Asthma/COPD Flashcards
Two main pharmacologic classes
Anti-inflammatory agents •Glucocorticoids (inhaled, oral) –Bronchodilators •Beta2-adrenergic agonists (long and short-acting)
Inhalation drug therapy advantages
Advantages
– Therapeutic effects are minimized
– Relief of acute attacks is rapid
– Systemic effects are minimized
Types of inhaled medications
– Metered-dose inhalers (MDI)
– Respimats
– Dry-powder inhalers (DPIs).
– Nebulizers
inhallations should be seperated by
one minute
what is recomended to use withan inhaler
spacer
what is considered to deliver more drug to the lungs and does not require a spacer. This is activated by the air of the lungs
Dry powder inhaler
what type of inhaler uses a spacer
MDI
What question should you ask during a follow up
how is the pt using the inhaller. If they are not using it corrctly they won’t get the right amount of medicine
Anti-inflamatory are the ___ of asthma therpay and are taken ___ for long term conrol
foundation
daily
Principal anti-inflamatory drugs are ____
inhalled glucocorticoids
examples of inhalled glucocorticoids
– Beclomethasone dipropionate [QVAR]
– Budesonide [Pulmicort]
– Fluticasone [Flovent]
Glucocorticoids - MOA
– Suppress inflammation
– Most effective anti-asthma drug
– Decrease synthesis and release of inflammatory mediators
– Reduce infiltration and activity of inflammatory cells
– Decrease edema of the airway mucosa caused by beta2
agonists
– Reduce bronchial hyperactivity and decrease airway
mucus production
– May increase the # of bronchial beta2 receptors and their
responsiveness to beta2 agonists
most effective anti-asthma drug
glucocorticoids
glucocorticoids may increase the number of
bronchial beta 2 receptors asnd theary responsiveness to bet2
Important pt education for glucocorticoids
preventative medication. Must be taken daily. not used as abortive medication. benificial effects develop slowly
Inhaled - first-line therapy for management of inflammatory component of asthma
glucocorticoids
inhaled glucocortioid is safeter than
systemic version
SE of glucocortioid
• Oropharyngeal candidiasis, dysphonia = most common
adrenal suppression
Oral glucocorticoid use
– Management of acute exacerbations
– Short burst, use shortest duration possible
– Use when symptoms cannot be controlled with safer
medications.
Oral glucocorticoid ADR
Adverse effects: adrenal suppression, osteoporosis,
hyperglycemia, peptic ulcer disease.
• Growth suppression in the young patient.
Oral glucocortoid recomendatiosn to avoid Adverse effects
eat calcium. Weight bearing exercise. Vit d
High dose inhalled glucocortoid ADR
catarax and glacoma
should use oral glucocortoic less than
10 days. Really the shortest duration possible
• Prolonged glucocorticoid use can decrease
the ability
of the adrenal cortex to produce glucocorticoids of its
own
High levels of glucocorticoids are required to s
o survive
severe stress
Adrenal suppression prevents p
production of
endogenous glucocorticoids
Patients must be given increased doses of
oral or IV
glucocorticoids at times of stress
failure to increase dose of glucocorticoids during times of stress
can prove fatal
addrenal supression is life threatnein gat times of
s of severe physiologic stress
e.g., surgery, trauma, or systemic infection
Discontinuation of systemic glucocorticoid
– Most be done slowly
– Recovery of adrenocortical function takes
several months
– Dosages of exogenous sources must be
gradually reduced
– During this patient must be given oral or IV
glucocorticoids at times of severe stress
In children there is A dose-dependent reduction in bone
formation with use of
inhaled corticosteroids
• Vitamin D and calcium sufficiency should
be ensured with
adequate dietary intake of
vitamin D and calcium
Oral Glucocorticoids examples
Prednisone, methylprednisolone,
prednisolone
Oral Glucocorticoids adult dose
40 to 60mg/day for 3 to 10 days
Oral Glucocorticoids pediatric dose
1 to 2 mg/kg/day for 3 to 10
days
Oral Glucocorticoids SE
increased appetite. Increased energy.
Oral Glucocorticoids recomendations
take with food. taper dose 60, 40, 20 ect.
Leukotriene Modifiers action
suppress effects of leukotrienes
leukotriens
Promote smooth muscle
constriction, blood vessel permeability, and
inflammatory responses through direct action
and recruitment of eosinophils and other
inflammatory cells
In patients with asthma, leukotriene
modifiers can reduce
bronchoconstriction
and inflammatory responses such as
edema and mucus secretion
Leukotriene modifieres are considered
second line agents.
Leukotriene modifiers Adverse Neuopsychiatric effects
including
depression, suicidal thinking, and suicidal behavior
• Zileuton [Zyflo] action and monitoring
– blocks leukotriene synthesis
– Monitor ALT (one a month for 3 months, then every 2
to 3 months x 1 year, then periodically).
Montelukast [Singulair} MOA
Leukotriene Receptor Blocker
Montelukast three indications
– 1. Prophylaxis and maintenance therapy
– 2. Prevention of EIB >15 y.o.
– 3. Relief of allergic rhinitis
Montelukast Side Effects
Neuropsychiatric effects
No serious drug interactions with
Montelukast
