COPD drugs Flashcards
Mast cell stabilizer
cromolyn sodium
cromyolyn sodium MOA
- stabilize mast cells –> prevent histamine release
- decrease bronchial hyper-reactivity (not direct bronchodilator)
What is the only anti-asthmatic that blocks both early and late phase responses?
cromolyn sodium
Cromolyn uses
- decrease hyper responsiveness
- mild to moderate asthma with allergic component
- limited overall use
- NOT bronchodilating
- NOT for acute asthma
Cromolyn adverse effects
- cause bronchospasm, wheezing
- throat irritation, cough, dry mouth
- bad taste
- joint swell, pain, HA
What is one of the safest anti-asthma meds?
cromolyn
Leukotriene modifiers
montelukast
zileuton
LTD4 leukotriene receptor antagonist
montelukast
leukotriene synthesis inhibitor
zileuton
Alternative to steroids for mild persistent asthma
leukotriene modifiers
leukotriene modifiers use
- aspirin sensitive asthma
- allergic rhinitis, chronic sinus
- limited effects in acute attacks
- may cause some bronchodilation
Leukotriene modifiers side effects
- well tolerated
- mild HA, GI
zileuton side effects
occasional reversible liver toxicity increase serum (warfarin and theophylline)
montelukast side effects
psychosis/depression risk
Biologic for airway
omalizumab
omalizumab MOA
prevent IgE from binding
- blocks all components of allergic response
omalizumab PK
onset 12 weeks
omalizumab use
- moderate to severe disease not well controlled by inhaled steroids
- allergic asthma –> non seasonal allergic
- reduce frequency and severity of exacerbation
- allow reduction of anti-inflammatory GC dose
omalizumab adverse effects
- irritation at injection site
- CV and stroke risk
BBW omalizumab
analphylaxis
new subset of asthma
eosinophilic asthma
new biologic for asthma
IL-5 antagonist
IL5
critical eosinophil promoting cytokine
bronchial thermoplasty
- recently approved
- non-pharmacologic to reduce bronchoconstriction
bronchial thermoplastic MOA
destroy smooth muscle, not just dilating
- heat generating probe
benefits of bronchial thermoplasty
- decrease airway wall thickness
increase airway diameter - eliminate bronchocinstriction capability
COPD LABA
indacaterol
- once daily
COPD only
indacaterol
COPD only
T/F ICS drugs alone are not approved for use in COPD
true
T/F adding ICS drugs to LABAs or other COPD drugs is not recommended
false
is recommended for severe disease and with frequent exacerbations
anticholinergic for COPD
ipratropium
tiotropium
target of anticholinergic agents for COPD
M3
- reduce bronchoconstriction due to airway nerve Ach release
T/F anticholinergics are anti constrictors
true
ipratropium
SAMA
tiotropium
LAMA
anticholinergics airways
only approved for COPD
- off label use in asthma
first LAMA for long term asthma maintenance therapy
tiotropium
anticholinergic adverse effects
- few systemic
- dry mouth
- pharyngeal irritation
- increase IOP
- constipation
- urinary retention
- tachycardia
- blurred vision
PDE4 inhibitor
roflumilast
roflumilast
reduce COPD exacerbations
- reduce inflammation not bronchoconstrictions
- not for bronchospasms: prevent exacerbation, not treat
roflumilast adverse effects
- D/N
- CNS: suicide risk
- weight loss
- altered liver metabolism
Mainstay of COPD therapy
bronchodilators
Bronchodilators work
improve airflow
reduce hyperinflation
alleviate acute smyptoms
For COPD a ____ combo is preferred over adding ICS
LABA-LAMA
Tiotropium use
COPD and asthma
T/F ICS should always be used in asthma
true
When would you use an ICS to a LABA or LAMA
- severe disease
- frequent exacerbations
- not for COPD alone
theophylline can be used for added _____ effect
bronchodilator
Roflumilast is not termed _____ and not used in ______
bronchodilator
asthma
roflumilast specifically approved for ____
COPD
Roflumilast used for
- reduce/prevent exacerbations
- NOT treat acute exacerbations
_____ are not major drug choice for COPD
inhaled steroids
New ____ therapies are being developed
triple
