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Pharm main > Drugs for Obstructive Lung Dz > Flashcards

Drugs for Obstructive Lung Dz Flashcards

1
Q

SABA

A

Albuterol- DOC
pirbuterol
terbutaline
Levobuterol

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2
Q

SABA- MOA

A

stim Beta 2 of bronchial tree –> inc cAMP/ decrease intracellular Ca –> relax SM

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3
Q

SABA- physiologic effects

A

bronchodilation
inc mucocilliary clearance
dec immune mediators

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4
Q

SABA- use

A

all asthma pts should have as a recue inhaler
Asthma- PRN during an attack, before exposure to trigger
COPD- part of initial tx as a scheduled drug

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5
Q

SABA- AE

A

tachycardia, anxiety
prolonged QT interval
tremor, hypoK, hypoglycemia

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6
Q

SABA- route of admin and AE

A

injected > oral > inhaled

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7
Q

SABA- mortality AE

A

causes down reg of Beta 2 in response to overstimulation –> inc mortality

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8
Q

Anticholinergic drugs

A

Ipratropium Bromide, Tiatropium

Atropine

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9
Q

Anticholinergics- MOA

A

competitive antagonist for Gq linked Ach receptor –> dec cytoplasmic Ca –> dec vagal tone and cause brochodilation

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10
Q

SABA need to know

A

beta agonist –> bronchodilation
(asthma): DOC- recue inhaler (PRN during attack), pre exposure
(COPD):initial tx, scheduled med
AE: tachycardia, anxiety
risk: inc mortality b/c of down- regulation of beta 2 receptors from overstimulation

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11
Q

Anticholinergic axn

A

Bronchodilation, dec vagal tone

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12
Q

Anticholinergics use

A

COPD- DOC as scheduled med
Asthma- add to Beta 2 agonist and steroid in status asthmaticus
emotionally triggered asthma if cant tolerate SABA

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13
Q

Iptratropium bromide and tiatroium

A

quaternary anticholinergics= less systemic absorption and NO CNS penetration= no systemic effects
15 min onset

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14
Q

Atropine

A

tertiary anticholinergic can cause- blurred vision, tachy, and urinary retention

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15
Q

Anticholinergics-shouldnt be sprayed where

A

IN THE EYES

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16
Q

Anticholinergics need to know

A 
block Ach binding --> bronchodilation
COPD- DOC as scheduled med
status asthmaticus (3rd drug)
emotionally triggered asthma (if cant tol SABA)
quaternary- no systemic AE
Atropine- does have systemic AE
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17
Q

Systemic Corticosteroids- drugs

A

Prednisone
Methylprednisone
hydrocortisone
prednisolone- pediatrics

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18
Q

Systemic corticosteroids- MOA

A

inhibit NfKb –> stop the inflammation

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19
Q

Systemic corticosteroids- uses

A

Exacacerbations that are not responsive to SABA = bust therapy= non tapered 3-10 days with 2 asymptomatic nights and FEV1 at 80% of the max

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20
Q

Systemic Corticosteroids- burst therapy and growth

A

doesn’t effect growth

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21
Q

Systemic corticosteroids- NTK

A

most effective
inhibit NfKb –> stop inflammation
used in Burst therapy
dont inhibit growth

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22
Q

Daily meds for pts with persistant asthma

A

ICS- DOC for all persistent asthma pts

Systemic corticosteroids- dont want to use these

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23
Q

ICS- drugs

A 
fluticosone
budenoside
beclamethasone
flunisolide
triamcinolone
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24
Q

ICS- use, advantages

A

daily med for pts with persistent asthma

advantages- dec asthma related deaths and stop remodeling

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25
Q

ICS- MOA

A

suppress inflammatory cytokines
prevent epithelial destruction and airway remodeling
block Eos recruiting

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26
Q

ICS- and beta agonists

A

inc response to beta agonists by inhibiting beta receptor downregulation

27
Q

ICS- AE

A

normally well tolerated
hoarseness, dysphonia, oral candidiasis
high dose: glaucoma, skin thinning, dec bone density.

28
Q

ICS- how to prevent AE

A

rinse, gargle, spit
spacer
vaporizer
for high dose effects of dec Bone density - give Vit D and Ca supplements to post menopausal women

29
Q

ICS- dosing

A

goal is to tx with stronger meds at less frequent intervals b/c better compliance
have steep dose response curve so as inc the dose may inc AE more than benefit
Fluticasone is strongest > budenoside > beclamethasone > flunisolide> triamcinolone

30
Q

ICS- NTK

A

DOC as daily med in persistant asthma
suppress inflammatory cytokines and prevent epithelial destruction
AE of hoarseness, dysphonia, and oral candidiasis can be prevented with rinse/ gargle
DON’t stunt growth
work synergistically with SABA

31
Q

Systemic Corticosteroids as persistent med- use

A

dont want to use them due to AE

used for asthma refractory to ICS and LABA

32
Q

what do u do if using systemic corticosteroids for more than 14 days

A

taper the dose to alternate day

33
Q

systemic corticosteroids- AE

A 
Growth retardation
Cushing syndrome
Glucose intolerance
cataracts
osteoporosis
HTN
myopathy
imparied wond healing
PUD
mood distrubances
avascular necrosis of the hip
hypokalemia
depression
34
Q

Systemic corticosteroids as daily med- NTK

A

dont use, bad effects
if using more than 14 days taper
ONLY TIME THESE CAUSE GROWTH RETARDATION

35
Q

LABA- drugs

A

Salmeterol
Formoterol
Normally in combo w/ ICS

36
Q

LABA- use

A

DOC for addition to ICS

37
Q

LABA- MOA

A

same as SABA but take longer

improve responsiveness to ICS

38
Q

LABA- CI

A

CI in use w/o an ICS b/c of excessive B2 down regulation

39
Q

LABA- AE

A

Tachyphylaxis

40
Q

LABA-dosages (esp in combo)

A

if on combo med and change the dose this only inc the dose of ICS, not LABA
PTS CANNOT INC DOSE BY DOUBLING UP ON SPRAYS B/C ALREADY MAXED OUT ON LABA

41
Q

LABA- NTK

A

DOC for adding to ICS
CI if not added
AE- tachyphylaxis from B2 downregulation
cant inc by taking more sprays

42
Q

Methylxanthies- drugs

A

Theophylline, Aminophylline

43
Q

Methylxanthies- MOA

A

unknown
PDE inhibitors –> inc cAMP
antagonize adenosine

44
Q

Methylxanthine- axn

A

mild bronchodilators

45
Q

Methylxanthine- and adenosine

A

block anti arythmatic effect of adenosine

46
Q

Methylxanthine- kinetics

A

They have a very narrow therapeutic dose
non linear kinetics = small dose inc –> big inc in serum concentration= saturation kinetics
MM kinetics

47
Q

methylxanthines- uses

A

Add to ICS instead of LABA

mono tx in kids under 5

48
Q

Metabolism

A

CYP450 3a4= drug interactions
CYP450 inducers= phenytoin, phenobarbital, carbimazapine
Inhibitors= Cimetidine, Ciprofloxacin, INH

49
Q

Methylxanthine- elimination

A

quickest in younger pts
smoking
blackened food
slower in older pts and hepatic dysfunction

50
Q

methylxanthines and smoking

A

smoking inc rate of metabolism so pt require a higher dose.
IF pts are going to stop smoking need to tell the doc so can dec dose.
drug reacts with the PCAs in the cig not the nicotine

51
Q

methylzanthines- AE

A

lower dose- N/V HA, insomnia, tremor, tachycardia and palplatations
higher dose- hypoK, hyperG, seizure, hypoTN, arrythmia

52
Q

Methylxanthins- NTK

A 
have narrow therapeutic index- MM kinetics
smoking (PCAs) inc rate of metabolism
met slower by hepatic dysfunction
can use instead of LABA to add to ICS
can use as monto tx in pts under 5
53
Q

Leukotriene modifiers- drugs

A

Zafirlukast

Motelukast

54
Q

LT mods- MOA

A

block receptor site for LT –> bronchodilation
prevent chemotaxis of inflammatory cells esp eos
prevent mucus secretion and airway edema

55
Q

LT mods- use

A

asthma- not everyone responds to this but if pt does very good
if pt can handle LABA use this PO
second line addn to ICS instead of LABA
Comorbid rhinitis, exercise induces asthma and ASA/NSAID induced asthma

56
Q

Zafirlukast- AE, use

A

SEVERE HEPATOTOXICITY
potentiates Warfarin, potentiated by ASA dec in erythromycin
almost never used

57
Q

Montelukast- AE and use

A

mild HA,
FDA approv for allergic rhinitis
ASA induced Asthma

58
Q

LT mods- AE

A

depression, insomnia, anxiety

59
Q

Omalizunab

A

anti IgE Ab

sub q

60
Q

Omalizunab- MOA

A

binds free IgE in circulation and prevents it from binding to mast cells and basos- cant respond to allergens

61
Q

Omalizunab- uses

A

asthma in pts >12 y/o with testing verified allergen and Th2 rxn.
must be in facility w/ EPI b/c anaphylaxis can happen

62
Q

Anti Asthmatics in pregnancy

A

ICS add LABA
have SABA on hand
acute exacerbation in preg= prednisone

63
Q

Tx Ashthma goals

A

prevent airway remodeling (ICS)
use inhaler less than 2x/ week
normal asymptomatic activity and normal PFTs
minimal chronic symptoms

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