Drugs Flashcards
What are the names of the 2 long acting beta agonists?
Salmeterol, Formoterol
Can long acting beta agonists be used in mono therapy for asthma?
NO - increased risk of asthma death if you do!
What’s a common substance that one should avoid/limit when using beta agonists?
caffeine
What is considered the long-term control drug of choice in patients with any degree of asthma?
Inhaled corticosteroids
What are the names of 3 systemic corticosteroids used in respiratory disorders?
dexamethasone, prednisone, solumedrol
If a patient has asthma and COPD, which drug class is indicated?
Anticholinergics. Not for asthma, unless COPD is also present.
How does cromolyn work? Based on this, what indications does it have?
Inhibits release of histamine. Can be effective when taken before an exposure or exercise but do not relieve asthmatic symptoms once present.
This medication is no longer recommended for asthma due to its narrow therapeutic window?
Theophylline
What can happen with a theophylline overdose?
seizures or potentially fatal arrhythmias
Which drug class increases liver enzymes, and therefore requires periodic monitoring of LFTs?
Leukotriene antagonists - zafirlukast, montelukast, zileuton
What are two non-asthma indications for the use of theophylline?
erectile dysfunction and pulmonary hypertension
What patient education is required for taking Zafirlukast?
Food impairs absorption
What drug class do Leukotriene antagonists interact with?
CYP450 drugs - i.e. warfarin
What is the indication for use of a leukotriene antagonist?
Prophylaxis of asthma, Montelukast can also be used for prevention of exercise-induced bronchospasm
What symptoms are associated with an overdose of theophylline?
nausea/vomiting, tremor, anxiety, possible seizure,
Besides emergency management, what therapeutic management can be used to treat theophylline overdose?
Propranolol and activated charcoal
How does Buproprion, an anti-depressant, help people quit smoking?
By boosting levels of dopamine and NE, it mimics nicotine and reduces cravings
How does nicotine gum, patch, etc help people quit smoking?
has about half the peak level of smoking, so it can help people stop and reduce withdrawal symptoms
Varenicline (Chantix) is a partial agonist of nicotinic receptors so it produces less euphoric effect, but can help with
withdrawal symptoms
It is very important to monitor patients on Chantix for:
suicidal thoughts and mood changes
A woman wants to quit smoking but is concerned about gaining weight when she does, what medication could help her?
Naltrexone (Revia)
Name some benefits of prescribing dabigatran over warfarin? down sides?
Few interactions, no routine monitoring required. But, it is way expensive and can’t be used if have mechanical heart valves.
Drugs used to prevent embolism and stroke in patients with Afib?
Warfarin and dabigatran
What medication significantly improves outcome and ability to perform ADLs after a stroke?
Alteplase (Activase) - has to be given within 3 hours
What other indications does Alteplase (Activase) have?
It is a thrombolytic so can be used in MI, massive PE, acute arterial occlusion of a limb
What drug is indicated after an acute stroke in patients not eligible for thrombolytic therapy and hemorrhage has been excluded?
Aspirin, followed by anticoag drugs
How should you instruct a patient to administer a MDI?
slowly and deeply inhale before and during
How should you instruct a patient to administer a DPI?
quickly and deeply
T/F. Twice-daily dosing of inhaled corticosteroids provides adequate control of asthma in most patients.
true. Once-daily dosing can be sufficient in some patients
What time frame can be expected before we notice the maximum response from inhaled corticosteroids?
months
What are systemic effects of high-dose inhaled corticosteroid therapy? And how can this be reduced?
adrenal suppression, skin thinning, osteoporosis, easy bruising, cataracts.
Use of inhalation chamber coupled with mouth washing after MDI use can decrease local (cough, dysphonia, candidiasis) and systemic side effects.
Use of SABA more than how many days a week indicates inadequate control and the need to step up treatment?
> 2 days/week
Describe the stepwise order of medications for persistent asthma:
Step 1: SABA prn
Step 2: low dose ICS
Step 3: low dose ICS + LABA (or medium ICS)
Step 4: medium ICS + LABA
Step 5: high ICS + LABA
Step 6: high ICS + LABA + oral corticosteroid
At what step should referral to an asthma specialist be warranted?
If step 4 or more higher is needed
T/F. Once asthma is controlled for >3 months, patients should stay on current medication regimen.
False. Step down if possible
At which steps should subcutaneous allergen immunotherapy for patients with allergic asthma be considered?
Steps 2-4
Patients on systemic corticosteroid treatment (oral or parenteral), concurrent treatment with what supplements are needed?
calcium and vitamin D to prevent steroid-induced bone mineral loss (osteoporosis)
What syndrome has been diagnosed in a small number of patients who have taken montelukast or zafirlukast?
Churg-Strauss
Contraindication to Buproprion?
at risk for seizures, eating disorders
What are the names of the inhaled corticosteroids?
-ONE
beclomethasone, fluticasone, triamcinolone, mometasone
Which steroid administration route is indicated for acute symptomatic sarcoidosis?
Systemic
First line long-term therapy in persistent asthma:
ICS
If you’re using your SABA more than 2 days/week for symptom relief, what is the next step?
Indicates inadequate control and time to step up to an inhaled corticosteroid!
What are considered “long-term” control med:
- anti-inflammatory agents (steroids)
- LABA - salmeterol and formoterol OR
bronchodilators - cromolyn, tiotropium, theophylline - Leukotriene modifiers
What are considered “quick-relief” meds:
- SABA
- Ipratroprium bromide
- steroids (if don’t respond to SABA)
Which types of asthma exacerbations do you treat with supplemental oxygen?
Moderate and severe!
