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Respiratory Medicine Exam I > Drugs Used in COPD and Asthma > Flashcards

Drugs Used in COPD and Asthma Flashcards

1
Q

List 6 short-acting beta agonist bronchodilators

A 
Albuterol
Levalbuterol
Metaproterenol
Pirbuterol
Epinephrine
Terbutaline
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2
Q

Short-acting antimuscarinic bronchodilator

A

Ipratropium

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3
Q

Combination short-acting bronchodilator

A

Albuterol/ipratropium

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4
Q

List 4 Long-acting beta-adrenergic bronchodilators

A

Formoterol
Indacaterol
Olodaterol
Salmeterol

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5
Q

2 long acting antimuscarinic bronchodilators

A

Aclidinium

Tiotropium

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6
Q

What are 7 aerosol corticosteroids used in tx of asthma?

A 
Beclomethasone
Mometasone
Fluticasone
Triamcinolone
Budesonide
Ciclesonide
Flunisolide
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7
Q

3 examples of combination LABA+Corticosteroid inhalers used in asthma

A

Formoterol/budesonide
Formoterol/mometasone
Salmeterol/fluticasone

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8
Q

Leukotriene inhibitors used in tx of asthma

A

Montelukast
Zafirlukast
Zileuton

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9
Q

Methylxanthines used in tx of asthma

A

Dyphylline

Theophylline

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10
Q

Monoclonal Ab used in tx of asthma

A

Omalizumab

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11
Q

MOA, effects, and clinical applications of Albuterol

A

MOA: selective beta2 agonist

Effects: prompt, efficacious bronchodilation

Clinical applications: asthma, COPD

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12
Q

Drug of choice in acute asthmatic bronchospasm

A

Albuterol

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13
Q

Pharmacokinetics and toxicities of albuterol

A

Aerosol inhalation; duration several hours, also available via nebulizer and parenteral use

Toxicity: tremor, tachycardia; overdose causes arrhythmia

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14
Q

Albuterol has similar MOA, effects, clinical applications, pharmacokinetics, and toxicities to what other beta agonists?

A

Metaproterenol

Terbutaline (although terbutaline is available as an oral drug)

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15
Q

MOA, effects, and clinical applications of salmeterol

A

MOA: Selective beta2 agonist

Effects: slow onset, primarily preventative action; potentiates corticosteroid effects

Clinical applications: bronchodilation, prevention of asthma exacerbation

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16
Q

Pharmacokinetics and toxicities associated with salmeterol

A

Aerosol inhalation; duration 12-24 hrs (high lipid solubility allows longer MOA)

Toxicity: tremor, tachycardia; overdose leads to arrhythmias

17
Q

Salmeterol has similar MOA, effects, clinical applications, pharmacokinetics, and toxicities to what other beta agonist?

A

Formoterol

18
Q

Nonselective alpha and beta agonist that causes bronchodilation + all other sympathomimetic effects on CV and other organ systems; used in anaphylaxis and sometimes for asthma (although rarely)

A

Epinephrine

19
Q

MOA, effects, and clinical applications of isoproterenol

A

MOA: B1 and B2 agonist (available as aerosol, nebulizer, or parenteral)

Effects: bronchodilation + powerful CV effects

Clinical use: asthma (but beta 2 selective agents are preferred)

20
Q

MOA, effects, and clinical applications of fluticasone

A

MOA: alters gene expression (corticosteroid)

Effects: reduces mediators of inflammation; powerful prophylaxis of exacerbations

Clinical use: asthma; adjunct in COPD, hay fever (nasal)

21
Q

Pharmacokinetics and toxicities associated with fluticasone

A

Aerosol; duration several hours

Toxicity: oropharyngeal candidiasis, vocal cord changes (limited by aerosol application)

22
Q

Fluticasone has similar MOA, effects, clinical applications, pharmacokinetics, and toxicities to what other agents?

A

Beclomethasone
Budesonide
Flunisolide
Others…

23
Q

It’s not in the DSA or lecture, but just in case: MOA, effects, clinical use, pharmacokinetics, and toxicities associated with cromolyn

A

MOA: alter function of delayed Cl- channels; inhibit inflammatory cell activation

Effect: prevention of bronchospastic response to allergen inhalation

Clinical use: asthma (other routes used for ocular, nasal, and GI allergy) [largely replaced now with inhaled bronchodilators and leukotriene inhibitors]

Pharmacokinetics: aerosol; duration 6-8 hrs

Toxicity: cough

24
Q

MOA, effects, and clinical use of theophylline

A

MOA: unknown; PDE inhibition, adenosine receptor antagonist

Effects: bronchodilation, cardiac stim, increased skeletal muscle strength (diaphragm)

Clinical uses: mild to severe persistent asthma, chronic asthma, COPD,

25
Q

Pharmacokinetics and toxicities associated with theophylline

A

Oral administration; duration 8-12 hrs but ER preparations often used; metabolized by CYP450 enzymes

Toxicity: nausea, vomiting, tremor, arrhythmias [very high doses can lead to medullary stimulation, convulsions, and death]

26
Q

Drug similar to theophylline but with better therapeutic ratio

A

Roflumilast (FYI — not mentioned in DSA)

27
Q

MOA, effects, and clinical use of montelukast and zafirlukast

A

MOA: block leukotriene D4 receptors (via CysLT1 receptors)

Effects: block airway response to exercise and antigen challenge

Clinical uses: prophylaxis of asthma, especially in children and ASA-induced asthma

28
Q

T/F: montelukast and zafirlukast are orally administered, last several hours, and have minimal toxicities associated with them

A

True

29
Q

MOA and main toxicity of zileuton

A

Inhibits lipoxygenase —> reduces synthesis of leukotrienes

Risk of hepatotoxicity

30
Q

MOA, effects, and clinical use of Omalizumab

A

MOA: humanized IgE antibody reduces circulating IgE

Effects: reduces frequency of asthma exacerbations

Clinical uses: severe asthma that is inadequately controlled by other agents

31
Q

Pharmacokinetics and toxicities associated with omalizumab

A

Parenteral; duration 2-4 weeks

Toxicity: injection site reactions (anaphylaxis extremely rare)

32
Q

T/F: LABAs like salmeterol and formoterol are given as daily control inhalers, and are ALWAYS combined with an inhaled corticosteroid

A

True

33
Q

General “step-up” protocol in asthma tx

A
  1. SABA prn
  2. Add low dose corticosteroid inhaler (alternative: Cromolyn, LTRA, or theophylline)
  3. Low dose corticosteroid inhaler+LABA or Medium dose corticosteroid inhaler (alt: add LTRA, thoephylline, or zileuton)
  4. Medium dose corticosteroid inhaler + LABA (alt: medium dose corticosteroid + either LTRA, thoephylline, or zileuton)
  5. High-dose corticosteroid + LABA and consider omalizumab for pts with allergies
  6. High-dose corticosteroid + LABA + oral systemic corticosteroid, and conisder omalizumab for pts with allergies

Respiratory Medicine Exam I (9 decks)

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