Drugs for Asthma and COPD Flashcards
Anti-inflammatory drug classes (3)
Corticosteroids
Antibodies
Leukotriene receptor modifiers
Bronchodilators (3)
Beta-2 agonists
Anti-cholinergic drugs
Methylxanthines
Absorption/deposition of beta-2 agonists
10-20% is inhaled and enters the lungs —> systemic circulation
80-90% is swallowed and enters the GI tract —> liver —> first-pass metabolism and systemic circulation
What is unique about Terbutaline (SABA)?
It is the only b-2 drug available by subQ injection
Avoid Terbutaline in patients with…
A sulfa allergy
Metaproterenol (SABA) is used for…
Bronchial asthma and reversible bronchospasm.
Major warning associated with Metaproterenol (SABA)
Paradoxical bronchospasm
Use of Pirbuterol (SABA) is…
Prevention and reversal of bronchospasm.
Major warning associated with Pirbuterol (SABA) is…
Cardiovascular effects
Levalbuterol (SABA) is used for…
Treatment and prevention of bronchospasm
What warning is associated with Levalbuterol (SABA)?
Paradoxical bronchospasm
Fomoterol (LABA) is given for the…
Maintenance treatment of patients with asthma/COPD, along with an additional control agent.
Salmeterol (LABA) is given for…
Prevention of exercise-induced bronchospasm.
Indacaterol and Vilanterol (LABA) are given to which patients?
Patients with COPD.
Oldaterol (LABA) is given as a…
One-daily maintenance bronchodilator for airway obstruction in COPD patients.
All LABAs share the following 2 characteristics:
- Must be given as concomitant treatment with another med, like an ICS.
- Increase the risk of asthma-related deaths and hospitalizations.
What class of drug is Atropine?
Anti-cholinergic drugs
Aside from Atropine, what suffix is associated with anti-cholinergic drugs?
-ium
Ipratropium, Tiotropium, Aclidinium
Ipratropium is an anti-choinergic and is an analog of…
Atropine, but does not produce the same atropine-like effects because it is poorly absorbed.
Tiotropium is indicated for…
Long-term, once-daily treatment of bronchospasm in COPD.
Aclidinium is indicated for…
Long-term maintenance of bronchospasm in COPD
Examples of Methylxanthines include…
Theophylline
Theobromide
Caffeine
MOA of Theophylline…
- Inhibit PDE and slow cAMP degradation.
- Inhibit adenosine’s action of bronchoconstriction.
—> both lead to bronchodilation and suppression of response to airway stimuli.
What are the contraindications for Methylxanthines?
Acid-peptic Dz
Seizures
Arrhythmias
What is the most effective controllers and anti-inflammatory agents of Asthma?
Inhaled corticosteroids
What is the MOA of ICS?
- Switch off transcription of multiple genes encoding inflammatory proteins.
- Reduce levels of eosinophils, T-cells and mast cells in airway mucosa.
How often are ICS taken?
2x daily
What should be given as first-line therapy in patients with persistent asthma?
ICS
If symptoms are not controlled well with an ICS, what else could be added?
A LABA in addition to an ICS
What are the suffixes of ICSs?
- sone
- ide
The major caution of giving Beclomethasone is…
In patients who have been on systemically active corticosteroids prior, it can cause adrenal insufficiency and death.
Budesonide should not given during…
Should not be given in treatment of status asthmaticus or acute attacks.
Ciclesonide should not be given in….
The treatment of acute bronchospasm AND in patients with a Thrush infection.
Flunisolide might be able to….
Reduce or eliminate the need for OCS
Major side effect of Fluticasone is…
Thrush
Mometasone is contraindicated in patients with…
A known milk hypersensitivity
Triamcinolone is given to patients who need…
Systemic corticosteroid therapy
Triamcinolone does not relieve…
Deaths from…. have happened
Does not relieve acute bronchospasm.
Deaths from adrenal insufficiency has happened.
Major OCS used is…
Prednisone
Leukotriene antagonists are given for…
Treatment and prevention of acute asthma attacks
The MOA of Leukotriene antagonists is…
Block activation nd cascade from CysLT receptors
Montelukast inhibits…
It is given to…
Inhibits actions of LTD4 at the CysLT1 without agonist activity.
Given to prevents allergies and asthma attacks.
Zariflukast inhibits…
It’s major toxicity is…
Inhibits LTD4 and LTE4.
Hepatotoxicity.
Zileuton inhibits…
It should not be given to…
Inhibits LOX, therefore LTB4, LTC4, LTD4 and LTE4.
Not recommended in cases with active liver disease or elevated liver enzymes > 3x normal.
Omalizumab is of what drug class?
Monoclonal antibody drugs
Omalizumab MOA
- Binds to free IgE, thus decreasing cell-bound IgE.
- decrease expression of IgE receptors.
- Decreased mediator release.
- Decrease allergic inflammation AND prevents exacerbation.
Omalizumab is given for…
What must the patient have in addition?
Moderate to severe persistent asthma.
Patients must have a positive skin test or in vitro reactivity to perennial aeroallergen and SX are not adequately controlled otherwise.
Omalizumab, aside form asthma, can be used in the treatment of…
What is the major warning of its use?
Chronic idiopathic urticaria.
Anaphylaxis.
