Drugs for Asthma Flashcards
Asthma
Chronic inflammatory disorder of the airway
Signs and symptoms of Asthma
-Sense of breathlessness
-Tightening of the chest
-Wheezing
-Dyspnea
-Cough
-Symptoms are a result of bronchoconstriction and inflammation.
Causes of Asthma
-Immune mediated airway inflammation.
Inflammatory response
-Allergen binds to immunoglobulin E antibodies on mast cell.
-Mast cells release mediators: histamine, prostaglandins, leukotrienes, interleukins.
-Mediators are responsible for bronchoconstriction and promote infiltration and activation of inflammatory cells.
Chronic Obstructive Pulmonary Disease (COPD)
-Chronic, progressive, irreversible disorder.
-Combination of chronic bronchitis and emphysema
-Both processes are caused by exaggerated inflammatory reaction to cigarette smoke.
Symptoms of COPD
-Cough
-Dyspnea
-Wheezing
-Sputum production
Chronic Bronchitis
-Chronic cough and excessive sputum, hypertrophy of mucus secreting glands of the epithelium of the larger airways.
Emphysema
-An enlargement of the air space within the bronchioles and alveoli brought on by deterioration of the walls of these air spaces.
2 main pharmacologic classes for asthma
-Anti-inflammatory
-Bronchodilators
Advantages to inhalation drug therapy
-Therapeutic effects are enhanced
-Systemic effects are minimized.
-Relief of acute attacks is rapid.
-Gets drugs into the lungs as quick as possible.
Three types of inhalation drug administration
-Metered dose inhalers (MDI)- if more than 1 puff is required wait 1 min in between puffs. Rinse mouth out after.
-Dry powder inhaler (DPI)
-Nebulizers
Anti-inflammatory drugs: Glucocorticoids
-Budesonide (Pulmicort)- suspension for nebulization.
-Fluticasone (Flovent)- MDI and DPI
-Prednisone (Oral)
Glucocorticoids mechanism of action
-Decrease synthesis/production and release of inflammatory mediators.
-Decrease infiltration and activity of inflammatory cells.
-Decrease edema of airway mucosa.
Glucocorticoids use
-Prophylaxis of chronic asthma and managing COPD.
-Dosing is on a fixed schedule, not PRN.
Inhaled glucocorticoids
-First line therapy for management of inflammatory component of asthma.
-Safer than oral
Adverse effects of PO glucocorticoids
-When used acutely, does not cause significant adverse effects.
-Prolonged therapy can cause adrenal suppression, osteoporosis, hyperglycemia, immunosuppression, fluid retention, hypokalemia, peptic ulcer disease
Adverse effects of inhaled glucocorticoids
-Oropharyngeal candidiasis- gargle after use.
-Dysphonia hoarseness- gargle, rinse mouth after use.
Anti-inflammatory drugs: Leukotriene Modifiers
-Suppress effects of leukotrienes
-In asthma, leukotriene modifiers reduce bronchoconstriction and inflammatory responses such as edema and mucus secretion.
Leukotriene Modifier drugs
-Montelukast (Singulair)
-Zileuton (Zyflo)-PO
-Zafirlukast (Accolate)-PO
Adverse effects of leukotriene modifiers
-Neuropsychiatric effects, including depression, suicidal thinking, and suicidal behaviors. In children it can cause nightmares.
Anti-inflammatory drugs: Mast cell stabilizers
-Cromolyn
-Good for people with exercise induced asthma-taken 15 min before exercise.
-Used for prophylaxis, not for quick relief.
Cromolyn therapeutic uses
-Chronic asthma
-Exercise induced bronchospasm
-Allergic rhinitis
-Suppresses bronchial inflammation
Cromolyn administration routes
-Inhalation
-Nebulizer
-MDI
Cromolyn adverse effects
-Cough
-Bronchospasms
Bronchodilators: Beta2-Adrenergic agonists
-Most effective drugs for relief of acute bronchospasm and prevention of exercise induced bronchospasm.
-Use in asthma is quick relief and long term control.
Beta2-Adronergic Agonist mechanism of action
-Through activation of beta2 receptors in the smooth muscle of the lung, promote bronchodilation, relieving bronchospasm.
-Suppress histamine release in lung and increase ciliary motility.
Two types of Beta2-Adronergic agonist
-Short acting beta2- agonist (SABA)
-Long acting beta2 agonist (LABA)
SABA
-Use in asthma
-Inhaled taken PRN to stop an ongoing attack
-EIB: Taken before exercise to prevent an attack.
-Hospitalized patients undergoing a severe acute attack: nebulized SABA.
SABA
-Albuterol, proventil
-taken PRN, preventive
-
SABA adverse effects
-Tachycardia
-angina
-Tremor
LABA
-Acilidinium bromide/ Tudorza
-Salmetrol/ Serevent diskus
LABA
-Long term control, fixed doses, not PRN.
-Used for people with COPD.
Adverse effects of LABA
-May increase asthma, contraindicated in asthma alone
Adverse effects of oral beta2-adronergic agonist
-Angina pectoris
-Tachydysrhythmias
-Tremor
Bronchodilators: Methyxanthines
-Theophylline
-Benefits are mainly from bronchodilation.
-Narrow therapeutic index: plasma levels 10-20 mcg/mL
-Toxicity related to theophylline levels
Methyxanthines administration
-Given PO or IV.
-IV given for COPD in ICU response.
Glucocorticoid/LABA combinations
-Fluticasone/salmeterol (Advair)
-Budesonide/formoterol (Symbicort)
-Indicated for long-term maintenance in adults and children.
-May have black box warning, may effect asthma.
Anticholinergic drugs
-Work by blocking muscarinic receptors in the bronchi decreasing bronchoconstriction.
-For COPD
Anticholinergic drugs
-Ipratropium/Atrovent- derivative of atropine, muscarinic antagonist.
-Inhaled to relieve bronchospasms.
Adverse effects of anticholinergic drugs
-Dry mouth
-Sore pharynx
Four classes of chronic asthma
-Intermittent
-Mild persistent
-Moderate persistent
-Severe persistent
Treatment goals for chronic asthma
-Reduce impairment
-Reducing Risk
Drugs for acute severe exacerbation
-Airway is #1.
-Requires immediate attention
-Goal is to relieve airway obstruction and hypoxemia, normalize lung function as quickly as possible.
Initial therapy for acute severe exacerbation
-Oxygen to relieve hypoxemia
-Systemic glucocorticoids to reduce airway inflammation.
-Nebulized high dose SABA to relieve airflow obstruction.
Drugs for exercise induced asthma
-Starts either during or immediately after exercise, peaks in 5-10 min and resolves 20-30 min later.
Drugs for exercise induced asthma
-SABA or cromolyn administered prophylactically.
-Inhaled SABAs generally preferred over cromolyn
-Beta2 agonists should be inhaled immediately before exercise.
-Cromolyn should be inhaled 15 min before exercise.
