asthma drugs Flashcards
What are the two main drug categories used for asthma treatment?
Anti-inflammatory drugs & Bronchodilators
What are the four types of anti-inflammatory drugs for asthma?
Glucocorticoids, Leukotriene Modifiers, Cromolyn, IgE Antagonist
What are the three types of bronchodilators for asthma?
Beta2 Agonists, Methylxanthines, Anticholinergics
What are the two types of glucocorticoids used in asthma treatment?
Inhaled & Oral
Name some inhaled glucocorticoids.
Beclomethasone, Budesonide + formoterol, Ciclesonide, Fluticasone + salmeterol, Mometasone + formoterol
Name some oral glucocorticoids.
Methylprednisolone, Prednisolone, Prednisone
What is the mechanism of glucocorticoids?
Suppress inflammation, reduce bronchial hyperreactivity, decrease mucus production
How are glucocorticoids used in asthma treatment?
For chronic asthma, taken daily on a fixed schedule
Are glucocorticoids used as rescue meds?
No
What is the first-line treatment for asthma inflammation?
Inhaled glucocorticoids
What are common adverse effects of inhaled glucocorticoids?
Dysphonia, hoarseness, oral candidiasis (thrush)
What are common adverse effects of oral glucocorticoids?
Adrenal suppression, osteoporosis, hyperglycemia, peptic ulcers, infection, weight gain, insomnia
What are contraindications/cautions for glucocorticoids?
Pregnancy/lactation, live virus vaccines, diabetes, HTN, heart failure, kidney dysfunction
What drug interactions occur with prednisone?
Potassium-depleting diuretics, NSAIDs, hypoglycemic agents
What order should Beta2 agonists & inhaled steroids be taken in?
Use Beta2 agonist first, then steroid
Name three leukotriene modifiers.
Zafirlukast, Zileuton, Montelukast
Are leukotriene modifiers rescue meds?
No
What are the adverse effects of leukotriene modifiers?
Depression, suicidal ideation, liver injury
What drug interactions occur with leukotriene modifiers?
Inhibit metabolism of warfarin & theophylline, phenytoin inhibits montelukast
What is the only mast cell stabilizer used for asthma?
Cromolyn
How is cromolyn administered?
Nebulizer
What are the adverse effects of cromolyn?
Very safe; rare cough/bronchospasm
What is the IgE antagonist used for asthma?
Omalizumab
Who can use omalizumab?
Patients ≥12 years old with moderate-severe allergy-related asthma uncontrolled with corticosteroids
How is omalizumab administered?
SubQ injection
What are the adverse effects of omalizumab?
Injection-site reactions, viral infections, cardiovascular events, malignancy, anaphylaxis
What are the two types of Beta2-adrenergic agonists?
SABAs & LABAs
What are SABAs used for?
Rescue medication for acute bronchospasm
Name some inhaled SABAs.
Albuterol + budesonide/ipratropium, Levalbuterol
Name some oral SABAs.
Albuterol, Terbutaline
What are LABAs used for?
Long-term asthma control, used with glucocorticoids
Name some inhaled LABAs.
Arformoterol, Formoterol + budesonide/aclidinium/mometasone, Salmeterol + fluticasone, Olodaterol + tiotropium
What are common adverse effects of Beta2 agonists?
Tachycardia, angina (oral), tremors
What are contraindications/precautions for Beta2 agonists?
Tachydysrhythmias, caution in DM, hyperthyroidism, heart disease, HTN, angina
What drug interactions occur with Beta2 agonists?
Beta blockers (counteract each other), MAOIs/TCAs
What is the difference between SABA & LABA use?
SABAs are for immediate relief (PRN), LABAs are scheduled & always used with steroids
What is the methylxanthine used for asthma?
Theophylline
What is the therapeutic range for theophylline?
10–20 mcg/mL
What happens at different theophylline toxicity levels?
<20 mcg/mL: uncommon AEs, 20–25 mcg/mL: N/V/D, insomnia, >30 mcg/mL: severe dysrhythmias, seizures, death
What should be done for theophylline toxicity?
Stop theophylline, give activated charcoal, lidocaine (dysrhythmias), IV diazepam (seizures)
What substances interact with theophylline?
Caffeine, tobacco/marijuana (increase clearance), cimetidine/fluoroquinolones (increase levels)
Name a cousin of theophylline.
Aminophylline
What are the two types of inhaled anticholinergics?
SAMA (Short-acting) & LAMA (Long-acting)
Name a SAMA.
Ipratropium + albuterol
Name some LAMAs.
Tiotropium + olodaterol, Aclidinium + formoterol, Umeclidinium + vilanterol
What are common adverse effects of inhaled anticholinergics?
Dry mouth, hoarseness
What are contraindications for inhaled anticholinergics?
Soy/peanut allergy (some contain soy lecithin), narrow-angle glaucoma, BPH
How should inhaled anticholinergics be taken?
2 puffs, rinse mouth, 5 min between different inhalers
