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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
ICS- MOA
suppress inflammatory cytokines prevent epithelial destruction and airway remodeling block Eos recruiting
26
ICS- and beta agonists
inc response to beta agonists by inhibiting beta receptor downregulation
27
ICS- AE
normally well tolerated hoarseness, dysphonia, oral candidiasis high dose: glaucoma, skin thinning, dec bone density.
28
ICS- how to prevent AE
rinse, gargle, spit spacer vaporizer for high dose effects of dec Bone density - give Vit D and Ca supplements to post menopausal women
29
ICS- dosing
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
ICS- NTK
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
Systemic Corticosteroids as persistent med- use
dont want to use them due to AE | used for asthma refractory to ICS and LABA
32
what do u do if using systemic corticosteroids for more than 14 days
taper the dose to alternate day
33
systemic corticosteroids- AE
``` Growth retardation Cushing syndrome Glucose intolerance cataracts osteoporosis HTN myopathy imparied wond healing PUD mood distrubances avascular necrosis of the hip hypokalemia depression ```
34
Systemic corticosteroids as daily med- NTK
dont use, bad effects if using more than 14 days taper ONLY TIME THESE CAUSE GROWTH RETARDATION
35
LABA- drugs
Salmeterol Formoterol Normally in combo w/ ICS
36
LABA- use
DOC for addition to ICS
37
LABA- MOA
same as SABA but take longer | improve responsiveness to ICS
38
LABA- CI
CI in use w/o an ICS b/c of excessive B2 down regulation
39
LABA- AE
Tachyphylaxis
40
LABA-dosages (esp in combo)
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
LABA- NTK
DOC for adding to ICS CI if not added AE- tachyphylaxis from B2 downregulation cant inc by taking more sprays
42
Methylxanthies- drugs
Theophylline, Aminophylline
43
Methylxanthies- MOA
unknown PDE inhibitors --> inc cAMP antagonize adenosine
44
Methylxanthine- axn
mild bronchodilators
45
Methylxanthine- and adenosine
block anti arythmatic effect of adenosine
46
Methylxanthine- kinetics
They have a very narrow therapeutic dose non linear kinetics = small dose inc --> big inc in serum concentration= saturation kinetics MM kinetics
47
methylxanthines- uses
Add to ICS instead of LABA | mono tx in kids under 5
48
Metabolism
CYP450 3a4= drug interactions CYP450 inducers= phenytoin, phenobarbital, carbimazapine Inhibitors= Cimetidine, Ciprofloxacin, INH
49
Methylxanthine- elimination
quickest in younger pts smoking blackened food slower in older pts and hepatic dysfunction
50
methylxanthines and smoking
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
methylzanthines- AE
lower dose- N/V HA, insomnia, tremor, tachycardia and palplatations higher dose- hypoK, hyperG, seizure, hypoTN, arrythmia
52
Methylxanthins- NTK
``` 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
Leukotriene modifiers- drugs
Zafirlukast | Motelukast
54
LT mods- MOA
block receptor site for LT --> bronchodilation prevent chemotaxis of inflammatory cells esp eos prevent mucus secretion and airway edema
55
LT mods- use
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
Zafirlukast- AE, use
SEVERE HEPATOTOXICITY potentiates Warfarin, potentiated by ASA dec in erythromycin almost never used
57
Montelukast- AE and use
mild HA, FDA approv for allergic rhinitis ASA induced Asthma
58
LT mods- AE
depression, insomnia, anxiety
59
Omalizunab
anti IgE Ab | sub q
60
Omalizunab- MOA
binds free IgE in circulation and prevents it from binding to mast cells and basos- cant respond to allergens
61
Omalizunab- uses
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
Anti Asthmatics in pregnancy
ICS add LABA have SABA on hand acute exacerbation in preg= prednisone
63
Tx Ashthma goals
prevent airway remodeling (ICS) use inhaler less than 2x/ week normal asymptomatic activity and normal PFTs minimal chronic symptoms

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