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Adv Pharm > Chapter 62: Drugs For Asthma and COPD > Flashcards

Chapter 62: Drugs For Asthma and COPD Flashcards

1
Q

Asthma

A

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

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2
Q

COPD

A

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

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3
Q

2 diseases of COPD

A

Emphysema
Chronic bronchitis

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4
Q

COPD etiology

A

Cigarette smoking
Environmental
Genetic (Alpha 1 antitrypsin deficiency)

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5
Q

COPD characteristics s/sx

A

Dyspnea, excess mucus secretions
Airway obstruction, bronchospasm
Permanent irreversible damage to the lung tissue

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6
Q

3 advantages of admin drugs by inhalation

A

Therapeutic effects are enhanced by delivering drugs directly to their site of action

Systemic effects are minimized

Relief of attack is rapid

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7
Q

Types of inhalation drugs

A

MDIs
DPIs
nebulizers

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8
Q

Inhalation drug spacer

A

Helpful with younger and older population
Helps with hand mouth coordination

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9
Q

Oral glucocorticoids

A

Prednisone
Medrol dose pack (methylprednisolone)

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10
Q

IV glucocorticoids

A

Solu-Cortef
Solumedrol

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11
Q

Glucocorticoids uses

A

Control inflammation in both asthma and COPD exacerbation, Specifically for moderate to severe asthma.

Generally used for exacerbation

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12
Q

Glucocorticoids MOA

A

Produces glucocorticoids (anti-inflammatory) and mineralocorticoid (Na and water rentention) effects.

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13
Q

Glucocorticoids ADR

A

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

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14
Q

Glucocorticoids long term use SE

A

(greater than 10 days) osteoporosis, glaucoma, immunosuppression, impaired wound healing adrenal suppression

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15
Q

Inhaled CS

A

mometasone (Asmanex)
fluticasone (Flovent)
budesonide (Pulmocort)
beclomethasone (Qvar)

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16
Q

Inhaled CS use

A

First line treatment for Asthma and should be used daily and used for COPD exacerbations.

Maintenance medication for asthma

17
Q

inhaled CS MOA

A

Anti-inflammatory effect. Very effective and are much safer than systemic glucocorticoids.

18
Q

Inhaled CS route

A

May be inhaler or nebulizer

19
Q

Inhaled CS SE

A

Throat irritation, hoarseness, dry mouth, coughing, oral candidiasis. But avoid the systemic SE. Rinse mouth AFTER use!

20
Q

CS differences

A

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

21
Q

CS safety and monitoring

A

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.

22
Q

CS prescribing considerations

A

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)

23
Q

SABA

A

Selective beta2-adrenergic agonists
Albuterol

24
Q

Albuterol use

A

Most effective drugs available for relieving acute bronchospasm and preventing Exercise Induced Bronchospasm.

25
Q

Alb MOA

A

Selectively stimulates B2 adrenergic receptors relaxing smooth muscle of bronchi

26
Q

Alb admin

A

inhalation

27
Q

all SE

A

tremors, restlessness, anxiety, nervousness, tachycardia, palpitations

28
Q

LABA

A

Long acting beta 2 adrenergic agonists

Salmeterol
Formeterol
Vilanterol

29
Q

LABA uses

A

COPD, asthma. Seen in combination inhalers

Maintenance, prevent attacks
Last 12-24 hr

30
Q

LABA MOA

A

Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle. Long Lasting

31
Q

LABA SE

A

Tachycardia

32
Q

Anticholingerics

A

Short acting AC
Ipratropium bromide

Long acting AC
Tiotropium bromide (Spiriva)

Combination SABA and anticholinergic
Duoneb
Albuterol and ipratropium

SAMA, LAMA

33
Q

Anticholingeric MOA

A

Blocks acetylcholine receptors producing bronchodilation and reducing bronchoconstriction.​

34
Q

Anticholingeric use

A

COPD, asthma exacerbation (alternate)

35
Q

Combo drugs

A

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)

36
Q

Combo drugs action

A

anti-inflammatory effect
Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle
do not admin in acute asthma attack *
Commonly used in asthma

37
Q

HFA tips

A

Priming needed
May use with spacers

38
Q

DPI tips

A

Breath-activated (take deep/fast breath)

39
Q

Asthma types

A

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

Adv Pharm (76 decks)

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