COPD and Asthma Flashcards

1
Q

Most effective drug for relieving acute bronchospasm and preventing EIB

A

B2 adrenergic antagonists

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2
Q

How are LABAs taken? With what?

A

Fixed schedule, not PRN. Always with glucocorticoids

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3
Q

B2 Adrenergic agonists moa

A

Activate b2 adrenergic receptors in smooth muscle of lungs, promoting bronchodilation and relieving bronchospasm

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4
Q

Methylzanthines moa

A

Produces bronchodilation by relaxing smooth muscle of bronchi

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5
Q

Anticholinergics mechanism of action

A

Muscarinic antagonist: blocks muscarinic cholinergic receptors in the bronchi, preventing bronchoconstriction

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6
Q

Anticholinergics timing

A

Therapeutic in 30 secs, 50% of max effects in 3 mins, persists for 3 hours

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7
Q

Indicated in pts experiencing frequent attacks, for long term control. Preferred for stable COPD

A

LABA

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8
Q

Used PRN in acute attacks, EIB, hospitalized pts with severe attacks

A

SABAs

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9
Q

Maintenance therapy for chronic stable asthma, less effective than b2 agonists but longer duration of action, can decrease frequency of attacks, not for COPD unless nothing else

A

Methylzanthines

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10
Q

Approved for COPD and off label use in asthma, allergen induced asthma, EIB

A

Anticholinergics

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11
Q

Contraindicated in asthma

A

LABAs

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12
Q

LABAs adverse effects

A

Increase risk of severe asthma and asthma related deaths when used as monotherapy for long term control

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13
Q

SABAs adverse effects

A

Systemic: tachycardia, tremor, angina

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14
Q

Methylzanthines adverse effects

A

Toxicity: normal levels 10-20, mild effects 20-25 nausea, vomiting, diarrhea, insomnia. Severe effects 30+ v fib, convulsions

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15
Q

Treatment of Methylzanthines toxicity

A

Activated charcoal, lidocaine for dysrhythmias, diazepam for convulsions

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16
Q

Anticholinergics adverse effects

A

Irritation of pharynx, dry mouth, increased intraoccular pressure in pts with glaucoma

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17
Q

Methylzanthines interactions

A

Caffeine, tobacco, marijuana smoke

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18
Q

Formoterol (oxeze turbohaler)

A

LABA

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19
Q

Salmeterol (serevent)

A

LABA

20
Q

Albuterol (ventolin)

A

SABA

21
Q

Theophylline

A

Methylzanthine

22
Q

Ipratopium (atrovent)

A

Anticholinergic

23
Q

Tiotropium (spiriva)

A

Anticholinergic

24
Q

Most effective drug for long term control of airway inflammation

A

Glucocorticoids

25
Q

2nd line therapy for allergy related asthma, modest benefits for serious drawbacks, unknown long term effects

A

IgE antagonists

26
Q

Used as second line if glucocorticoids can’t be used, or add on therapy when inhaled glucocorticoids can’t be used

A

Leukotriene modifiers

27
Q

Glucocorticoids indication

A

Prophylaxis of chronic asthma, inhaled are first line for inflammatory component of asthma

28
Q

12+ with moderate to severe asthma, allergy related and can’t be controlled with glucocorticoids, asthma caused by specific allergen (allergen skin test required before use to determine allergen reactivity)

A

IgE antagonist indications

29
Q

Prophylaxis and maintenance therapy of asthma in pts 1+, prevention of EIB in 15+, relief allergic rhinitis, Not for quick relief of symptoms

A

Leukotriene modifier indications

30
Q

How long for Leukotriene modifiers to develop max effects

A

24hrs

31
Q

IgE antagonist pharmacokinetics

A

Administered sub-Q, Slow absorption, peak conc in 7-8 days, approx half life of 26 days

32
Q

Reduces symptoms by suppressing inflammation, reduces bronchial hyperactivity and decreases airway mucous production

A

Glucocorticoids moa

33
Q

Forms a complex with free IgE and thereby inhibits binding with mast cells, limits ability of allergens to release mediators that promote bronchospasm and airway inflammation

A

IgE Antagonist MOA

34
Q

Suppress effects of Leukotrienes, decrease bronchoconstriction and inflammatory responses in asthma

A

Leukotriene modifiers MOA

35
Q

Inhaled Glucocorticoids Adverse effects

A

Oral Candiasis, dysphonia, slow growth in children and adolescents, promotes bone loss, increase risk of cataracts and glaucoma

36
Q

What education would you provide a patient on the risk of oral candiasis when taking glucocorticoids?

A

Rinse thoroughly with water or milk after taking, use spacer so more of the meds are absorbed in lungs vs mouth

37
Q

Adverse effects of oral glucocorticoids

A

Adrenal suppression, Osteoporosis, hyperglycaemia, peptic ulcer disease, growth suppression, decreased ability of adrenal cortex to make glucocorticoids on its own with prolonged therapy, required for high stress situations like surgery or trauma

38
Q

Adverse effects of IgE antagonists

A

Injection site reactions, viral infections, URTI, sinusitis, headache pharyngitis, small risk of cardiovascular and malignancy problems, life threatening anaphylaxis in 0.1%, urticaria and edema of throat/tongue, most like with first doses

39
Q

How should monitoring occur for adverse affects from IgE antagonists

A

First dose 2hrs, following doses 30 mins

40
Q

Adverse effects of Leukotriene modifiers

A

Generally well tolerated, neuropsychiatric effects rare but possible, mood changes and suicidality

41
Q

Budesonide (pulmicort)

A

Inhaled Glucocorticoid

42
Q

Fluticasone (Flovent)

A

Inhaled Glucocorticoid

43
Q

Prednisone (Winipred)

A

Oral Glucocorticoid

44
Q

Omalizumab (xolair)

A

IgE antagonist

45
Q

Montelukast (Singulair)

A

Leukotriene modifier

46
Q

Zafirlukast (accolate)

A

Leukotriene modifier

47
Q

Zileuton (zyflo)

A

Leukotriene modifier