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Therapeutics Spring 2015 > Asthma/COPD drugs > Flashcards

Asthma/COPD drugs Flashcards

1
Q

Albuterol

A

Ventolin

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2
Q

What class of drug is Abuterol?

A

Beta-2 Adrenergic Agonist

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3
Q

By what pathway does albuterol cause bronchodialation?

A

Stimulates Gs and Adenyl Cyclase –> increase cAMP–>activated PKA—>which phosphorylates myosin LC kinase causing bronchodialation

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4
Q

Terbutaline

A

Brethine

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5
Q

What class of drug is terbutaline?

A

Beta-2 adrenergic agonist

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6
Q

What is the rate of onset of albuterol?

A

inhalation–> 5 min

oral –> 30 min

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7
Q

What is the duration of albuterol?

A

inhalation –> 3-4 hours

oral –> 3-8 hours

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8
Q

What is the rate of onset of terbutaline?

A

inhalation –> 5 min

oral –> 30 min

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9
Q

What is the duration of action of terbutaline?

A

Inhalation –> 3-6 hours

oral –> 3-8 hours

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10
Q

Salmeterol

A

Severent

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11
Q

what class of drugs does salmeterol belong too?

A

Beta-2 adrenergic agonists

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12
Q

what is the rate of onset of salmeterol?

A

inhalation–> > 20 min

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13
Q

What is the duration of action of salmeterol?

A

12 hours

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14
Q

Formoterol

A

foradil, brovana

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15
Q

What class does formoterol belong too?

A

Beta-2 adrenergic agonists

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16
Q

What is the rate of onset of formoterol?

A

<10 min

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17
Q

What is the duration of action of formoterol?

A

> 12 hours

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18
Q

Which B2 agonists are only for use in combination with glucocorticoids?

A

Salmeterol and formoterol

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19
Q

What are ADE associated with B2 adrenergic agonists?

A
  • Skeletal muscle tremors
  • Tachycardia & palpitations
    ( less with B2 selective agents)
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20
Q

by what mechanism does B2 adrenergic agonists cause tachycardia and palpitations?

A

High doses can stimulate B1 receptors in the heart

Reflex tachycardia from baroreceptors (caused by drop in BP due to vaso/bronchodialation)

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21
Q

True or False?

Salmeterol and formoterol are contraindicated as monotherapy?

A

True

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22
Q

LABAs

A

Salmeterol/formoterol

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23
Q

SABAs

A

Albuterol/terbutaline

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24
Q

What is the mechanism of glucocorticoids?

A

Decrease protein synthesis

  • causes decreased esinophils/macrophages/mast cells
  • decreased prostaglandin/leukotryine syntheses
  • decreased hyperresponsiveness of bronchiole smooth muscle
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25
Q

How are inhaled glucocortocoids dosed?

A

One inhalation in the morning

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26
Q

What type of infection does glucocorticoid use perpetuate?

A

Fungal thrush infections

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27
Q

What class of drugs does Advair belong too?

A

Glucocorticoid Combo

  • inhaled steroid + LABA
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28
Q

Advair

A

Fluticasone + salmeterol combo

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29
Q

What are the doses of advair?

A

100,250,500 ug of fluticasone

50 ug salmeterol

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30
Q

Symbicort

A

budesonide + formoterol

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31
Q

Dulera

A

mometasone + formoterol

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32
Q

What are 3 examples of methylxanthines?

A

caffeine
theophylline
theobromine

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33
Q

What is the mechanism of theophylline?

A
  1. PDE4 inhibitor
    - increases cAMP –>PKA–>MLCK-PO4–> relaxation\
  2. Blocks Adenosine receptor
    - antagonizes bronchoconstriction
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34
Q

What is the therapeutic range pf theophylline?

A

10-15 ug/mL

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35
Q

What are some ADE/toxicities of theophylline?

A

N/V, nervousness, abdominal discomfort at 20 ug/mL
Cardiac arrhythmias, hypotension, CNS stimulation > 25
Seizures/ Cardiac arrest –> 40-100 ug/mL

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36
Q

What is a caution of theophylline?

A

can aggravate pre-existing seizure disorders

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37
Q

What antacids will delay theophylline absorption?

A

magnesium/Al containing antacids

38
Q

What condition increases the half life of theophylline?

A

CHF

39
Q

What agents increase theophylline blood levels by competing for CYP450?

A 
Cimetidine
Allopurinol
erythromycin
fluoroquinolones (cipro)
propranolol
leukotryine inhibitors
40
Q

What class of drugs does Cromolyn sodium belong too?

A

Mast cell degranulation inhibitors

41
Q

What class of drugs does nedocromil sodium belong too?

A

Mast cell degranulation inhibitors

42
Q

What dosage forms do mast cell degranulation inhibitors come in?

A

Adults– metered dose inhaler

children- 1% aerosol solution

43
Q

Omalizumab

A

Xolair

44
Q

What dosage form does Xolair come in?

A

SC injection

45
Q

Why does Xolair only come in injectable?

A

It is a humanized mouse anti-human IgE antibody

46
Q

How does Xolair work?

A

It inhibits the binding of IgE antibodies to the FcER1 receptors on mast cells and basophils.

47
Q

What is an ADE of Xolair?

A

Anaphylaxis
Injection site rxns
Increased incidence of infection
immunogenicity

48
Q

Zileuton

A

Zyflo

49
Q

What class of drugs does Zileuton belong too?

A

leukotryine inhibtors

50
Q

What is the mechanism of action of Zileuton?

A

5- lipoxygenase inhibitors

51
Q

What is the role of 5 - lipoxygenase inhibitors?

A

It converts arachidonic acid to 5HPETE during the formation of the leukotryines

52
Q

Can you use Zyflo for an acute attack?

A

No

53
Q

What are ADE of Zyflo?

A 
Doubles blood levels of theophylline
Increases PT time of warfarin
Headache
Dyspepsia
Some incidence of liver toxicity
54
Q

Zafirlukast

A

Accolate

55
Q

Montelukast sodium

A

Singulair

56
Q

What class of drugs do Zafirlukast belong too?

A

Leukotryine inhibitors

57
Q

What class of drugs do montelukast belong too?

A

Leukotryine inhibitors

58
Q

How do montelukast and zafirlukast work?

A

Selective competitive inhibitor of CysLT-1 receptor

59
Q

What is the role of CysLT-1 receptor?

A

It inhibits the PLC–>IP3–> Ca–> myosin–> contraction pathway

60
Q

Can Zafirlukast and montelukast be used in children?

A

Yes

61
Q

How are CysLT-1 antagonists metabolized?

A

The liver

62
Q

Can Zafirlukast and montelukast be taken with food?

A

No, food reduces bioavailability and broken down by bile acids

63
Q

Can Zafirlukast and montelukast be used in an acute attack?

A

No, but can be used with B2 agonists

64
Q

Ipratropium

A

Altrovert

65
Q

Tiotropium

A

Spiriva

66
Q

what class of drugs do ipratropium and tiotropium belong too?

A

muscarinic antagonists (anticholenergics)

67
Q

What is the dose regimen of ipratropium?

A

inhaled QID

68
Q

what is the dose regimen of tiotropium?

A

Inhaled QD

69
Q

is PRN dosing used for inhaled muscarinic agonists?

A

PRN is not used in quaternary ammonium compounds

70
Q

Indacaterol

A

Arcapta

71
Q

What is indacaterol used for?

A

COPD only

72
Q

What are formoterol and salmeterol used for?

A

Asthma and COPD

73
Q

What is the dose of indacaterol?

A

75 ug once daily

74
Q

Is monotherapy with LABAs containdicated in COPD?

A

No, inflammatory damage already done.

75
Q

What is the role of Alpha-1 anti-trypsin in COPD?

A

normally produced to inhibit proteases (like elastase)

76
Q

What class of drugs does prolastin belong too?

A

Alpha-1 anti-trypsin replacement

77
Q

What class of drugs does aralast belong too?

A

Alpha-1 anti-trypsin replacement

78
Q

what class of drugs does zemaira belong too?

A

Alpha-1 anti-trypsin replacement

79
Q

How are Alpha-1 anti-trypsin replacement drugs dosed?

A

IV 1x/week

80
Q

What class of drugs does Ivacaftor belong too?

A

CFTR regulator

81
Q

Ivacaftor

A

Kalydeco

82
Q

How does ivacaftor work?

A

it holds CFTR in a favorable conformation for Cl- to flow through in response to cAMP

83
Q

How is ivacaftor dosed?

A

orally BID

84
Q

What class of drugs do Dornase alfa belong too?

A

Mucolytics for tx of CF

85
Q

N-acetylcysteine

A

Mucomyst

86
Q

What class of drugs does mucomyst belong too?

A

Mucolytics

87
Q

What function does hypertonic saline have in CF?

A

mucolytics

88
Q

what are 3 classes of drugs for CF?

A

Mucolytics
Bronchodialators
Antibiotics

89
Q

What are 2 gram (-) antibiotics used in CF?

A

tobramycin

azithromycin

90
Q

What kind of drug is Ataluren?

A

small molecule to suppress premature stop codons in CF
(nonsense mutations)
Not approved yet

91
Q

VX-809 is what kind of drug?

A

small molecule chaperone for deltaF508 CFTR

prevents the deletion of phenylananine codon

92
Q

what kind of drug is Bronchitol?

A

Inhaled mannitol solution- rehydrates the mucus

Therapeutics Spring 2015 (12 decks)

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