Asthma/COPD Deck 2 Flashcards
Cromolyn Class
mast cell stabalizer
Cromolyn is for
prevention, inhaled, prevention. Not quickl relief!!
Cromolyn MOA
Stabilizes cytoplasmic membrane of mast
cells, thereby preventing release of histamine and
other mediators; in addition, inhibits eosinophils,
macrophages, and other inflammatory cells
Cromolyn uses and route
Route: nebulizer
• Uses: chronic asthma, exercise-induced
bronchospasm (EIB)
Cromolyn AE
cough or bronchospasm.
Omalizumab [Xolair] MOA
– Antagonism of immunoglobulin E (IgE)
Omalizumab [Xolair] USE
– Patients age 12 years or older with moderate to
severe asthma that (1) is allergy related and (2)
cannot be controlled with an inhaled glucocorticoid
Omalizumab [Xolair] ADR
injection-site reactions, viral infection, URI,
sinusitis, HA, pharyngitis, CV events, malignancy
Omalizumab [Xolair] Black Box
- life-threatening anaphylaxis
(most likely with first dose, period of observation in
office).
Omalizumab [Xolair] is used in a
allergists office
Bronchodilators use
Symptomatic relief, do not alter underlying disease process (inflammation)
Beta 2 agonist MOA
• Through activation of beta2 receptors in the smooth
muscle of the lung, these drugs promote
bronchodilation, relieving bronchospasm
• Beta2 agonists have a limited role in suppressing
histamine release in the lung and increasing ciliary
motility
SABA take
PRN
Exercize endused take SABA
before exercise
SABA ADR
– tachycardia, angina, tremor
Inhaled long-acting beta2-agonists (LABA) when are they given
Long-term control in patients who experience frequent attacks
LABA dosing is
is on a fixed schedule, not PRN
LABA effective in treating
COPD
LABA when used to treat asthma must always be combined with
glucocorticoid
Use of what alone in asthma is contraindicated
LABA
LABA ADR
tachycardia, agina, tremor
LABA black box warning
risk for asthma-related deaths.
– Salmeterol [Serevent Diskus], formoterol [Foradil Aerolizer], and arformoterol [Brovana)
Vilanterol – available in
combination – flucticasone/vilanterol
[Breo Ellipta] and umeclidinium/vilanterol [Anoro Ellipta]
Rule of Two (5 items) Should know this for the exam
• No symptoms more than twice per
week.
• Should not use a short-acting beta agonist no more than twice per week.
• No interference with normal activity.
• No more than one to two flare-up in the
past year.
• Peak flow levels should be higher than
80% of the predicted or personal bests.
Theophylline produces
brochodialtion by relaxing smooth muscle from the bronki
Theophylline has a
narrow therapeutic indix
Theophylline plasma levels should be between
10 to 20 mcg
Theophylline Toxcicity is related to
levels
Theophylline the drug is usually
administered by mouth, but may be given IV
Theophylline is uesed for
maintenic therapy of chronic stable asthma
Theophylline plasma levels below 20 mcg
adverse effects uncommon
Theophylline plasma 20 to 25 mcg
n/v diarrhea, insomnia, restless ness
Theophylline plasma above 30 mcg
severe dysrhymias and convulions
death may occr from cardio respiroarty collapse
Theophylline no (methylxanthines) no longer recommended for
COPD
Theophylline toxicity treatment
– Stop theophylline
– Activated charcoal together with a cathartic
– Dysrhythmias respond to lidocaine
– Intravenous diazepam may help control seizures
Theophylline interactions
– Caffeine
– Tobacco and marijuana
– Cimetidine
– Fluoroquinolone antibiotics
Anti-Cholinergics improve lung functions
by blocking muscarinic receptors in the bronchi
Anti-Cholinergics approved fro only
COPD. Off label for asthma
Ipratropium and tiotropium have a
longer duration of action
Ipratropium action and use
– Administered by inhalation to relieve bronchospasm
– Therapeutic effects begin within 30 seconds, reach 50% of
maximum in 3 minutes, and persist about 6 hours
Ipratropium ADR
– Dry mouth and irritation of the pharynx
– Glaucoma
– Cardiovascular events
