Asthma & COPD Flashcards
What is the pathophysiology of asthma?
- reversible, chronic hyper-responsiveness leading to inflam
What is the etiology of asthma?
- triggers
i. e. airborne allergens, virus, cold
What is the goal of asthma therapy?
- reduce impairment & lung remodeling
- reduce risk
What are the steps of treatment in a 0-4 y/o with asthma?
- step 1: SABA
- step 2: low dose ICS (alt: montelukast or cromolyn)
- step 3: med dose ICS
- step 4: med dose ICS + montelukast or LABA
- step 5: high dose ICS + montelukast or LABA
- step 6: high dose ICS + montelukast or LABA + daily oral steroids
What are the steps of treatment in a 5-11 y/o with asthma?
- step 1: SABA
- step 2: low dose ICS (alt: cromolyn or theophilline as last line)
- step 3: med dose ICS OR low dose ICS + either LABA, LTRA, or theophylline
- step 4: med dose ICS + LABA (alt: med dose ICS + either LTRA or Theophylline)
- step 5: high dose ICS + LABA (alt: high dose ICS + either LTRA or Theophylline)
- step 6: high dose ICS + LABA + oral steroid (alt: high dose ICS + either LTRA or Theophylline + oral steroid)
When can you rx a LABA?
- once the patient is on ICS
What are the steps of treatment in a patient over 12 y/o with asthma?
- step 1: SABA
- step 2: low dose ICS (alt: cromolyn, nedocromil, LTRA, or theophylline)
- step 3: med dose ICS OR low dose ICS + LABA (alt: low dose ICS + either LTRA, theophylilne or Zileuton)
- step 4: med dose ICS + LABA (alt: med dose ICS + either LTRA, theophylline, or Zileuton)
- step 5: high dose ICS + LABA AND consider omalizumab in pts w/ allergies
- step 6: high dose ICS + LABA + oral corticosteroids AND consider omalizumab in pts w/ allergies
What is the MOA of SABAs?
- bind b-receptors in lungs –> smooth m. relaxation
What is the onset of SABAs?
- ~5 mins
What are adverse effects of SABAs?
- heart palpitations
- anxiety
- tachycardia
- tremor
What should be done when patient admits to using SABA >2d/w?
- step up tx
What are examples of SABAs?
- albuterol
- levalbuterol
What is not a prefered step 1 asthma rx?
- short acting bronchodilator anticholinergis
What is an example of short acting bronchodilator anticholinergics?
- ipatropium (Atrovent HFA)
What is the MOA of anticholinergics?
- inhibits cholinergic & muscarinic receptors
- causes bronchodilation
What are the ADEs of anticholinergics?
- dry mouth
- increased wheezing
What is the MOA of inhaled corticosteroids (ICS)?
- decrease number & activity of inflam cells
- enhance effect of b-adrenergic rxs
- inhibit bronchoconstriction
- direct smooth m. relaxation
- decrease mucous production
What are the ADEs of ICS?
- cough, dysphonia MC
- oral thrush if no rinse & spit
What are the ADEs of high dose ICS?
- adrenal suppression
- osteoporosis
- skin thinning
- easy bruising
- cataracts
- growth suppression/retardation
What are the ADEs of low to med dose ICS?
- growth suppression
- altered growth velocity
What are examples of ICSs?
- suffix: -methasone
- suffix: -esonide
- suffix: -isolide
What are examples of mast cell stabilizers?
- cromolyn (Intal)
- nedocromil (Tilade)
What are examples of leukotriene receptor antagonist (LTRA)?
- montelukast (Singulair)
- zafirlukast (Accolate)
- zileuton (Zyflo)
What is the MOA of mast cell stabilizers?
- stabilize mast cells
- blockade of chloride channels
What are ADEs of mast cell stabilizers?
- cough
- irritation
What is the MOA of LTRAs?
- interference w/ pathway of leukotriene mediators
What are the ADEs of LTRA?
- depression & suicidal ideation in children
What is the MOA of Zileuton (Zyflo)
- similar to LTRA
- only blocks enzyme not the receptor
What are the drug interactions of zileuton (Zyflo)?
- inhibits metabolism of warfarin & theophylline
What interactions occur with zafirlukast?
- food: take on empty stomach
- substrate and inhibitor of CYP2C9
What is the MOA of theophylline?
- mild to mod bronchodilator
- non-selective phosphodiesterase inhibitor
What are the ADEs of theophylline
- similar to caffeine
way to many to list
What are drug interactions of theophylline?
- metabolized and induced by CYP1A2 & 3A4
- increased clearance when smoking
What is the MOA of LABAs?
- tail binds to b-receptor at exosite
- head binds to same spot as SABA
- bronchodilation
What are examples of LABA?
- salmeterol (Serevent)
- formoterol (Foradil)
- suffix: -terol
What are the ADEs of LABAs?
- tachycardia
- tremor
- hypokalemia
- bronchospasms & hyperresponsiveness
- heart issues
What must be done prior to rxing omalizumab?
- IgE tested
When is omalizumab recommended?
- in steps 5 or 6 for pts with allergies & severe persistent asthma inadequadly controlled on high ICS + LABA
What is the MOA of omalizumab?
- binds IgE antibody preventing it to bind on mast cell or basophil receptor
- leads to decrease release of mediators
What are the ADEs of omalizumab?
- urticaria
- anaphylaxis
- injection site pain/burning
When are oral steroids recommended?
- only for most severe difficult to control asthma d/t well documented risk for side effects
What are the ADEs of short term use of oral steroids?
- hyperglycemia
- increased appetite
- fluid retention
- wt gain
- mood alteration
- HTN
What are the ADEs of long term use of oral steroids?
- growth suppresion
When do you taper oral steroids?
- over 10d used
What is the 1st line tx for exercise induced bronchospasm?
- SABA
What is the 2nd line tx for exercise induced bronchospasm?
- LTRA
What is teh 3rd line tx for exercise induced bronchospasm?
- cromolyn
What might be a trigger of asthma?
- GERD
What are the steps of COPD tx?
- step 1: flu vaccine, decrease risk factors, SABA
- step 2: ADD LABA
- step 3: ADD ICS
- step 4: ADD O2
What are other medications for COPD?
- mucolytics
- antioxidants
- immunoregulators
- antitussives
What is the MC cause of COPD exacerbations?
- infection
- air pollution
What are the cardinal sx of COPD exacerbations from abx?
- increased dyspnea
- sputum volum
- sputum purulence
What is the tx of COPDers with mild infx exacerbations?
- 1 cardinal sx = no tx
- PCN, amoxicillin, doxycline, bactrim
What is the tx of COPDers with moderate infx exacertabitons?
- augmentin (amox/clavulanic acid)
What is the tx of COPDers with severe infx exacerbations?
- high dose levofloxacin
How long is tx for COPD exacerbated by infx?
- 7-10 d abx
