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Respiratory II, Test 2 > Asthma/COPD medications > Flashcards

Asthma/COPD medications Flashcards

1
Q

Albuterol

A

SABA** this is drug of choice in tx of asthma

used as a rescue inhaler, onset is <15 minutes - they are fast acting but have a relatively short duration of action

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2
Q

Salmeterol

A

LABA

  • slower onset, duration >12 hours of bronchodilation
  • useful for nighttime asthma attacks
  • NOT suitable for tx of acute bronchospastic attacks because onset of action is too slow

*** LABA should be used in asthma only in combination with inhaled corticosteroid

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3
Q

Formoterol

A

LABA

  • slower onset, duration >12 hours of bronchodilation
  • useful for nighttime asthma attacks
  • NOT suitable for tx of acute bronchospastic attacks because onset of action is too slow

*** LABA should be used in asthma only in combination with inhaled corticosteroid

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4
Q

Epinephrine

A

non-selective Beta agonist used in times of emergency

** Epinephrine is the drug of choice for treatment of anaphylactic reactions.
Give SQ

  • Causes bronchodilation via B2, vasoconstriction via alpha1 (maintains BP and decreased edema), inhibition of mediator release via B2
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5
Q

Ipratropium Bromide

A
  • a quaternary muscarinic antagonist, drug of choice with COPD**
  • only give as *inhaled aerosol** (few SE’s when swallowed b/c its poorly absorbed, quaternary amine does not diffuse across membranes)

Parasympathetic - mediated bronchospasm is a significant component of airway resistance in some asthmatics and COPD patients, especially *psychogenic exacerbations]

Therapeutic use:

  • see greater amount of bronchodilation that beta agonists: thus used for COPD
  • also used for allergic rhinitis and chronic postnasal drip syndrome
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6
Q

tiotropium

A
  • longer acting muscarinic antagonist
  • used for maintenance therapy in chronic bronchitis and emphysema
  • dry powder inhaler device
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7
Q

Theophylline

A

= it is a methylxanthine

  • bronchodilator - used to be main stay of tx to treat COPD, formerly a fist-line agent for tx of asthma (now has been replaced to low benefit, narrow therpuetic window)
  • still used for nocturnal asthma with slow release formula (but corticosteroids and salmeterol are probably more effective)

Other effects: CNS stimulation, modest peripheral vasodilation, improved skeletal muscle contractility, and a thiazide-like diuresis

** know its drug/drug interactions, and that it is dosing related SE’s

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8
Q

Beclomethasone

A

inhaled corticosteroids

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9
Q

Budesonide

A

**inhaled corticosteroids

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10
Q

Ciclesonide

A

inhaled corticosteroids

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11
Q

Flunisolide

A

inhaled corticosteroids

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12
Q

Fluticasone

A

**inhaled corticosteroids

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13
Q

Mometasone

A

inhaled corticosteroids

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14
Q

Triamcinolone

A

inhaled corticosteroids

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15
Q

methylprednisolone

A

oral corticosteroid

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16
Q

prednisone

A

oral corticosteroid

17
Q

montelukast

A

Luekotriene receptor antagonist (LTRA)

Alternative or adjunctive therapy to low-dose corticosteroids for mild persistent asthma.

Useful as oral prophylaxis in exercise-induced asthma

18
Q

zafirlukast

A

Luekotriene receptor antagonist (LTRA)

19
Q

Cromolyn sodium

A

Cromolyn compound= anti-inflammatory agent that indirectly inhibits antigen-induced bronchospasm and directly inhibits the release of histamine and other autocoids from sensitized mast cells.

  • *** do not directly relax smooth muscle, therefore they are not useful for control of acute bronchospasm.
    • Cromolyn compounds are primarily prophylactic - . When inhaled several times daily, they inhibit both the immediate and late asthmatic responses to antigenic challenge or exercise.
  • May suppress the activating effects of chemoattractant peptides on eosinophils, neutrophils, and monocytes.
20
Q

Omalizumad

A

Anti-IgE Antibody

21
Q

degranulation from mast cells?

A

histamine, kinins, leukotrienes (SRS), prostaglandins, serotonin, PAF

  • see that there are so many things released: the corticosteroids suppress inflammation at this level (rather than antihistamines which only act on one mediator )
22
Q

histamine, TNFalpha, proteases, heparin

A

immediate mediators that cause bronchoconstriction, cough, vasodilation, edema

23
Q

Luekotrienes/Prostaglandins

A

ex. Motelukast

lipids releaesed in minutes that cause bronchoconstriction , chemotaxis, mucus secretion

24
Q

Interleukins, GM-CSF

A

cytokines that are released in hours that cause bronchoconstriction, chemotaxis, inflamm. cell proliferation

25
Q

what is the stepwise tx that increases with severity?

A

Mild: SABA PRN, ie. albuterol

Mild +: Low dose ICS

Moderate: ICS + LABA i.e. Formoterol/Salmeterol

Severe: high dose ICS + LABA

Very Severe: high dose ICS + LABA + oral corticosteroid

they still have a SABA, short acting, because the corticosteroid is not good for immediate acting

26
Q

Beta adrenergic agonists

A

Albuterol (SABA), Formoterol, Salmeterol (LABA)

Uses:

  • drug of choice for rapid relief of bronchospasm
  • Highly effective and safe for intermittent, prophylactic treatment of asthma.
  • Intermittent use on an as-needed basis for relief of acute, severe bronchospasm. Not general prophylaxis.

Overuse:

  • Side effects intensify will overuse, but a greater danger is the tendency to continue to self-medicate during periods when symptoms are escalating.
  • To avoid a medical emergency, patients should be encouraged to seek medical attention as soon as possible after they detect a decline in the efficacy of their usual therapeutic regimen.

MOA:
- Beta2-adrenergic receptor couples to Gs protein and activates adenylyl cyclase enzyme leading to increased cellular levels of cyclic AMP.
Cyclic AMP stimulates phosphorylation cascade that leads to decreased intracellular calcium and smooth muscle relaxation.

Oral therapy:
- Oral administration increases incidence of adverse side effects:
muscle tremor, cramps, cardiac tachyarrhythmias, metabolic disturbances, hypokalemia
- Appropriate situations for oral therapy: brief therapy in children with upper respiratory tract infections who cannot manipulate inhaler or in severe asthma exacerbations where inhaler cannot be used or when aerosol is irritating

27
Q

Long term use of LABA

A

***** LABA should be used in asthma only in combination with an inhaled corticosteroid.

Continued use of a LABA may cause down-regulation of b2 receptors with loss of the protective effect from rescue therapy with a short-acting agent.

LABA should not be used for monotherapy in patients with persistent asthma, especially in children.

Stop use of a LABA, if possible, once asthma control is achieved and maintain the use of an asthma-controller medication such as an inhaled corticosteroid”.

28
Q

SE of Beta adrenergic Agonists?

A

*** Patients with cardiovascular disease or diabetes are at higher risk of adverse effects.

** Skeletal muscle tremor (most frequent side effect)

CVS: ***tachycardia, dysrhythmias, hyper- or hypotension (see tachycardia from hypotension caused by Beta2, and in high doses will actually stimulate Beta1)

((hypokalemia, worsen hyperglycemia in diabetics, CNS: restlessness, apprehension, anxiety, tremors, drug interactions with thyroid, digitalis, methylxanthines))

29
Q

Combivnet

A

Albuterol + Ipratropium bromide

  • used in COPD and severe asthma
30
Q

Anaphylaxis tx?

A

starts with epi

Albuterol via nebulizer
IV fluids
Oxygen
Secondary therapy
H1 antagonist - diphenhydramine
H2 antagonist - ranitidine
Corticosteroid - hydrocortisone, methylprednisolone
Aminophylline
NE, glucagon - for hypotension
31
Q

Corticosteroids

A
  • block the steps involved in the inflammatory cascade and used In asthma (and some COPD)

MOA: general anti-inflammatory response, steroid receptor agonists that bind to intracellular receptors and regulate gene txn –> thus this takes time to build up

SE’s: aerosol delivery has greatly improved the safety of this tx.

** Asthmatics who require inhaled beta-adrenergic agonist therapy 3 - 4 or more times weekly are candidates for inhaled steroid therapy: asthmatic patients maintained on inhaled corticosteroids show improvement of sx and lower requirements for “rescue” with a bronchodilator

Potential SE’s:
HPA suppression - low risks until high doses
Bone resorption - modest risks
Carbohydrate and lipid - minor risks
Cataracts and skin thinning - dose-related
Purpura - dose-related
Dysphonia - usually resolves
Candidiasis - use spacer device and rinse mouth
**Growth retardation - of concern in children

32
Q

what is used most to tx patients with COPD?

A
  • Inhaled ipratropium bromide or tiotropium- especially useful in patients with a vagally-mediated psychogenic component.
  • Inhaled beta2-adrenergic agonists- As with asthma, continuous (overuse) of bronchodilators may be associated with worsening of symptoms.
  • A subgroup of COPD patients may benefit from corticosteroid therapy, but generally mixed results of steroids in COPD.

Respiratory II, Test 2 (9 decks)

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