Chapter 62: Drugs For Asthma and COPD Flashcards
Asthma
A condition in which a persons airways become inflamed, narrow and swell, and produce extra mucus, causing bronchoconstriction.
Very common
May be minor or lead to life threatening attack.
Managed with inhalers
COPD
A group of lung diseases that block airflow making it difficult to breathe
Very common (more than 3 million cases in US per year)
Treatment can help but not cure
3rd leading cause of death in US
2 diseases of COPD
Emphysema
Chronic bronchitis
COPD etiology
Cigarette smoking
Environmental
Genetic (Alpha 1 antitrypsin deficiency)
COPD characteristics s/sx
Dyspnea, excess mucus secretions
Airway obstruction, bronchospasm
Permanent irreversible damage to the lung tissue
3 advantages of admin drugs by inhalation
Therapeutic effects are enhanced by delivering drugs directly to their site of action
Systemic effects are minimized
Relief of attack is rapid
Types of inhalation drugs
MDIs
DPIs
nebulizers
Inhalation drug spacer
Helpful with younger and older population
Helps with hand mouth coordination
Oral glucocorticoids
Prednisone
Medrol dose pack (methylprednisolone)
IV glucocorticoids
Solu-Cortef
Solumedrol
Glucocorticoids uses
Control inflammation in both asthma and COPD exacerbation, Specifically for moderate to severe asthma.
Generally used for exacerbation
Glucocorticoids MOA
Produces glucocorticoids (anti-inflammatory) and mineralocorticoid (Na and water rentention) effects.
Glucocorticoids ADR
Na and fluid retention, adrenal insufficiency, Cushing syndrome, infection, hyperglycemia, HTN, petechiae /ecchymosis, insomnia, emotional lability, weight gain, redistribution of fat.
Hyperglycemia and HTN are short term SE
Most seen w/in 2 weeks of use and are usually reversible
Glucocorticoids long term use SE
(greater than 10 days) osteoporosis, glaucoma, immunosuppression, impaired wound healing adrenal suppression
Inhaled CS
mometasone (Asmanex)
fluticasone (Flovent)
budesonide (Pulmocort)
beclomethasone (Qvar)
Inhaled CS use
First line treatment for Asthma and should be used daily and used for COPD exacerbations.
Maintenance medication for asthma
inhaled CS MOA
Anti-inflammatory effect. Very effective and are much safer than systemic glucocorticoids.
Inhaled CS route
May be inhaler or nebulizer
Inhaled CS SE
Throat irritation, hoarseness, dry mouth, coughing, oral candidiasis. But avoid the systemic SE. Rinse mouth AFTER use!
CS differences
Doses differ based on anti inflammatory effect
Short acting -cortisone, used for lotions and creams
Intermediate acting prednisone, methylprednisolone commonly used in COPD and asthma exacerbations
Long acting dexamethasone used for COVID, cerebral edema
CS safety and monitoring
Weaning or tapering of the dose is necessary to prevent exacerbation of asthma symptoms and suppression of adrenal function.
Can irritate gastric mucosa and should be taken with food to avoid ulceration.
Candida albicans (yeast) oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. If occurs, treat with antifungal medication.
To minimize bone loss, take lowest dose that controls symptoms, ensure adequate intake of Ca and Vitamin D and participate in weight bearing exercises.
Alternating day dosing is often used to minimize adrenal suppression.
CS prescribing considerations
Therapeutic Goal: To achieve symptom control through suppression of airway inflammation
Base line Data: H and P with emphasis on the respiratory system. Pulmonary Function Tests
Monitoring: FEV1 or peak flow. Assess for oral candidiasis and glaucoma. Monitor for evidence of adrenal insufficiency (hypoglycemia, hypotension, mental status changes). Consider a bone density test for older adults or others at risk.
Evaluating Therapeutic Effects: Monitor Peak expiratory Flow. PFTs, nighttime awakenings, SABA use (recuse inhaler)
SABA
Selective beta2-adrenergic agonists
Albuterol
Albuterol use
Most effective drugs available for relieving acute bronchospasm and preventing Exercise Induced Bronchospasm.
Alb MOA
Selectively stimulates B2 adrenergic receptors relaxing smooth muscle of bronchi
Alb admin
inhalation
all SE
tremors, restlessness, anxiety, nervousness, tachycardia, palpitations
LABA
Long acting beta 2 adrenergic agonists
Salmeterol
Formeterol
Vilanterol
LABA uses
COPD, asthma. Seen in combination inhalers
Maintenance, prevent attacks
Last 12-24 hr
LABA MOA
Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle. Long Lasting
LABA SE
Tachycardia
Anticholingerics
Short acting AC
Ipratropium bromide
Long acting AC
Tiotropium bromide (Spiriva)
Combination SABA and anticholinergic
Duoneb
Albuterol and ipratropium
SAMA, LAMA
Anticholingeric MOA
Blocks acetylcholine receptors producing bronchodilation and reducing bronchoconstriction.
Anticholingeric use
COPD, asthma exacerbation (alternate)
Combo drugs
Corticosteroids with long acting beta 2 agonist (LABA)
Advair(fluticasone and salmeterol) HFA (2 BID), DPI (1 BID)
Symbicort (budesonide and formeterol) HFA (2 BID)
Dulera (mometasone and formeterol) HFA (2 BID)
Breo (fluticasone and vilanterol) DPI (1 daily)
Combo drugs action
anti-inflammatory effect
Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle
do not admin in acute asthma attack *
Commonly used in asthma
HFA tips
Priming needed
May use with spacers
DPI tips
Breath-activated (take deep/fast breath)
Asthma types
Mild, intermittent: 2x/week day s/sx, 2x.month or less night s/sx, lungs fine bw attacks
Mild, persistent: 2+/week day s/sx, 2+/month night s/sx, interfere with daily activities
Moderate, persistent: daily day s/sx, 1+/week night sx, interfere with daily activities
Severe, persistent: daily day s/sx, frequent night s/sx, daily activities limited
*tx based on day s/sx
