COPD and Asthma Pharma Flashcards
Beta receptors are what kind of receptor?
GPCR
What does activation of beta-2 receptors in the lung do?
relaxation of airway smooth muscle and bronchodilation
What are SABA’s used for?
immediate relief of symptoms, have an onset of action of 5 to 15 minutes, and generally last 4-6 hours.
What are LABA’s used for?
last up to 24 hours and are used for long-term control of COPD and asthma.
What is important to check in someone who uses an inhaler?
Their technique! even with good technique, only 10% of inhaled medications are deposited
side effects include tremor, palpitations, tachycardia, hypokalemia, hyperglycemia, and lactic acidosis. Which drug is this?
beta receptor agonists
What are LABAs indicated for in COPD?
group B, C or D alone in or with ICS
How should COPD with persistent dyspnea on one bronchodilator be managed?
Add another bronchodilator (i.e. LABA and LAMA)
LABA’s are monotherapy for: COPD or asthma
COPD
NOT indicated for asthma first line monotherapy (that’s ICS)
Which subclass of muscarinic receptors are targeted by LAMAs and SAMAs?
M3
What does binding of acetylcholine at the M3 receptor do?
release intracellular calcium and bronchoconstriction
How do muscarinic receptor antagonists work?
Inhaled muscarinic antagonists competitively and reversibly inhibit the effects of acetylcholine on the M3 muscarinic receptor on airway smooth muscle cells causing bronchodilation.
What are adverse effects of muscarinic antagonists?
Potential side effects include dry mouth, constipation, urinary retention, and precipitation of narrow angle glaucoma. Be aware of other anticholinergic medications your patient is taking.
What is the indication for muscarinic antagonist use in COPD?
Per GOLD guidelines, LAMAs (either alone or in combination with a LABA and/or inhaled corticostertoid) are indicated for groups B, C, and D COPD.
What is the indication for muscarinic antagonist use in asthma?
Per GINA guidelines, LAMAs can be considered at step 4 or 5 in patients who continue to have exacerbations despite a medium or high dose ICS + LABA.
Common side effects of this drug class are: hyperglycemia, hypertension, weight gain, increased susceptibility to infections, and osteoporosis
corticosteroids
What are notable adverse effects of ICS specifically?
thrush (patients should rinse their mouth out after each use), dysphonia, skin bruising, increased incidence of pneumonia, and a small increased risk of cataracts and glaucoma.
Are ICS used in COPD?
nope. LAMA + LABA preferred
If ICS is insufficient to control asthma, what is the next step?
add a LABA or increase dosage
What is a popular leukotriene antagonist?
montelukast
Which class of drugs has a medication which can increase INR on warfarin therapy?
leukotriene inhibitors
What is a common SE of montelukast?
head ache
When can leukotriene antagonists be used in asthma?
leukotriene antagonists are used as an adjunct to ICS therapy to try to improve symptom control and decrease ICS dose in patients with persistent asthma
What disease are phosphodiesterase 4 inhibitors used for?
COPD
Gastrointestinal side effects including abdominal pain, diarrhea, nausea, poor appetite, and weight loss are common and occur in 10% of patients with which drug?
PDE-4 inhibitors
Per GOLD guidelines, when can PDE4 inhibitors be used in COPD?
roflumilast is indicated in patients with GOLD group D COPD, frequent exacerbations despite inhaled therapy, chronic bronchitis, and severe to very severe airflow obstruction (Evidence B).
What are side effects of theophylline that limit its use in asthma?
Use of the drug is limited by its narrow therapeutic window which requires frequent monitoring of plasma drug levels. Dose-related toxicities include palpitations, potentially fatal dysrythmias, anorexia, and seizures. Theophylline is metabolized through CYP1A and 3A4 and drug-drug interactions are common.
