asthma/COPD Flashcards
1
Q
short-acting beta2 agonists
A
- albuterol and terbutaline
- bronchodilators
- inhaled
- use as needed basis and acute exacerbation
- b for “bute” and beta
2
Q
levalbuterol
A
- R isomer of albuterol
- most beta agonists are racemix mixture and only the R isomer is effective
- S isomer may promote inflammation
3
Q
adverse SE of SABA
A
- musculoskeletal tremor
- tachycardia
- hyperglycemia
- hypokalemia
- hypomagnesemia
- prolonged QT
- lactic acidosis
- paradoxical bronchospasm
- tolerance with chronic use
- selectivity is lost with higher doses
4
Q
LABA
A
- Salmeterol and Formoterol
- bronchodilators
- **always use in combo with inhaled corticosteroids!
- use: long-term control of symptoms
5
Q
antimuscarinics
A
- M3>M2 (M3 = bronchoconstriction and M2 = negative feedback)
- bronchodilation
- Tiotropium and Ipratropium bromide
- tiotropium preferred (more selective and longer half-life)
6
Q
Tiotropium
A
- antimuscarinic (M3>M2) –> bronchodilation
- also has anti-inflammatory props and decreases mucous production
- 1st line agent for chronic stable COPD
7
Q
Ipratropium bromide
A
- antimuscarinic –> bronchodilator
- tx: chronic COPD but less preferred than tiotropium
- shorter t1/2, less M3 selectivity
8
Q
SE of antimuscarinics
A
- dry mouth
- bladder outlet obstruction
- glaucoma
- paradoxical bronchospasm
- cardiovascular mortality and CVA??
- need higher doses to prevent vagal induced bronchospasm
** opp of SLUDGE
9
Q
Aclidinium bromide
A
- newer antimuscarinic
- M3>M2 affinity
- metabolized in plasma –> short circulation t1/2 –> less SE
- higher doses can be given more safely (bettter at preventing vagal induced bronchoconstriction)
10
Q
methylxanthines
A
- theophylline, theobromine, caffein
- PDE inhibitors –> weak bronchodilators
- anti-inflammatory role
- improve contractility and reverse fatigue of diaphragm in PTs with COPD
- restore corticosteroid sensitivity
- narrow tx toxic window
11
Q
problems with methylxanthines
A
- narrow tx window
- SE at tx doses: anorexia, nausea, HA, insomnia, GERD
- SE at slightly higher doses: cardiac arrthymia and seizures
- drug interactions: cyp450 metabolism
12
Q
inhaled corticosteroids
A
- anti-inflammatory agents
- budenoside, fluticasone propionate, beclmethasone diproprionate and mometasone
- 1st line tx for persistent asthma
- additive effect with B2 agonist
- steroid sensitivity can be restored with theophylline
- but many SE
13
Q
leukotriene inhibitors
A
- montelukast, pranlukast, zafirlukast, zileuton
- use as add-on tx for mild asthma
- no role in COPD
- DOC for asprin-induced asthma
- prophylaxis for exercise-induced bronchospasm
- SE: liver toxicity for zileuton, association with Churg-Strauss syndrome
14
Q
sodium cromoglycate and nedocromil sodium
A
- prevent mast cell degranulation and mediator release from macrophages and eosinophils
- alternative tx for mild persistent asthma
- no role in COPD
15
Q
omalizumab
A
- anti-IgE antibody
- administered subQ every 2-4 weeks
- only used in PTs with very severe asthma who are poorly controlled on oral corticosteroids
