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CPR II Exam 2 > Drugs for Asthma and COPD > Flashcards

Drugs for Asthma and COPD Flashcards

1
Q

What are the anti-inflammatory drugs used for asthma

A
  1. hormone containing: corticosteriods
  2. non-hormone containing leukotriene receptor modifiers
  3. antibodies
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2
Q

What are the bronchodilator drugs used for asthma?

A
  1. b2-agonists (SABA/LABA)
  2. anticholinergic drugs
  3. methylxanthines
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3
Q

What are the b2 agonists SABA drugs most widely used in asthma/COPD tx? (4)

A

albuterol, terbutaline, metaproterenol, pirbuterol

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4
Q

albuterol

  • indications
  • adverse effects
  • contraindications
A

SABA

  • asthma, acute bronchitis, COPD
  • headache, dizziness, insomnia, dry mouth, cough
  • paradoxical bronchospasm, deterioration of asthma, CV effects
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5
Q

terbutaline

  • indications
  • adverse effects
  • contraindications
A

SABA, only b2*
NOTE: only b2 drug available by subQ injection, NOTE RECOMMENDED IN PT WITH SULFUR ALLERGY
- tx of prophylaxis of bronchospasm associated with asthma, bronchitis, emphysema
- not recommended as med for tocolysis
- headache, nausea, tachycardia, palpitations

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6
Q

metaproterenol

  • indications
  • adverse effects
A

SABA

  • bronchodilator for BRONCHIAL ASTHMA and REVERSIBLE BRONCHOSPASM
  • can produce paradoxical bronchospasm
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7
Q

pirbuterol

  • indications
  • indications
  • adverse effects
A

SABA

  • prevention and reversal of bronchospasm
  • can produce clinically significant CV effect (pulse rate, BP)
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8
Q

What are the b2-agonist LABA drugs used to treat asthma? (5)

A

fomoterol, salmeterol, indacaterol/vilanterol, olodaterol

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9
Q

fomoterol

  • indications
  • contraindications
A

LABA

  • asthma in patients older than 5 (add on to long term meds**), maintenance treatment of bronchoconstriction in COPD
  • increases the risk of asthma-related deaths and asthma-related hospitalizations
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10
Q

salmeterol

- indications

A

LABA

- pt >4 years, prevention of exercise-induced bronchospasm (EIB), maintenance tx of bronchospasm

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11
Q

indacaterol/vilanterol

A

LABA

- used in long-term, once-daily maintenance of bronchodilator treatment of airflow obstruction

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12
Q

olodaterol

A

LABA

- used in long-term, once daily maintenance bronchodilator treatment of airflow obstruction

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13
Q

What is the action of anticholinergic drugs?

A

they block ACh, inhibiting parasympathetic nerve impulses

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14
Q

What are the anti-muscarinic agents most widely used in asthma/COPD? (4)

A

atropine, ipratropium, tiotropium, aclidinium

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15
Q

atropine

  • indications
  • cautions/warnings
A
  • indicated for temporary blockage of severe or life threatening muscarinic effects
  • when recurrent use of essential in patients with coronary artery dz, total dose should be restricted to 2-3mg to avoid detrimental effects of atropine-induced tachycardia of myocardial oxygen demand
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16
Q

ipratropium

A

used as bronchodilator for maintenance treatment of bronchospasm
- poorly absorbed after aerosol administration -> relatively free of systemic atropine-like effects

17
Q

tiotropium

A

indicated for the long-term, once-daily maintenance treatment of bronchospasm

18
Q

aclidinium

A

indicated for long-term maintenance treatment of bronchospasm associated with COPD

19
Q

What are the methylxanthines listed? (3)

A

theophylline, theobromine, caffeine

20
Q

What are the two distinct actions of theophylline in the airways of patients with reversible obstruction?

A
  1. smooth muscle relaxation

2. suppression of the response of the airways to stimuli

21
Q

What are the extreme cautions listed for theophylline?

A

active peptic ulcer disease, seizure disorders, cardiac arrhythmias
- due to increased risk of exacerbation

22
Q

What are the most effective anti-inflammatory asthma controllers?

A

inhaled corticosteroids (ICS)

  • they reduce eosinophils and sputum (several effects on the inflammatory process)
  • they switch off the transcription of multiple activated genes that encode inflammatory proteins
23
Q

What does a withdrawal of ICS result in?

A

slow deterioration of asthma control, indicating that they suppress inflammation and symptoms, but do not cure the underlying condition

24
Q

What are the inhaled corticosteroids used to treat asthma? (7)

A

beclomethasone, budesonide, ciclesonide, flunisolide, fluticasone, mometasone, triamcinolone

25
Q

beclomethasone

  • indications
  • cautions
A
  • prescribed as maintenance treatment for asthma and as prophylactic therapy in pt >5 years
  • death due to adrenal insufficiency has occured in asthmatic patients during and after transfer from systemic corticosteroids to less systemically available inhaled corticosteroids
    NOTE: after withdrawal from systemic corticosteroids, a number of months are required for recovery of HPA function
26
Q

budesonide

  • indications
  • cautions
A
  • maintenance treatment of asthma as prophylactic therapy
  • should NOT be used with primary treatment of status asthmaticus or other acute episodes of asthma
  • also contraindicated in people with hypersensitivity to milk proteins
27
Q

ciclesonide

  • indications
  • cautions
A
  • maintenance treatment of asthma as prophylactic therapy in adults >12 years old
  • NOT indicated in releif of acute bronchospasm. use also not recommended in presence of candida albicans infection
28
Q

flunisolide

  • indications
  • cautions
A
  • maintenance and treatment of asthma as prophylactic therapy in patients >6 years
  • contraindicated in patients for primary treatment of status asthmaticus
    NOTE: flunisolide may reduce or eliminate the need for oral corticosteroids
29
Q

mometasone

  • indications
  • cautions
A
  • maintenance treatment of asthma as prophylactic therapy

- contraindicated in patients with a known hypersensitivity to milk proteins

30
Q

triamcinolone

  • indications
  • cautions
A
  • maintenance treatment of asthma as prophylactic therapy, also patients who require systemic corticosteroid administration
    NOTE: not indicated for the relief of acute bronchospasm
  • contraindicated in primary treatment of status asthmaticus or other acute episodes where intensive measure are required. deaths due to adrenal insufficiency have occured
31
Q

prednisone

  • indications
  • cautions
A
  • anti-inflammatory or immunosuppressive agent, used for treatment of certain endocrine conditions
  • may lead to HPA axis suppression
32
Q

What are the leukotriene antagonists listed?

A

montelukast, zafirlukast

33
Q

What are leukotriene antagonists used for?

A

treatment and prevention of acute asthmatic attacks
- they bind to CysLT receptors and block their activation and the subsequent inflammatory cascade commonly associated with asthma and allergic rhinitis

34
Q

montelukast

leukotriene antagonists

A
  • treats allergies and prevents asthma attacks, by inhibiting actions of LTD4 at the CysT1 receptor without any agonist activity
  • NOT indicated for use in the reversal of bronchospasm in acute asthma attacks
35
Q

zafirlukast

  • indications
  • cautions
A

selective and competitive receptor antagonist of LTD4 and LTE4, components of slow reacting substance of anaphylaxis (SRSA)

  • prophylaxis and chronic treatment of asthma
  • hepatotoxicity -> cases of life-threatening hepatic failure have been reported
36
Q

Zileuton

A

5-lipoxygenase inhibitor, inhibits LTB4, LTC4, LTD4, LTE4- used as prophylaxis and chronic treatment of asthma
- NOT recommended in cases where active liver disease or persistent hepatic fuction enzymes are >3 times upper limit of normal

NOTE: immediate-release tablets were withdrawn from US market in 2008

37
Q

omalizumab

- indications

A

anti-IgE antibody

  • moderate to severe persistent asthma in patients >6 years, also for treatment of chronic idiopathic urticaria in adults >12, who remain symptomatic despite H1 antihistamine treatment
  • anyphylaxis!! administer only in healthcare setting because reaction can be life-threatening. observe patients for an appropriate period of time after administration

CPR II Exam 2 (5 decks)

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