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Pharm III > E2: Asthma and COPD > Flashcards

E2: Asthma and COPD Flashcards

1
Q

What class of drugs are the most effective bronchodilators?

A

B2 agonists

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2
Q

Aside from being a B2 agonists, what are the other MOAs of the B2 agonist class? (4)

A

Activate adenylate cyclase
Increase cAMP
Relax smooth muscles
Stabilize mast cells

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3
Q

What is the first line tx for asthma?

A

Short acting beta agonists (SABA)

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4
Q

What are the SABAs? (2)

A

Albuterol

Levalbuterol

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5
Q

Why are SABAs used to stop an asthma attack in progress?

A

Fast-acting!

Last ~4-8 hours

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6
Q

How are SABAs/LABAs administered?

A

Inhaled

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7
Q

What are the long acting beta agonists? (3)

A

Salmeterol
Formoterol
Vilanterol

*Often combined w/ Fluticasone

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8
Q

How long does it take for LABAs to start working? How long do they last? How does this effect the way they are used?

A

Take 20-30 minutes to start working
Last for ~12 hours

***Therefore not used as a rescue inhaler! Used prophlyactically!

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9
Q

LABAs are very ______

A

bronchoselective

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10
Q

When txing a pt with asthma, you should combine always combine a LABA with a _____.

A

Corticosteroid

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11
Q

Name the 2 muscarinic antagonists.

A

Ipratroium (Atrovent)

Tiotropium (Spiriva)

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12
Q

What are muscarinic antagonists used to tx?

A

COPD/Emphysema

Can also use if pt is intolerant to B2 agonists

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13
Q

Are muscarinic antagonists absorbed systemically or do they remain locally? Why?

A

Local - NO SYSTEMIC ABSORPTION

-Quaternary ammonium causes meds to remain trapped in lungs

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14
Q

Which of the 2 muscarinic antagonists is longer acting?

A

Tiotropium (taken once daily)

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15
Q

What are the 2 MOAs of Theophylline?

A
  1. Block adenosine receptors (which cause bronchoconstriction)
  2. Increase cAMP (phosphodiesterase inhibitor)
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16
Q

What are the adverse effects of the B2 agonists (SABA/LABA)?

A

Tachycardia
Nervous/dizzy
Tremor

*Usually short lived effects

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17
Q

What does tolerance mean in regards to pts on B2 agonists? How can you prevent this?

A

Tolerance: down regulation of # of beta receptors

-Prevent with corticosteroids

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18
Q

What is Theophylline used to tx?

A

COPD/emphysema not controlled by B2 agonists or muscarinic antagonists
*But rarely used due to adverse effects!

19
Q

What are 2 important pharmacokinetic components of Theophylline?

A

LOW therapeutic index!

Do not switch patients between brands once patient has started

20
Q

Name 4 drugs that increase clearance of Theophylline.

A

Phenytoin
Smoking
Rifampin
Oral contraceptives

21
Q

Name 2 drugs that decrease clearance of Theophylline.

A

Cimetidine

Erythromycin

22
Q

What are 4 adverse effects of Theophylline? (One of them is kind of a benefit)

A

Nervousness, insomnia
Arrhythmias
Weak diuretic
Decreased diaphragm fatigue/increases contraction

23
Q

What is usually the cause of fatalities associated with a Theophylline overdose?

A

Arrhythmias

24
Q

Name the 3 Inhaled Corticosteroids.

A

Fluticasone
Beclomethasone
Flunisolide

25
Q

Why are corticosteroids helpful in the tx of asthma? (2)

A

Decrease inflammation

Improve response to B2 agonists (therefore may decrease the requirement for B2 agonists)

26
Q

In what instances are oral steroids used?

A

Severe cases of asthma

Asthma exacerbation

27
Q

Are inhaled corticosteroids absorbed systemically?

A

NO!

Only oral steroids are

28
Q

What are 3 adverse effects of inhaled corticosteroids? How can you help reduce these effects?

A

Oropharyngeal candidiasis (thrush)
Hoarseness
Modest decrease in bone density (women)

*Decrease effects with spacer

29
Q

Name the Leukotriene Inhibitor

A

Montelukast

30
Q

Leukotriene Inhibitors are used in conjunction with:

A

B2 agonists

31
Q

What are 2 benefits of Leukotriene Inhibitors (Montelukast)?

A

Decrease asthmatic response to exercise and cold air

Decrease need for corticosteroids

32
Q

What are the adverse effects of the Leukotriene Inhibitors? (6)

A 
HA
Abd pain
URI
Sore throat
Sleepiness
Psych issues
33
Q

What Leukotriene Inhibitor may decrease an asthmatic’s rxn to ASA and NSAIDs

A

Zileuton

34
Q

MOA of Omalizumab

A

Monoclonal Abs to IgE (prevents binding of IgE to mast cells and basophils)

35
Q

When is Omalizumab used?

A

Asthmatics with reactivity to allergens that are not controlled with steroids

36
Q

How/when is Omalizumab administered?

A

Sub Q injection every 3-4 weeks

37
Q

What is the primary adverse effect of Omalizumab?

A

Potential serious allergic rxn

38
Q

MOA of Benralizumab

A

Monoclonal Ab targeting IL-5

39
Q

When is Benralizumab used?

A

Severe asthma with eosinophilic phenotype

40
Q

MOA of Cromolyn Sodium

A

Inhibits release of histamine from mast cells

41
Q

When is Cromolyn Sodium used?

A

Primarily used in CHILDREN with asthma

42
Q

How often is Cromolyn Sodium used?

A

Several times a day, chronically, and prophylactically

43
Q

What is the primary adverse effect of Cromolyn Sodium?

A

Bad taste

Pharm III (7 decks)

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