be Rx Roflumilast (PDE-4 inhibitor)
No, that drug has wt loss and psychiatric SE
71
When should you consider a PDE-4 inhibitor (Roflumilast) for COPD?
VERY LAST OPTION
72
Roflumilast (PDE-4 inhibitor) should always be used with _____ for COPD
maintenance bronchodilator
73
Inhaler spacers should only be used with A. Metered dose inhalers (MDI) B. Powdered dose inhalers (DPI)
Metered dose inhalers (MDI)
74
HFA, Respimat, QVAR are A. Metered dose inhalers (MDI) B. Dry Powder inhalers (DPI)
MDI
75
Ellipta, Diskus, Pressair, Handihaler, Neohaler, and Respiclick are A. Metered dose inhalers (MDI) B. Dryer powder inhalers (DPI)
DPI
76
Metered dose inhalers (MDI) should be inhaled A. Slowly and deeply B. Quickly and forcefully
Slowly and deeply
77
Dryer powder inhalers (DPI) should be inhaled A. Slowly and deeply B. Quickly and forcefully
Quickly and forcefully

Pharmacology (14 decks)

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