Drugs for asthma and COPD

Question 1

what are the 2 goals of therapy for asthma?

Answer 1

1. terminate acute bronchospasms (Attacks)
2. reduce the frequency of attacks

Question 2

3 examples COPD conditions

Answer 2

-inflammation
-airway obstruction
-air trapping

Question 3

What are the 2 main therapeutic classes for asthma/COPD?

Answer 3

-anti-inflammatory agents
-bronchodilators

Question 4

What is the principle pharmacological anti-inflammatory drug?

Answer 4

Glucoorticoids

Question 5

What type of schedule is glucocorticoids on?

Answer 5

fixed schedule only

Question 6

What is the principle pharmacological bronchodilators?

Answer 6

Beta 2 agonists

Question 7

What type of schedule are beta 2 agonists on?

Answer 7

fixed schedule or PRN

Question 8

What must beta 2 agonists be used with?

Answer 8

glucocorticoids

Question 9

What are 3 advantages to using the inhalation route?

Answer 9

• therapeutic effects are enhanced
  -systmeic effects are minimized
  -relief of acute attacks is rapid

Question 10

What are 4 types of inhalation devices that are used?

Answer 10

-Respimats- delivers drug via a fine mist/very small particles ensures greater delivery to lungs
-Metered-dose inhalers (MDIs)- pressurized device. Have spacers
-dry-powder inhalers (DPI)- delivers drug in powder
-nebulizers- converts solution into a mist

Question 11

What is the prototype for inhaled glucocorticoids?

Answer 11

Beclomethasone

Question 12

what are the MOAs of beclomethasone?

Answer 12

-inhibits production & release of leukotrienes, prostaglandins, and histamine
-increases number of bronchial beta-2 receptors & sensitivity to beta-2 agonsists.
-decreases edema of the airway mucosa by decreasing vascular permeability
-decreases production of mucus.
-reduces migration & activity of inflammatory cells

Question 13

Indication for us of inhaled glucocorticoids?

Answer 13

prophylaxis of chronic persistent asthma

Question 14

How long should you administer a beta 2 agonist before using an inhaled glucocorticoid?

Answer 14

5-10 min prior to increase dispersion of the drug

Question 15

adrs for inhaled glucocorticoids?

Answer 15

• oropharyneal candidiasis/dysphonia
  -temporarily delays growth in children
  -promotion of bone loss with long-term use
  -minimal adrenal suppression with LT & high-doses

Question 16

What is the PO/IV prototypes for glucocorticoids?

Answer 16

PO: prednisone
IV:Dexamethasone

Question 17

What are the indications of use for PO/IV glucocorticoids?

Answer 17

-moderate-severe persistant asthma
-acute excerbations of COPD or asthma

Question 18

Why would you take PO/IV glucocorticoids?

Answer 18

reserved for those unresponsive to other therapies

Question 19

what happens when you use PO/IV glucocorticoids longer than 10 days?

Answer 19

toxicity increases with duration of use

Question 20

ADRs for PO/IV glucocorticoids?

Answer 20

-adrenal suppression
-hyperglycemia
-osteoporosis
-Peptic ulcer disease (PUD)
-Growth suppression in the young population

Question 21

What should you do to the dose of IV/PO glucocorticoids during times of stress?

Answer 21

Increase dose!
3x3x3 rule

Question 22

MOA of zileuton?

Answer 22

-Blocks leukotriene synthesis by inhibiting the enzyme 5- lipooxygenase

Question 23

ADR of zileuton?

Answer 23

Hepatotoxic
(monitor ALT monthly X3 months, then every 3 months for remainder of first year)

Question 24

MOA of montelukast?

Answer 24

Blocks leukotriene receptors
-has high affinity to leukotriene airways receptors and pro inflammatory cells

Question 25

What are the therapeutic effects of leukotriene modifiers?

Answer 25

-Reduce bronchoconstriction
-reduce vascular permeability
-reduce mucus secretions

Question 26

ADRs for both leukotriene modifiers?

Answer 26

• Neuropsychiatric effects
  -depression/anxiety-hallucinations
  -insomnia/restlessness- suicidal ideations

Question 27

Churg-strauss syndrome is an adr to what leukotriene modifier?

Answer 27

Montelukast

Question 28

Churg-strauss syndrome is characterized by :

Answer 28

• weight loss
  -pulmonary vasculitis
• flu-like symptoms

Question 29

What is the prototype for mast cell stabilizers?

Answer 29

cromolyn sodium

Question 30

Is cromolyn sodium a bronchodilator?

Answer 30

No, it suppresses inflammation administered via nebulizer.

Question 31

What are the indications for use for cromolyn sodium?

Answer 31

-prophylaxis in treating mild persistent chronic asthma
- prevention of bronchospasm induced by exercise
-prevents symptoms R/T seasonal attacks & known allergen exposure

Question 32

When should cromolyn sodium be administered?

Answer 32

prior to onset of attack or drug will have no beneficial effects

Question 33

MOA of mast cell stabilizers?

Answer 33

• stabilizes the cytoplasmic membrance of mast cells
  -prevents ruptures of mast cell after exposure by an antigen
  -blocks a calcium channel essential for mast cell de-granulation & thereby prevents the release of histamine and related mediators.

Question 34

How is omalizumab administered?

Answer 34

SQ

Question 35

Another name for “igE antagonsist”

Answer 35

omalizumab

Question 36

What is omalizumab used for?

Answer 36

-Indicated only for allergy-related asthma
- reserved for individuals unresponsive to inhaled glucocorticoids

Question 37

MOA of omalizumab?

Answer 37

Forms complexes with igE in the blood and reduces amount available to bind with receptors on the mast cell

Question 38

ADRs of omalizumab?

Answer 38

-upper respiratory viral infections
-sinusitis
-pharyngitis
-anaphylaxis