COPD and Asthma Pharma

Question 1

Beta receptors are what kind of receptor?

Answer 1

GPCR

Question 2

What does activation of beta-2 receptors in the lung do?

Answer 2

relaxation of airway smooth muscle and bronchodilation

Question 3

What are SABA’s used for?

Answer 3

immediate relief of symptoms, have an onset of action of 5 to 15 minutes, and generally last 4-6 hours.

Question 4

What are LABA’s used for?

Answer 4

last up to 24 hours and are used for long-term control of COPD and asthma.

Question 5

What is important to check in someone who uses an inhaler?

Answer 5

Their technique! even with good technique, only 10% of inhaled medications are deposited

Question 6

side effects include tremor, palpitations, tachycardia, hypokalemia, hyperglycemia, and lactic acidosis. Which drug is this?

Answer 6

beta receptor agonists

Question 7

What are LABAs indicated for in COPD?

Answer 7

group B, C or D alone in or with ICS

Question 8

How should COPD with persistent dyspnea on one bronchodilator be managed?

Answer 8

Add another bronchodilator (i.e. LABA and LAMA)

Question 9

LABA’s are monotherapy for: COPD or asthma

Answer 9

COPD

NOT indicated for asthma first line monotherapy (that’s ICS)

Question 10

Which subclass of muscarinic receptors are targeted by LAMAs and SAMAs?

Answer 10

M3

Question 11

What does binding of acetylcholine at the M3 receptor do?

Answer 11

release intracellular calcium and bronchoconstriction

Question 12

How do muscarinic receptor antagonists work?

Answer 12

Inhaled muscarinic antagonists competitively and reversibly inhibit the effects of acetylcholine on the M3 muscarinic receptor on airway smooth muscle cells causing bronchodilation.

Question 13

What are adverse effects of muscarinic antagonists?

Answer 13

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.

Question 14

What is the indication for muscarinic antagonist use in COPD?

Answer 14

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.

Question 15

What is the indication for muscarinic antagonist use in asthma?

Answer 15

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.

Question 16

Common side effects of this drug class are: hyperglycemia, hypertension, weight gain, increased susceptibility to infections, and osteoporosis

Answer 16

corticosteroids

Question 17

What are notable adverse effects of ICS specifically?

Answer 17

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.

Question 18

Are ICS used in COPD?

Answer 18

nope. LAMA + LABA preferred

Question 19

If ICS is insufficient to control asthma, what is the next step?

Answer 19

add a LABA or increase dosage

Question 20

What is a popular leukotriene antagonist?

Answer 20

montelukast

Question 21

Which class of drugs has a medication which can increase INR on warfarin therapy?

Answer 21

leukotriene inhibitors

Question 22

What is a common SE of montelukast?

Answer 22

head ache

Question 23

When can leukotriene antagonists be used in asthma?

Answer 23

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

Question 24

What disease are phosphodiesterase 4 inhibitors used for?

Answer 24

COPD

Question 25

Gastrointestinal side effects including abdominal pain, diarrhea, nausea, poor appetite, and weight loss are common and occur in 10% of patients with which drug?

Answer 25

PDE-4 inhibitors

Question 26

Per GOLD guidelines, when can PDE4 inhibitors be used in COPD?

Answer 26

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).

Question 27

What are side effects of theophylline that limit its use in asthma?

Answer 27

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.