COPD drugs

Question 1

Mast cell stabilizer

Answer 1

cromolyn sodium

Question 2

cromyolyn sodium MOA

Answer 2

• stabilize mast cells –> prevent histamine release

- decrease bronchial hyper-reactivity (not direct bronchodilator)

Question 3

What is the only anti-asthmatic that blocks both early and late phase responses?

Answer 3

cromolyn sodium

Question 4

Cromolyn uses

Answer 4

• decrease hyper responsiveness
• mild to moderate asthma with allergic component
• limited overall use
• NOT bronchodilating
• NOT for acute asthma

Question 5

Cromolyn adverse effects

Answer 5

• cause bronchospasm, wheezing
• throat irritation, cough, dry mouth
• bad taste
• joint swell, pain, HA

Question 6

What is one of the safest anti-asthma meds?

Answer 6

cromolyn

Question 7

Leukotriene modifiers

Answer 7

montelukast

zileuton

Question 8

LTD4 leukotriene receptor antagonist

Answer 8

montelukast

Question 9

leukotriene synthesis inhibitor

Answer 9

zileuton

Question 10

Alternative to steroids for mild persistent asthma

Answer 10

leukotriene modifiers

Question 11

leukotriene modifiers use

Answer 11

• aspirin sensitive asthma
• allergic rhinitis, chronic sinus
• limited effects in acute attacks
• may cause some bronchodilation

Question 12

Leukotriene modifiers side effects

Answer 12

• well tolerated

- mild HA, GI

Question 13

zileuton side effects

Answer 13

occasional reversible liver toxicity 
increase serum (warfarin and theophylline)

Question 14

montelukast side effects

Answer 14

psychosis/depression risk

Question 15

Biologic for airway

Answer 15

omalizumab

Question 16

omalizumab MOA

Answer 16

prevent IgE from binding

- blocks all components of allergic response

Question 17

omalizumab PK

Answer 17

onset 12 weeks

Question 18

omalizumab use

Answer 18

• 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

Question 19

omalizumab adverse effects

Answer 19

• irritation at injection site

- CV and stroke risk

Question 20

BBW omalizumab

Answer 20

analphylaxis

Question 21

new subset of asthma

Answer 21

eosinophilic asthma

Question 22

new biologic for asthma

Answer 22

IL-5 antagonist

Question 23

IL5

Answer 23

critical eosinophil promoting cytokine

Question 24

bronchial thermoplasty

Answer 24

• recently approved

- non-pharmacologic to reduce bronchoconstriction

Question 25

bronchial thermoplastic MOA

Answer 25

destroy smooth muscle, not just dilating | - heat generating probe

Question 26

benefits of bronchial thermoplasty

Answer 26

- decrease airway wall thickness increase airway diameter - eliminate bronchocinstriction capability

Question 27

COPD LABA

Answer 27

indacaterol - once daily COPD only

Question 28

indacaterol

Answer 28

COPD only

Question 29

T/F ICS drugs alone are not approved for use in COPD

Answer 29

true

Question 30

T/F adding ICS drugs to LABAs or other COPD drugs is not recommended

Answer 30

false | is recommended for severe disease and with frequent exacerbations

Question 31

anticholinergic for COPD

Answer 31

ipratropium | tiotropium

Question 32

target of anticholinergic agents for COPD

Answer 32

M3 | - reduce bronchoconstriction due to airway nerve Ach release

Question 33

T/F anticholinergics are anti constrictors

Answer 33

true

Question 34

ipratropium

Answer 34

SAMA

Question 35

tiotropium

Answer 35

LAMA

Question 36

anticholinergics airways

Answer 36

only approved for COPD | - off label use in asthma

Question 37

first LAMA for long term asthma maintenance therapy

Answer 37

tiotropium

Question 38

anticholinergic adverse effects

Answer 38

- few systemic - dry mouth - pharyngeal irritation - increase IOP - constipation - urinary retention - tachycardia - blurred vision

Question 39

PDE4 inhibitor

Answer 39

roflumilast

Question 40

roflumilast

Answer 40

reduce COPD exacerbations - reduce inflammation not bronchoconstrictions - not for bronchospasms: prevent exacerbation, not treat

Question 41

roflumilast adverse effects

Answer 41

- D/N - CNS: suicide risk - weight loss - altered liver metabolism

Question 42

Mainstay of COPD therapy

Answer 42

bronchodilators

Question 43

Bronchodilators work

Answer 43

improve airflow reduce hyperinflation alleviate acute smyptoms

Question 44

For COPD a ____ combo is preferred over adding ICS

Answer 44

LABA-LAMA

Question 45

Tiotropium use

Answer 45

COPD and asthma

Question 46

T/F ICS should always be used in asthma

Answer 46

true

Question 47

When would you use an ICS to a LABA or LAMA

Answer 47

- severe disease - frequent exacerbations - not for COPD alone

Question 48

theophylline can be used for added _____ effect

Answer 48

bronchodilator

Question 49

Roflumilast is not termed _____ and not used in ______

Answer 49

bronchodilator | asthma

Question 50

roflumilast specifically approved for ____

Answer 50

COPD

Question 51

Roflumilast used for

Answer 51

- reduce/prevent exacerbations | - NOT treat acute exacerbations

Question 52

_____ are not major drug choice for COPD

Answer 52

inhaled steroids

Question 53

New ____ therapies are being developed

Answer 53

triple