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Asthma/ COPD Flashcards

1
Q

Ashtma vs COPD

A

Asthma- allergen disease, reduced airway via smooth muscle thickining and bronchocontriction, eosinophils, CD4, symptoms- episodic SOB, cough, chest tightness, often reversible lung function

COPD-inflammation with irritation (cigerrette smoke), reduced airway via cellular damage by external irritants, CD8, symptoms- chronic cough, sputum porduction (excessive mucus production), DOE, often irreversible lung function,

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2
Q

Main featues of asthma

A

Airway inflammation, airway obstruction, bronchial hyperresponsiveness (easily triggered by stimuli)

Early resonse and late response

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3
Q

Main features of COPD

Bronchitis predominant COPD?

Emphysema predominant COPD?

A

Airway inflammation, structural changes/ “remodeling” (fibrosis), mucolilary dysfunction

Gasping for breath

Bronchitis predominant COPD- excessive muscus production

Emphysema predominant COPD- trouble breathing

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4
Q

Best way to treat COPD?

A

Smoking Ceasation- varenicline and bupropion

Only treatment that improves lung function

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5
Q

Inhaled therapy

A

Preferred route of delivery- Reduce systemic exposure

High concentration lower doses

Need good technique

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6
Q

Metered dose inhaler (MDI)

A

Advantages- small, compact, portable, easy to use, Can be used with a spacer (improved delivery), no drug preparation

Disadvantages- need proper technique/ coordination with breath (requires a breath hold), Expensive

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7
Q

Dry powder inhaler (DPI)

A

Advantages- small compact, portable, easy to use, usually cheaper vs MDI, less coordination needed

Disadvantages- patients must prepare the dose, requires fast inhalation (requires a beath hold) moisture sensitive (can’t put in bathroom)

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8
Q

Soft mist inhaler

A

Advantages- compact, portable, multi dose device , high lung deposition, does not contain propellant

Disadvantages- complicated process for first dose, slow moving mist, cannot use spacer, expensive

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9
Q

Nebulizer

A

Advantages- minimal technique requied, patient is not required to hold breath

Disadvantages- expensive, requires dose preparation, bulky (not portable), administration times 5-15 min, needd a power source, cleaning needed

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10
Q

Consideration for device selection

A

Patient related factors- age, physical and cognitive ability, prefernce

Availability of the drug

Convenience- portable, maintenance, cleaning

Cos

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11
Q

Short acting B2 agonist (SABA) MOA and use

A

MOA- stimulate adenylyl cyclase at beta blockers→ increase cAMP in bronchial smooth muscle→ bronchodilation

DOC for acute asthma attack and exercise induced asthma

onset of action-5 min

duration-3-4 hours

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12
Q

Albuterol

A
  • SABA
  • use PRN- ADR- mouth irratation, cough
  • ADR at high doses- skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
  • No difference in efficacy as other drugs in class
  • Less expnesive then levalbuteral- so albuterol preferred
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13
Q

Levalbuterol

A
  • SABA
  • use PRN- ADR- mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
  • No difference in efficacy as other drugs in class
  • More expnesive then albuteral- so albuterol preferred
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14
Q

Long acting B2 agonist (LABA)

A

MOA- stimulate adenylyl cyclase at beta blockers→ increase cAMP in bronchial smooth muscle→ bronchodilation (Same MOA as SABA)

DOC for asthma when combined with inhaled glucocorticoid

CANNOT BE USED AS MONOTHERAPY FOR ASTHMA

CAN BE USED AS MONOTHERPAY FOR COPD

Good for COPD- drys up mucus secretion

onset of action-30 min

duration-12-24 hours

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15
Q

Salmeterol

A
  • LABA- Long acting dosed twice a day
  • use PRN- ADR- mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
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16
Q

Formoterol

A
  • LABA- long acting dose twice a day
  • use PRN-ADR- mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
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17
Q

Indacaterol

A
  • LABA- ultra long acting dose once a day
  • use PRN-ADR- mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
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18
Q

Olodaterol

A
  • LABA- ultra long acting dose once a day
  • use PRN-ADR-mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
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19
Q

Vilanterol

A
  • LABA- ultra long acting dose once a day
  • use PRN-ADR-mouth irratation, cough
  • ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
    • lose selectivity and hit beta 1
20
Q

Ipratropium

A

Muscarinic antagonist- short acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated, (HOT, DRY, FAST, CRAZY)

  • dry mouth, eyes
  • bitter, metallic taste
  • constipation
  • urinary retention
  • NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)
21
Q

Tiotropium

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

  • dry mouth, eyes
  • bitter, metallic taste
  • constipation
  • urinary retention
  • NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)
22
Q

Aclidinium

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

  • dry mouth, eyes
  • bitter, metallic taste
  • constipation
  • urinary retention
  • NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)
23
Q

Umeclidinum

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

  • dry mouth, eyes
  • bitter, metallic taste
  • constipation
  • urinary retention
  • NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)
24
Q

Glycopyrolate

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated, (HOT, DRY, FAST, CRAZY)

  • dry mouth, eyes
  • bitter, metallic taste
  • constipation
  • urinary retention
  • NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)
25
Q

Theophylline

A

Methylxanthine derivatives

MOA- non-selectively inhibits phosphodiesterase (PDE)→ increasaes cAMP→ bronchodilation blocks adenosine recpotors→ bronchodilation

Considered high concentration to be effective

narrow theraputic index

Younger people- will clear drug quicker (higher dose)

Older people- will clear it slower (lower dose)

CYP 1A2 metabolism- tabacco smoke inducer of CYP 1A2

  • Smokers need higer dose
  • when they quit smoking need lower dose otherwise toxic effects

ADR- theophyline over 40

  • GI distress (enhanced grastic acid secretion)
  • Tremor
  • Insomnia
  • in overdose- severe nausea, vomitting, hypotension, agitation, arrthymias, cardiac arrest, seizures
26
Q

Roflumilast

A
  • MOA- selectively inhibits PDE-4 (found in the lung)→ increase cAMP→ Bronchodilation
  • USED FOR SEVERE ASTHMA/ COPD
  • Should be given with at least one other long acting broncodilator for COPD (LABA)
  • Partially metabolized by CYP 3A4
    • DDI- with rifampin, phenobarbital, phenytoin, carbamazepine
  • ADR
    • N/V/D, abdominal pain, HA, dyspepsia
    • Psychiatric events- scren for psych events prior to use, d/c therapy if mood changes
    • weight loss
27
Q

Corticosteroids

A

MOA- Bind to glucocorticoid receptor to

  • inhibit inflammatory cell migration and activation
  • inhibit cytokines and mediator release
  • upregulates b2 recepotris
  • inhibits IgE synthesis

DOC FOR ASTHMA IN COMBINATION WITH LABA

TAPER OFF

4-6 weeks for effect

used if on SABA but still chronic SOB

28
Q

Beclomethasone

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

29
Q

Budesonide

A

Inhaled corticosteroid

Safe in pregnancy

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

30
Q

Fluticasone propionate

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

31
Q

Fluticasone furoate

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

32
Q

Mometasone

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

33
Q

Flunisolide

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

34
Q

Ciclesonide

A

Inhaled corticosteroid

ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use, dystonia, sore throat, cough

35
Q

Prednisone

A

Oral/ IV corticosteroid

ADR- adrenal supression , cushings syndrome, growth retardation, osteroporosis (dose limiting),glucose intolerance, infection risk, mood changes, weight gain, edema

36
Q

Prednisolone

A

Oral/ IV corticosteroid

ADR- adrenal supression , cushings syndrome, growth retardation, osteroporosis (dose limiting),glucose intolerance, infection risk, mood changes, weight gain, edema

37
Q

Methyleprednisolone

A

Oral/ IV corticosteroid

ADR- adrenal supression , cushings syndrome, growth retardation, osteroporosis (dose limiting),glucose intolerance, infection risk, mood changes, weight gain, edema

38
Q

Hydrocortisone

A

Oral/ IV corticosteroid

ADR- adrenal supression , cushings syndrome, growth retardation, osteroporosis (dose limiting), glucose intolerance, infection risk, mood changes, weight gain, edema

39
Q

Corticosteriod in kids

A

Potential growth stunting but only in the first year not progressive

Still preferred DOC in children for asthma

40
Q

Zileuton

A

Lipoxygenase inhibitors

MOA- inhibits action of 5-lipoxygenas to inhibit the synthesis of leukotrienes

ADR- Insomnia, Headache, somnolence GI upset, Heptoxicity ( if LFT is greater then 3x the ULN, females greater then 65 at greater risk (monitor))

Neuropsychiatric events- abnormal dreams, hostility, agression, suicidality, agitation, hallucination

DO not use in alcoholics, hepititis

41
Q

Montelukast

A

MOA- competitively block action of leukotrienes at LTD4 receptor

Can be used for asthma, allergic symptoms, exercise-induced asthma, urticaria (if anti-hisamine failed)

ADR- Neuropsychiatric events- abnormal dreams, hostility, agression, suicidality, agitation, hallucination

42
Q

Zafirlukast

A

MOA- competitively block action of leukotrienes at LTD4 receptor

Can be used for asthma, allergic symptoms, exercise-induced asthma, urticaria (if anti-hisamine failed)

ADR- Neuropsychiatric events- abnormal dreams, hostility, agression, suicidality, agitation, hallucination, Hepatoxicity

DDI- with warfarin→ may increase risk of bleeding

43
Q

Cromolym sodium

A
  • Mast cell stabilizers- multiple daily doses
  • MOA- Block influx of Ca→ prevention of mast cell degreanulation→ stabilize mast cells→ prevent release of inflammatory mediator
  • Do not excert any firect bronchodilating, antihistaminic oranti-inflammatory effect (only used for mild cases of asthma)
  • Not for rescue symptoms
  • Clinical improvment in 2-6 weeks
  • Well tolerated
    • mild throat irratation, cough abnormal taste in mouth
44
Q

Nedrocromil sodium

A

Mast cell stabilizers- multiple daily doses

MOA- Block influx of Ca→ prevention of mast cell degreanulation→ stabilize mast cells→ prevent release of inflammatory mediator

Do not excert any firect bronchodilating, antihistaminic oranti-inflammatory effect (only used for mild cases of asthma)

Not for rescue symptoms

Clinical improvment in 2-6 weeks

Well tolerated

mild throat irratation, cough abnormal taste in mouth

45
Q

Omalizumab

A

Anti- IgE

MOA- moncolonal IgE antibody→ inhibits bindng of IgE to surface of mast cells & basophils→inhibit inflammatory mediators

Indicated for allergic asthma not relieved with corticosteroid therapy

Dose based on IgE levels and body weight- SQ injection

Must be older the 12

Takes up to 12 weeks to work

ADR-

  • Injection site reactions
  • anaphylaxsis→ usually 1.5-2 hours post dose (monitor in office)
  • Arthralgia, headache
  • Pharyngitis and sinitus
  • malignancies?
45
Q

Mepolizumab

A

IL-5 Antagonist

MOA- humanized interleukin-5, monoclonal antibody antagonist to reduce the amount of circulating eosinophils

Used for severe asthma for patients who continue to have exacerbations despite adequte therapy

SQ injection or IV every 4 weeks by HCP

Must be older then 18 with eosinophilic phenotype

ADR-

  • injection site reactions
  • headache
  • hypersensitivity reactions- monitor after first dose
  • malignancies
  • muscle and face bpain

Pharm (9 decks)

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