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Clinical Pharmacology > Asthma Maintenance Therapy > Flashcards

Asthma Maintenance Therapy Flashcards

1
Q

“Older” ICS that are more commonly used

A
  • Budesonide (comes in a nebulized suspension*)

- Fluticasone

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2
Q

“Older” ICS that are less commonly used

A
  • Beclomethasone

- Mometasone

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3
Q

Newer ICS

A

Ciclesonide

  • “ones” and “-ides”
  • Prodrug that is activated in the lung so it causes less ADRs
  • Smaller particle size to allow more to reach the lung
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4
Q

ICS mechanism of action

A
  • same as systemic steroids

- topical deposition minimizes systemic ADRs

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5
Q

ICS indications

A
  • 1st line agent for persistent asthma
  • Give lowest dose that maintains asthma control –>may need to change seasonally

-most benefits acheived at LOW doses

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6
Q

What should you do if a low dose ICS is not enough for adults?

A
  • Increase to a medium dose or add a LABA

- Definitely add a LABA +/- leukotriene modifier before going to high dose ICS

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7
Q

ICS pearls

A

-Most potent long-term controller of asthma symptoms

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8
Q

ICS pt education

A
  • Use a spacer
  • Rinse your mouth after use and spit it out
  • Takes 1-2 wks for full effect
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9
Q

ICS CYP3A4 substrates

A
  • Budesonide
  • Fluticasone
  • Ciclesonide

-minimal clinical implications

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10
Q

ICS local ADRs

A
  • dysphonia

- OP candidiasis (thrush)

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11
Q

ICS systemic effects

A
  • Increased intraocular pressure –> open angle glaucoma (monitor for in patients with FH of glaucoma)
  • Increased risk for skin bruising or purpura
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12
Q

LABA in Brigitte Schaefer’s Pronunciation

A
  • Salmeterol

- Formeterol

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13
Q

LABA MOA

A
  • Long duration of action (>12 hrs), highly lipid soluble

- Formeterol is a full ag, salmeterol is a partial ag

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14
Q

LABA indications

A

Add-on therapy for persistent asthma

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15
Q

LABA Black box warning

A

Monotherapy is medical negligence, increases risk of severe asthma attacks and death

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16
Q

Salmeterol Cyp interactions

A
  • Sub of 3A4

- Strong inhibitors can cause ADRs (tachy, paplitations) esp in heart disease

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17
Q

LABA ADRs

A
  • Same as SABAs

- Tachy, palpitations, tremor possible

18
Q

LAMA

A

Tiotropium

19
Q

LAMA MOA

A

Long-acting muscarinic antagonist

20
Q

LAMA Indications

A

Use as an add-on to high dose ICS plus LABA if asthma still not controlled

21
Q

LAMA Interactions and ADRs

A
  • Other anticholinergics -> increase ADRs

- Dry mouth most common, pharyngeal irritation

22
Q

Leukotriene Modifiers MOA

A

action of 5-liopoxygenase on arachidonic acid

23
Q

Leukotriene 5-lipoxygenase inhibitor

A

Zileuton (DO NOT USE, hepatotoxicity)

24
Q

Leukotirene Cysteinyl LTRA

A
  • Montelukastorres

- Zafirlukast (DO NOT USE, hepatotoxicity)

25
Q

ADRs of Montelukastorres

A
  • HA

- Rare neuropsych effects, monitor with pts and family

26
Q

Cromoglycates and include MOA

A
  • Cromolyn

- Alter Cl channels and prevent mast cell degranulation

27
Q

Cromoglycates Indications

A
  • Prophylactic only

- No effect on airway smooth muscle tone, ineffective in reversing bronchospasm

28
Q

Methylxanthines and include MOA

A
  • Theophylline
  • Non specific inhibition of PDE
  • Bronchodilator at high serum conc, but anti-inflammatory effect at lower serum conc.
29
Q

Methylxanthines interactions

A

1A2 and 3A4, main 1A2 inhibitors = ciprofloxacin, amiodarone, OCPs, cimetidine

30
Q

RF for decrease theophylline clearance

A
  • <1yo or >60yo

- Concurrent dz (CHF, fever >102, hypothyroid, liver dz)

31
Q

Methylxanthines ADRs

A
  • 10mcg = increase pulm fxn, no ADRs
  • 15 to 20mcg = anorexia, NV, abd discomfort, HA, nervousness
  • > 40mcg = decrease K, increase HR, neuromuscular irritability (seizures, arrhythmia, death)
32
Q

Anti-IgE Antibody

A

Omalizumab

33
Q

Anti-IgE MOA

A

Monoclonal Ab, binds to free IgE in circulation and blocks attachment to mast cells and basophils

34
Q

Anti-IgE Interactions

A

Approved for pts 6 yo and older with mod-severe persistent asthma with inadequate control by ICS

35
Q

Anti-IgE ADRs

A
  • Injection site rxns

- Immediate and delayed anaphylaxis rare

36
Q

IL-5 Antibody

A
  • Mepoluzimab
  • Reslizumab
  • Benralizumab
37
Q

IL-5 Antibody MOA

A
  • Mepo and Resli: decreased survival of eosino/baso -> decrease airway inflammation
  • Benra = prevents IL-5 binding, apoptosis of eosi/baso through cell-mediated cytotoxicity- -> decrease airway inflammation
38
Q

IL-5 Antibody Indications

A

12yo and older who have eosinophilic phenotype

39
Q

IL-4 Antagonists

A
  • Dupilumab

- Same indications as IL-5

40
Q

T/F: go low and slow wit drug titration

A

False, hit it early and hard

41
Q

Asthma and pregnancy

A
  • SABAs: cat C
  • LABAs: cat C
  • ICS: cat B
  • Follow up monthly who those who have controller therapy during pregnancy

Clinical Pharmacology (54 decks)

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