Asthma Drugs Lecture PDF Flashcards
Asthma is a chronic ____ disorder, it is also completeely ____
Inflammatory, reversible
2 categories of quick relief medication used to treat asthma and how they work
- anticholinergics that inhibit muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway resulting in bronchodilation
- short acting bronchodilators to relax bronchial smooth muscle
Examples of quick relief anticholinergics used to treat asthma (2)
Ipratropium bromide, atrovent
Examples of SABAs used to treat asthma (3)
albuterol (proventil and ventolin), levalbuterol (xopenenx), and pirbuterol (maxair autohaler)
Long term control medications to treat asthma and how they work (5)
- Glucocorticoids with powerful anti-inflammatory action care for persistent asthma, exceptionally safe profile
- Immunomodulators that use anti-IgE monoclonal antibodies as adjunctive therapy for those with sensitivity to relevant allergens and persistent asthma
- Leukotriene receptor antagonists which block aspirin induced asthma and decrease symptoms assoc. with allergen exposure as an alternative but not preferred therapy
- LABAs inhaled bronchodilators with duration of at least 12 hours after single dose, not used as monotherapy but used alongside corticosteroids
- Theophylline used as alternative or adjunctive therapy for inhaled corticosteroids in patient with mild persistent asthma
Examples of gluocorticoids used to treat asthma (3)
Beclomethasone (QVAR), budesonide (pulmacort), prednisone
Examples of immunomodulators used to treat asthma (1)
-Anti IgE omalizumab (Xolair)
Leukotriene receptor antagonists and LABA’s are often used _____ with other long term treatment options
adjunctively
Examples of Leukotriene receptor antagonists to treat asthma (3)
-zarfirlukast, accolate and montelukast, singulair
Examples of long acting bronchodilating agents (LABA’s) used to treat asthma (2)
Salmeterol (Serevent) and formoterol (foradil)
Advantages of inhalation administration of antiasthmatic drugs (2)
- Therapeutic effects are enhanced by delivering drug to direct site of action minimizing systemic effects
- produces rapid relief of acute attacks
Inhaled corticosteroids have ______ side effects compared to oral corticosteroids
Many less
Metered dose inhalers (MDI)
Small hand held pressurized devices that deliver measured dose (typically 1 or 2 puffs) of drug with each activation requiring propellant HFA (hydrofluoralkane)
Problems with meter dose inhalers (2)
- Requires hand lung coordination
- only 10% of dose reaches lungs rest is swallowed even when used correctly
Spacer function and how does it impact drug delivery?
Attaches to a meter dose inhalers to increase delivery of drug to lungs from 10% to 21%
Nebulizer
Small machine that converts a drug to a mist alongside saline with droplets much finer than those from inhalers, occurs thru face mask or mouthpiece held between teeth and although portable, takes longer to deliver the same amount of drug than an MDI
Dry powder inhalers (DPI’s)
Deliver a drug to lungs in dry micronized powder that does not require propellant and is completely breath activated without hand lung coordination necessary (delivers more drugs to lungs, approx 20%)
B2 adrenergic agonist mech of action
Selectively activates b2 adrenergic receptors promoting bronchodilation reducing airway resistance in the same way as epi
Classification of B2 adrenergic agonists by their function (2)
- Short acting with effects beginning almost immediately and peaking 30-60 minutes and wearing off 3-5 hrs
- long acting (all PO agents and some inhaled agents) to use for long term prophylaxis but not abort ongoing attack
Usage of a SABA for symptomatic relief more than ____ suggests _____
2 days a week, need to increase dose or start an inhaled corticosteroids (long term control)
Inhaled SABA ADR (1)
- usually well tolerated
- minimal systemic effects
Inhaled LABA ADR (1)
-increase risk of severe asthma and asthma related death when used incorrectly
SMART Trial
Study that found that LABA should only be used in patients taking first line agent for long term control as supplementary and never used alone which can cause serious adverse effects