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Pharm > Asthma meds > Flashcards

Asthma meds Flashcards

1
Q

What are the major characteristics of asthma?

A 
Variable airflow obstruction
Often reversible (w/ meds)
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2
Q

What is asthma?

A

Bronchial hyper-responsiveness to various triggers

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3
Q

What does chronic airway inflammation lead to?

A

Airway remodeling

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4
Q

What is the MC chronic disease of children?

A

Asthma

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5
Q

How many deaths occur from asthma each year?

A

5000

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6
Q

Are the deaths from asthma mostly preventable or unpreventable?

A

Preventable

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7
Q

Where do most deaths from asthma occur and why?

A

Out of the hospital

Inadequate therapy

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8
Q

What cells infiltrate with asthma?

A

Eosinophils

Mast cells

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9
Q

What are some mediators of asthma?

A

Prostaglandins
Thrombaxanes
Leukotrienes

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10
Q

What kinds of tx do we give to asthma pts?

A

Bronchodilators
Anti-inflammatory agents
Leukotriene receptor antagonists (LTRAs)
Anti-interleukin 5 (IL-5) antibodies

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11
Q

What kind of bronchodilators are there?

A

Beta 2 agonists
Anticholinergics
Theophylline

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12
Q

What kind of anti-inflammatory agents do we use for asthma?

A

Inhaled glucocorticosteroids (ICS)

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13
Q

What are the two classification groups for asthma?

A

Frequency of sx

Severity of sx

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14
Q

What is the breakdown of frequency of sx for asthma?

A

Intermittent (infrequent)

Persistent (frequent)

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15
Q

What is the breakdown of severity of sx for asthma?

A

Mild
Moderate
Severe

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16
Q

What is the frequency classification of asthma severity from step 2 to step 4?

A

Persistent

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17
Q

What is a hallmark dx study for asthma?

A

Abnormal PFTs that improve by >15% after bronchodilator therapy

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18
Q

What is the general approach to asthma tx?

A

Educate pt/caregivers
Pharmacotherapy
Individualization

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19
Q

What are the two main therapeutic options for asthma?

A

Bronchodilators

Inhaled corticosteroids

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20
Q

What are beta 2 agonists intended for with asthma?

A

Rescue medications for acute exacerbations

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21
Q

What are inhaled corticosteroids (ICS) good for with asthma?

A

Suppression of underlying inflammation

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22
Q

What kind of beta 2 agonists can treat asthma?

A 
Long acting (LABA)
Short acting (SABA)
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23
Q

What kind of anticholinergics can treat asthma?

A

Short acting muscarinic antagonists (SAMA)

Long acting muscarinic antagonists (LAMA)

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24
Q

What is an example of LTRAs?

A

Montelukast

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25
Q

What are two more modern asthma txs?

A

Anti-IgE monoclonal antibodies

Anti IL-5 monoclonal antibodies

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26
Q

What is the asthma step 1 long term tx?

A

None

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27
Q

What is the asthma step 1 quick relief tx (intermittent)?

A

Short acting bronchodilator:

Inhaled beta 2 agonist PRN

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28
Q

What is the long term tx for step 2 asthma (mild persistent)?

A

Preferred: low dose daily ICS
Alternate: LRTA (montelukast)

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29
Q

What is the quick relief tx for step 2 asthma?

A

Short acting bronchodilator:

Inhaled beta 2 agonist (SABA)

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30
Q

What is the long term tx for step 3 asthma (moderate persistent)?

A

Preferred: low dose ICS + LABA
Or: medium dose ICS
Or: low dose ICS + LRTA

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31
Q

What is the quick relief tx for step 3 asthma?

A

SABA

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32
Q

What is the long term tx for step 4 asthma (severe persistent)?

A

Preferred: medium or high dose ICS + LABA
Or: medium/high dose ICS + LABA and/or LAMA
Or: high dose ICS + LTRA/theophylline

33
Q

What is the short term tx for step 4 asthma?

A

SABA

34
Q

What is the most effective bronchodilator?

A

Beta 2 agonists (B2A)

35
Q

What are B2As specifically treating for asthma?

A

Intermittent bronchospasm

36
Q

What conditions are B2As the drug of choice for?

A

Acute asthma

EIB

37
Q

How do you increase the bronchoselectivity of B2As?

A

Inhalation

38
Q

What are SABAs?

A

Rescue medications

39
Q

What are some examples of SABAs?

A 
Albuterol
Levalbuterol
Metaproterenol
Terbutaline
Pirbuterol
40
Q

What is the onset of SABAs?

A

1-5 minutes

41
Q

What is the duration of SABAs?

A

2-6 hours

42
Q

What are LABAs?

A

Maintenance/control/prophylactic medications

43
Q

What are some examples of LABAs?

A

Salmeterol
Formoterol
Indacatrol

44
Q

What is the onset of LABAs?

A

5-15 minutes

45
Q

What is the duration of LABAs?

A

> 12 hours

46
Q

What is a concerning issue with LABAs?

A

Increased asthma-related deaths

47
Q

What are the anti-inflammatories for treating asthma?

A

Inhaled steroids

48
Q

When do patients see sx improvement with ICS?

A

1-2 weeks

49
Q

What do inhaled steroids avoid?

A

Systemic side effects

50
Q

What are high dose systemic steroids used for?

A

SA

Severe asthma unresponsive to B2RAs

51
Q

What is the systemic steroid used for asthma and how is it dosed? Also for how long do you give it?

A

Prednisone
PO 1-2 mg/kg/day
Divide BID or TID
3-10 days

52
Q

What is the first line tx for persistent asthma?

A

Inhaled steroids

53
Q

How do you minimize toxicities with corticosteroids?

A

Low moderate doses

54
Q

How do you reduce systemic absorption with corticosteroids?

A

Mouth rinsing/spitting

55
Q

How do you reduce oral thrush with corticosteroids?

A

BID dosing

56
Q

What is another systemic corticosteroid for asthma? How is it administered?
What is the dosing?

A

Methylprednisolone
IV
Loading dose = 2 mg/kg
then 0.5-1 mg/kg q6

57
Q

List 2 common inhaled steroids:

A

Beclomethasone

Fluticasone

58
Q

What do anticholinergics inhibit?

A

Constrictive tone

59
Q

Are cholinergic antagonists (anticholinergics) as potent beta 2 agonists?

A

No

60
Q

Which cholinergic antagonists have poor absorption?

A

Quaternary NH4+

61
Q

What are two cholinergic antagonists? And how long do they last?

A

Ipratropium 4-8 hours

Tiotropium > 24 hours

62
Q

What is combivent comprised of?

A

Atrovent

Albuterol

63
Q

Why is methylxanthines potency limited?

A

Narrow therapeutic index

64
Q

When do toxic effects of methylxanthines appear?

A

> 15 mg/L

65
Q

What is the therapeutic range of methylxanthines?

A

10-20 mg/L

*note overlap

66
Q

What is the mOA of methylxanthines?

A

Phosphodiesterase III and IV inhibition

67
Q

How often do you dose LTRAs (give a specific example)?

A

Montelukast qhs
QID
BID

68
Q

What are LTRAs best used as?

A

Adjunct therapy

69
Q

What is an issue with LTRAs Zafirlukast and Zileuton? What is the result?

A

Interact w/ warfarin

Prolong INR

70
Q

What does Zileuton also do? How do you address this?

A

Increase theophylline levels

Cut theophylline dose by 1/2

71
Q

What is another issue with both Zafirlukast and Zileuton?

A

Hepatotoxicity

72
Q

How common is anaphylaxis w/ anti-IgE monocolonal antibodies?

A

1-2/1000

73
Q

What do anti-IgE monoclonal antibody permit?

A

Reduced inhaled corticosteroid dose

74
Q

What is the greatest draw back of anti-IgE monoclonal antibody?

A

Very expensive

75
Q

What are anti-IgE monocolonal antibodies often used for?

A

Severe persistent asthma

76
Q

What is a logistical problem with anti interleukin IL-5 antibodies?

A

Very expensive

77
Q

What is great about anti-interleukin IL-5 antibodies?

A

Decreases exacerbations by 50%

78
Q

What is a risk w/ anti-interleukin IL-5 antibodies?

A

Possible anaphylaxis

79
Q

Key points about asthma meds:

A

Quick relief or long term
Anti-inflammatory agents
Tx is step wise
Preferred rescue meds = SABAs

Pharm (32 decks)

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