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HLST220: Pharmacology > Chapter 79: Drugs for COPD and Asthma > Flashcards

Chapter 79: Drugs for COPD and Asthma Flashcards

1
Q

very mild asthma is controlled

A

PRN SABA

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2
Q

mild asthma is controlled

A

on low dose ICS or LTRA or PRN budesonide/formoterol

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3
Q

risk of exacerbation

A
  • previous history of severe exacerbation
  • poorly controlled asthma
  • overuse of SABA
  • current smoker
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4
Q

treatment of asthma must address components of

A

inflammation and bronchoconstriction

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5
Q

what are the two pharmacologic agents used to treat asthma

A
  • anti-inflammatory agents
  • bronchodilators
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6
Q

inhalation drug therapy advantages

A
  • therapeutic effects enhanced
  • systemic effects minimized
  • relief of acute attacks is rapid
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7
Q

anti-inflammatory drugs are takes for ________ control

A

long term

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8
Q

what are the principle anti-inflammatory drugs

A

glucocorticoids (budesonide, fluticasone)

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9
Q

what is considered the most effective anti-asthma drugs available

A

glucocorticoids

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10
Q

glucocorticoids use

A

prophylaxis of chronic asthma

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11
Q

glucocorticoids dosing

A

fixed schedule
- should be taken daily

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12
Q

inhaled use of glucocorticoids

A

safer

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13
Q

oral use of glucocorticoids should be used

A

as brief as possible
- potential for toxicity; should only be used when symptoms cannot be controlled with other medications

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14
Q

adverse effects of inhaled forms of glucocorticoids

A
  • adrenal suppression
  • oropharyngeal candidiasis
  • dysphonia
  • can slow growth in children and adolescents
  • promotion of bone loss
  • increased risk of cataracts
  • increased risk of glaucoma
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15
Q

adverse effects of oral glucocorticoids

A
  • adrenal suppression (can be fatal in times of stress)
  • osteoporosis
  • hyperglycemia
  • peptic ulcer disease
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16
Q

discontinuing treatment of glucocorticoids must be done

A

slowly
- recovery of adrenocortical function

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17
Q

leukotriene modifiers MOA

A

suppress/block effects of leukotrienes
- promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through the direct action and recruitment of eosinophils and other inflammatory cells

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18
Q

leukotriene modifiers (Zafirlukast) use

A

prevention and treatment of chronic asthma symptoms (alone or in combination)

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19
Q

leukotriene modifiers (Zafirlukast) adverse effects

A

GI upset, headache, liver damage, neuropsychiatric effects (depression, sucidal thinking, sucidal behaviour)

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20
Q

Zafirlukast [Accolate] should not be used in

A

kids under 12

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21
Q

Cromolyn MOA

A

works on mast cells to suppress inflammation by preventing the release of histamine and other inflammatory mediators

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22
Q

cromolyn is used for

A

prophylaxis in mild to moderate asthma

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23
Q

Montelukast [Singulair] (leukotriene modifier)

A

used in kids 2+

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24
Q

cromolyn adverse effects

A

cough

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25
Q

cromolyn administration

A

inhaler and eye drops (not absorbed well)

26
Q

cromolyn excretion

A

urinary

27
Q

zafirlukast dosing

A

10mg once daily in the evening

28
Q

monoclonal antibody drug

A

omalizumab [Xolair]

29
Q

omalizumab [Xolair] MOA

A

forms complexes with free IgE therefore reducing the amount of IgE available to bind with mast cells

30
Q

omalizumab [Xolair] therapeutic uses

A

patients age 6+ with moderate to severe asthma that (1) is allergy related (2) cannot be controlled with an inhaled glucocorticoid

31
Q

omalizumab [Xolair] dosage

A

subcut q2-4wks

32
Q

omalizumab [Xolair] adverse effects

A
  • injection site reactions
  • viral infection
  • upper resp infections
  • sinusitis
  • headache
  • pharyngitis
  • cardiovascular events
  • malignancy
  • life threatening anaphylaxis
33
Q

phosphodiesterase-4 inhibitor example

A

Roflumilast [Daxas]

34
Q

Roflumilast [Daxas] use

A

add on to bronchodialator for severe COPD with chronic bronchitis

35
Q

Roflumilast [Daxas] MOA

A

inhibits PDE-4
- enzyme that breaks down cAMP; resulting in reduced inflammation

36
Q

Roflumilast [Daxas] should not be taken with

A

food
- delayed bioavailability

37
Q

Roflumilast [Daxas] side effects

A

diarrhea, weight loss, reduced appetite, nausea

38
Q

beta2 adrenergic agonists MOA

A

through activation of beta2 receptors in the smooth muscle of the lung, these drug promote bronchodilation, relieving bronchospasm

39
Q

Inhaled short-acting beta2 agonists (SABAs)

A
  • taken PRN to abort an ongoing attack
    -EIB: taken before exercise to prevent an attack
40
Q

Inhaled long-acting beta2 agonists (LABAs)

A
  • long term control in patients who experience frequent attacks
  • fixed schedule dosing
41
Q

SABA dosing

A

taken PRN to abort an ongoing attack

42
Q

LABA dosing

A

fixed schedule

43
Q

Beta2 adrenergic agonists inhaled preparations adverse effects

A

tachycardia, angina, tremor

44
Q

Beta2 adrenergic agonists oral preperations adverse effects

A

angina pectoris, tachydysrhythmias, tremor

45
Q

SABA prototype:

A

salbutamol [ventolin]

46
Q

LABA prototype

A

salmeterol [serevent]

47
Q

how to use a metered dose inhaler

A
  • wait 1 min before puffs
  • shake well before use
  • can use with spacer
  • all ages
  • prime before first use
48
Q

Methylxanthines example

A

Theophylline [theodur]

49
Q

Theophylline [theodur] MOA

A

produces bronchodialation by relaxing smooth muscle of the bronchi

50
Q

what is required with the use of Theophylline [theodur]

A

regular blood work
- plasma levels between 10-20mcg

51
Q

Theophylline [theodur] has a

A

narrow therapeutic index

52
Q

Theophylline [theodur] is excreted

A

heptic metabolism

53
Q

Theophylline [theodur] is influenced by

A

smoking, second hand smoke, heart and liver disease, other drugs

54
Q

Theophylline [theodur] drug interactions

A
  • caffeine
  • tabacco and marijuana
  • cimetidine
  • fluoroquinolone antibiotics
55
Q

Methylxanthines plasma levels between 20-25 effects

A

nausea, vomiting, diarrhea, insomnia, restlessness

56
Q

Methylxanthines plasma levels below 20

A

adverse effects uncoomon

57
Q

Methylxanthines plasma levels above 30

A

severe dysrhythmias

58
Q

Theophylline toxicity treatment

A
  • stop drug
  • activated charcoal
  • dysrhythmias respond to lidocaine
  • IV diazepam to control sezuires
59
Q

tiotropium [Spiriva] MOA

A
  • relieves bronchospasm by blocking muscarinic receptors in the lungs
  • maintenance of COPD
60
Q

tiotropium [Spiriva] adverse effects

A

dry mouth

61
Q

Ipratropium [Atrovent] adverse effects

A
  • dry mouth and irritation of the pharynx
  • glaucoma

HLST220: Pharmacology (46 decks)

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