Asthma & COPD Flashcards
SABAs… (2)
Albuterol
Levalbuterol
LABA (1)
Salmeterol
Leukotriene inhibitors
montelukast/zafirlukast
Zileuton
Inhaled CS (5)
Fluticasone Flunisolide Beclomethasone Budesonide Triamcinolone
a LABA should always be combined with…
inhaled CS
3 features of asthma…
reversible obstruction
airway inflammation
Increased airway responsiveness
What substances released from inflammatory cells cause bronchoconstriction and edema?
Leukotrienes
What substances released from inflammatory cells cause bronchoconstriction, sustained airway hyperreactivity, edema, chemotaxis of eosinophils?
platelet-activitating factor
Prostaglandins cause…
inflammation
These chemicals attract and activate eosinophils and stimulate IgE production in B-lymphocytes
Interleukins
What is the only drug that is used PRN to treat acute asthma attack/exacerbation
SABA
albuterol/levalbuterol
These drugs for asthma decrease the likelihood of bronchospasm and prevent attacks
LABA (salmeterol)
These are used to produce bronchodilation in COPD
cholinergic antagonists
Which three asthma drug classes can reduce inflammation
CS, Leukotriene inhibitors, Monoclonal Ab
This decreases the release of histamine from mast cells…
cromolyn
This is a CNS stimulant that can produce long-lasting bronchodilation
theophyline
What happens to cilia and goblet cells in COPD?
immobilized cilia
excess mucous production
Generally, COPD is treated with _______ or _______
LABA or inhaled anticholinergics
what two drugs can be used for acute COPD exacerbations?
ipratropium
albuterol
Mechanism for beta 2 agonists…
activate adenylate cyclase
increase cAMP
relax SM, bronchioles, stabilize mast cells
What class of drugs are the most effective bronchodilators?
beta-2 agonists
Where are beta 1 located?
heart
onset and duration of action for albuterol/levalbuterol…
fast onset
4-8 hours
onset and duration of action for salmeterol?
onset 20 minutes
duration 12 hours
In addition to a LABA and ICS, what should always be prescribed to asthma patients?
SABA
4 common beta 2 agonist S/Es?
tachy
nervousness
dizziness
tremor
What is responsible for tolerance to beta 2 agonists?
chronic use = receptor downregulation
Tolerance to beta 2 agonists occurs more/less in the lungs than other tissues
less
Tolerance to beta 2 agonists has more an effect on _______
side effects
2 muscarinic antagonists…
ipratropium
tiotropium
Use of ipratropium/tiotropium
COPD
When could you consider ipratropium/tiotropium (M antagonists) in asthma patients?
if B2 agonist alone isn’t sufficient
What are the advantages of Tiotropium?
longer duration of action
QD admin
Combivent is a rescue inhaler that contains…
albuterol + ipratropium
Mechanism for Theophylline
Blocks adenosine receptor
AND
PDE inhibitor –> increased cAMP + epi mimetic
When should theophylline be considered? Why?
insufficient beta 2 agonist response
low therapeutic index (easy to OD)
route of admin for theophylline?
PO
Is it safe to switch between brands of theophylline once a dose has been established?
no
What 4 things increase the clearance of theophylline in the liver?
Phenytoin, TOBB, rifampin, OCs
What two drugs decrease the clearance of theophylline?
cimetidine, erythromycin (P450 inhibitor)
Major, serious side effect of theophylline?
arrhythmia
mild SE of theophylline
nervousness, insomnia
_______ improve sxs and decrease the requirement for _______ in asthma patients w. in 1 week.
ICS
Beta agonists
When should PO CS be considered?
short course for exacerbation
taper to ICS
Does short term use of PO CS carry risk of serious SEs?
no
These drug has the following effects:
- decrease inflammatory cell number
- decrease cytokines and cytokine mediators
- decrease capillary permeability
- decrease mucus secretion
- increase beta 2 receptors on airway smooth muscle
CS
3 major side effects of ICS?
OP Candidiasis
Hoarseness
Decreased bone Density
What can be used to limit the SEs of ICS?
spacer
Two PO steroids used for asthma/COPD?
methylprednisolone, prednisone
4 major SEs of chronic systemic CS therapy?
osteoporosis, thin skin, hyperglycemia, truncal obesity
Short term SEs of systemic CS?
hyperactivity, insomnia, restlessness
Which drug class will decrease the asthmatic response to exercise or cold air, and decreases the need for steroids?
leukotriene inhibitors
Which leukotriene inhibitors block the receptor?
Zafirlukast + Montelukast
Which leukotriene inhibitor blocks 5-LOX, and therefore decreases synthesis?
Zileuton
Which drug may decrease asthmatic reaction to ASA?
Zileuton (blocks 5-lox)
4 SEs of leukotriene inhibitors?
increased URI
ST
Sleepiness
Psych sxs
Mechanism for Omalizumab?
Ab targeted to IgE
Prevents binding/activation of mast-cells/basophils
Omalizumab should be considered for what reason?
decrease CS need
Reduce exacerbation
adjunct to therapy
Route for omalizumab
SC Injection q 2–4 weeks
Mechanism for Benralizumab, mepolizumab, reslizumab…
Ab targeting IL-5… reduces eosinophil function
Indication for Benralizumab, mepolizumab, reslizumab
severe, eosinophilic asthma
decreases CS need
route for Benralizumab, mepolizumab, reslizumab
SC injection q 4 weeks
this drug inhibits the release of histamine from mast cells…
cromolyn
Describe the dosing for cromolyn…
several times daily, chronically
Cromolyn is effective as a _____ agent for asthma…
prophylactic
