Chapter 79: Drugs for COPD and Asthma Flashcards
very mild asthma is controlled
PRN SABA
mild asthma is controlled
on low dose ICS or LTRA or PRN budesonide/formoterol
risk of exacerbation
- previous history of severe exacerbation
- poorly controlled asthma
- overuse of SABA
- current smoker
treatment of asthma must address components of
inflammation and bronchoconstriction
what are the two pharmacologic agents used to treat asthma
- anti-inflammatory agents
- bronchodilators
inhalation drug therapy advantages
- therapeutic effects enhanced
- systemic effects minimized
- relief of acute attacks is rapid
anti-inflammatory drugs are takes for ________ control
long term
what are the principle anti-inflammatory drugs
glucocorticoids (budesonide, fluticasone)
what is considered the most effective anti-asthma drugs available
glucocorticoids
glucocorticoids use
prophylaxis of chronic asthma
glucocorticoids dosing
fixed schedule
- should be taken daily
inhaled use of glucocorticoids
safer
oral use of glucocorticoids should be used
as brief as possible
- potential for toxicity; should only be used when symptoms cannot be controlled with other medications
adverse effects of inhaled forms of glucocorticoids
- adrenal suppression
- oropharyngeal candidiasis
- dysphonia
- can slow growth in children and adolescents
- promotion of bone loss
- increased risk of cataracts
- increased risk of glaucoma
adverse effects of oral glucocorticoids
- adrenal suppression (can be fatal in times of stress)
- osteoporosis
- hyperglycemia
- peptic ulcer disease
discontinuing treatment of glucocorticoids must be done
slowly
- recovery of adrenocortical function
leukotriene modifiers MOA
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
leukotriene modifiers (Zafirlukast) use
prevention and treatment of chronic asthma symptoms (alone or in combination)
leukotriene modifiers (Zafirlukast) adverse effects
GI upset, headache, liver damage, neuropsychiatric effects (depression, sucidal thinking, sucidal behaviour)
Zafirlukast [Accolate] should not be used in
kids under 12
Cromolyn MOA
works on mast cells to suppress inflammation by preventing the release of histamine and other inflammatory mediators
cromolyn is used for
prophylaxis in mild to moderate asthma
Montelukast [Singulair] (leukotriene modifier)
used in kids 2+
cromolyn adverse effects
cough
cromolyn administration
inhaler and eye drops (not absorbed well)
cromolyn excretion
urinary
zafirlukast dosing
10mg once daily in the evening
monoclonal antibody drug
omalizumab [Xolair]
omalizumab [Xolair] MOA
forms complexes with free IgE therefore reducing the amount of IgE available to bind with mast cells
omalizumab [Xolair] therapeutic uses
patients age 6+ with moderate to severe asthma that (1) is allergy related (2) cannot be controlled with an inhaled glucocorticoid
omalizumab [Xolair] dosage
subcut q2-4wks
omalizumab [Xolair] adverse effects
- injection site reactions
- viral infection
- upper resp infections
- sinusitis
- headache
- pharyngitis
- cardiovascular events
- malignancy
- life threatening anaphylaxis
phosphodiesterase-4 inhibitor example
Roflumilast [Daxas]
Roflumilast [Daxas] use
add on to bronchodialator for severe COPD with chronic bronchitis
Roflumilast [Daxas] MOA
inhibits PDE-4
- enzyme that breaks down cAMP; resulting in reduced inflammation
Roflumilast [Daxas] should not be taken with
food
- delayed bioavailability
Roflumilast [Daxas] side effects
diarrhea, weight loss, reduced appetite, nausea
beta2 adrenergic agonists MOA
through activation of beta2 receptors in the smooth muscle of the lung, these drug promote bronchodilation, relieving bronchospasm
Inhaled short-acting beta2 agonists (SABAs)
- taken PRN to abort an ongoing attack
-EIB: taken before exercise to prevent an attack
Inhaled long-acting beta2 agonists (LABAs)
- long term control in patients who experience frequent attacks
- fixed schedule dosing
SABA dosing
taken PRN to abort an ongoing attack
LABA dosing
fixed schedule
Beta2 adrenergic agonists inhaled preparations adverse effects
tachycardia, angina, tremor
Beta2 adrenergic agonists oral preperations adverse effects
angina pectoris, tachydysrhythmias, tremor
SABA prototype:
salbutamol [ventolin]
LABA prototype
salmeterol [serevent]
how to use a metered dose inhaler
- wait 1 min before puffs
- shake well before use
- can use with spacer
- all ages
- prime before first use
Methylxanthines example
Theophylline [theodur]
Theophylline [theodur] MOA
produces bronchodialation by relaxing smooth muscle of the bronchi
what is required with the use of Theophylline [theodur]
regular blood work
- plasma levels between 10-20mcg
Theophylline [theodur] has a
narrow therapeutic index
Theophylline [theodur] is excreted
heptic metabolism
Theophylline [theodur] is influenced by
smoking, second hand smoke, heart and liver disease, other drugs
Theophylline [theodur] drug interactions
- caffeine
- tabacco and marijuana
- cimetidine
- fluoroquinolone antibiotics
Methylxanthines plasma levels between 20-25 effects
nausea, vomiting, diarrhea, insomnia, restlessness
Methylxanthines plasma levels below 20
adverse effects uncoomon
Methylxanthines plasma levels above 30
severe dysrhythmias
Theophylline toxicity treatment
- stop drug
- activated charcoal
- dysrhythmias respond to lidocaine
- IV diazepam to control sezuires
tiotropium [Spiriva] MOA
- relieves bronchospasm by blocking muscarinic receptors in the lungs
- maintenance of COPD
tiotropium [Spiriva] adverse effects
dry mouth
Ipratropium [Atrovent] adverse effects
- dry mouth and irritation of the pharynx
- glaucoma
