AsthmaCOPD Flashcards
Which drugs can be risk factors for asthma?
Beta Blocker, Ca antagonists, NSAIDS
What are the 2 phases of an asthma attack?
Immediate (mainly bronchospasm) Late-phase ( bronchospasm, vasodilation, edema and mucus)
What are long term control medications in asthma?
ICS, LABA, leukotriene modifiers, methylxanthines, cromolyn, Anti IgE
What are the quick relief medications in asthma?
SABA, anticholinergics, systemic corticosteroids
What is a major advantage of inhaled therapy?
Delivery of drugs directly to the airways, deliver higher drug concentrations locally. And minimize systemic side effects
What is the MOA for ICS?
Depress the inflammatory response + edema in the reps tract and diminishes bronchial hyper-responsiveness?
What is the most effective long-term controlled therapy for persistent asthma?
ICS, have to be used REGULARLY to be effective
What are local and systemic ADR of ICS?
Local: thrush, dysphonia, reflex cough. Systemic: hypothalamic- pituitary adrenal suppression, impaired growth in kids, and dermal thinning
What are the ICS?
Fluticasone, budesonide, beclomethasone, flunisolide, triamcinolone, mometasone, ciclesonide
What are the ICS/ LABA combo drugs?
Fluticasone+ salmeterol ( advair). Flucticason+ vilanterol, Budesonide+ fomoterol, mometasone+ fomoterol
Are LABAs a substitute for anti-inflammatory therapy?
no
Are LABAs used for monotherapy?
NO
What is the LABA black box warning?
May increase the chance of severe asthma episodes and death
What are some LABAs?
Salmeterol, formoterol, arformoterol tartrate, and formoterol fumarate
What drugs should be avoided d/t interactions that cause prolonged QT, palpitations, and tachycardia?
Ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, intraconazole, netazodone, nelfinavir, saqunavir, and telithromycin
What are 3 leukotriene receptor antagonists?
Montelukast ( singular), zarfirlukast, and zileuton
What is the MOA of the leukotriene recpetor antagonists?
Competitively antagonize leuk.. receptors D4 and E3 in the bronchiolar muscle, antagonizing endogenous leukotrienes causing bronchodilation
Which leuk., receptor antagonists interact with warfin?
Zarfirlukast and zileutin
What are the methylxanthines and their MOA?
Theophylline, aminophylline. Increase CAMP in bronchial smooth muscle ñ bronchodilate
Can the methylxanthines be used as a monotherapy?
YES
Why are the methlyxanthines used infrequently?
They have a narrow therapeutic window and a lot of drug interactions- there are safer alternatives
What are the 2 major categories and examples of interactions with methylxanthines?
1)drug-disease: viral illness, CHF, cirrhosis, and smoking. 2) drug-drug: cimetidine, ,macrolides, quinolones, CYP1A2/3A4 substrates
What type of drug is indicated for pts
Mast cell stabilizers
What is the MOA for mast cell stabilizers?
Stabilize mast cells preventing the release of inflammatory mediators. Must be used regularly for weeks for effect
What is the immunodilator and what is its black box warning?
Omalizumab. Anaphylaxis
How often is omalizumab administered?
Once every 2-4wks SUB Q
What is the MOA for systemic corticosteroids?
Decrease inflammation by suppression of migration of leukocytes and reversal of increased capillary permeability
What category is Albuterol
SABA- quick relief bronchdilator
What do the beta 2s do?
Increase CAMP- bronchodilation
Do Beta 2s treat or control asthma?
No- they only treat symptoms in acute exacerbations
A pt needs to have their plan re-evaluated if they have more than how many courses of systemic corticosteroids yearly?
3
Increased SABA use to how many times weekly indicated inadequate control and a need to step up treatment?
> 2 times weekly
What is the approach to initial management of asthma?
Quick relief- SABA, 2-4 puffs PRN, up to 3treatments per 20 min intervals or a single nebulizer tx. Step 1: mild intermittent- symptoms 1day/wk BUT 2 nights a month, preferred tx is low dose ICS, prn SABA
Step 3: moderate persistent: symptoms daily, >1 night a week, low dose ICS+ LABA and prn SABA
Step 4: severe persistent : continuous symptoms, medium or high dose ICS+LABA and prn SABA and oral steroid if needed
What are some risk factors for death by asthma?
2 or more hospitalizations or >3 ED visits in the past year. hospitalized or ED in the past month
uses >2 canisters of SABA/month
What is the foundation of therapy for COPD?
Anticholinergics + B2 agonist. Combo albuterol and ipratropium
What are the antocholinergics and are they indicated for chronic therapy?
Ipratroprium, tiotroprium. NO- relief of ACUTE bronchospasms
What is the MOA for the anticholinergics?
Muscarinic antagonist block muscarinic receptors, which respond to the parasympathetic bronchoconstriction tone
What are the antichol./ LABA combos?
Indacaterol + glycopyrronium. Tiotropium + olodaterol
When are antibiotics indicated for COPD?
When at least 2 of the following symptoms are present: Increased dyspnea
Increased sputum volume
Increased sputum purulence
Which organisms are most common pathogens treated in COPD?
Strep pneumo, H influenzae, and moraxella catarrhalis
Which antibiotics are used most often in Mild to moderate COPD and Severe COPD
Mild to mod: doxycycline, sulfamethoxazole/ trimethoprim, amoxicillin clavulante, macrolides, and fluoroquinolones Severe: antipseudomonal PNC, 3rd generation cephs, and fluoroquinolones.
