Exam 4 - Drugs For Asthma Flashcards
What is asthma?
Chronic inflammatory disorder of the airway
Characteristic signs and symptoms of asthma flare ups
Sense of breathlessness
Tightening of the chest
Wheezing
Dyspnea
Cough
Cause of asthma
Immune-mediated airway inflammation
What two things contribute to asthma symptoms?
Inflammation
Bronchoconstriction
Symptoms of COPD flare up
Airflow restriction
Inflammation
Cough
Excessive sputum production
Wheezing
Dyspnea
What is COPD a combination of?
Chronic bronchitis
Emphysema
What is chronic bronchitis?
Chronic cough and excessive sputum
Hypertrophy of mucous secreting glands of the epithelium of airways
What is emphysema?
Enlarged air spaces in bronchioles and alveoli
Common cause of COPD
Smoking cigarettes
*Two main pharmacologic classes of asthma drugs
*Anti-inflammatory agents
*Bronchodilators
What are the three classes of anti-inflammatory agents?
Glucocorticoids (prednisone)
Leukotriene Modifiers (Zafirlukast)
Mast cell stabilizers (Cromolyn)
What are the three classes of Bronchodilators?
Beta2 agonists (albuterol)
Methylxanthines (Theophylline)
Anticholinergics (Atrovent)
Three advantages of inhalation drug therapy
Therapeutic effects are enhanced
Systemic effects are minimized
Relief of acute attacks is rapid
Three types of inhalation drug therapy
Metered-dose inhalers (MDIs)
Dry-powder inhalers (DPIs)
Nebulizers
Patient teaching for inhalers
- Need to wait at least one minute between inhales of medication, especially when using more than one type of inhaler medication
- May have bad taste in mouth
- Need to rinse mouth or gargle after use to prevent infection in mouth
Which type of asthma drugs are taken daily for long-term control?
Anti-inflammatory drugs
Most effective anti-asthma drugs available
Glucocorticoids
Examples of glucocorticoid medication
Budesonide (Pulmicort)
Fluticasone (Flovent)
Prednisone
Functions of glucocorticoids
- Reduce bronchial hyperreactivity
- Decrease airway mucus production
- Increase number of bronchial beta2 receptors as well as their responsiveness to beta2 agonists
How are glucocorticoids administered?
Usually by inhalation
IV for acute conditions
Oral for chronic long-term use
Dosing must be on a fixed schedule, not PRN
How do glucocorticoids suppress inflammation?
- Decrease synthesis/production & release of inflammatory mediators
- Decrease infiltration & activity of inflammatory cells
- Decrease edema of the airway mucosa
Use for Glucocorticoids
Prophylaxis of chronic asthma & managing COPD
Which type of administration of glucocorticoids is safest?
Inhaled
When are inhaled glucocorticoids used?
As first line treatment for patients with persistent asthma
Should use them daily to manage
When should oral glucocorticoids be used?
In patients with moderate to severe asthma or management of acute exacerbations of asthma or COPD
Used only when symptoms cannot be controlled with safer inhaled medications
Why are oral glucocorticoids more dangerous?
Adverse effects are minor when taken acutely, but can be severe when used long term
Adverse effects of PO form of glucocorticoids from long-term use
Adrenal suppression
Osteoporosis
Hyperglycemia
PUD
Adverse effects of inhaled glucocorticoids
Oropharyngeal candidiasis
Dysphagia hoarseness
(Both can be avoided if gargle/rinse mouth after use)
In children/adolescents: can slow growth
Promotion of bone loss
Increased risk of cataracts
Increased risk of glaucoma
Function of leukotriene modifiers
Suppress effects of leukotrienes to prevent process of bronchoconstriction from happening
Also help with inflammation but are less effective than glucocorticoids
*Most commonly used leukotriene modifier
*Montelukast (Singulair)
Other available leukotriene modifiers
Zileuton (Zyflo) - PO
Zafirlukast (Accolate) - PO
*Adverse effects of all Leukotriene Modifiers
Neuropsychiatric effects:
- Depression
- Suicidal thinking
- Suicidal behavior
Prototype for Mast Cell Stabilizer drugs
Cromolyn
Uses of Cromolyn
Chronic asthma
Exercise-induced bronchospasm (EIB)
Allergic rhinitis
What does Cromolyn do?
*Suppresses bronchial inflammation
(Not a bronchodilator)
Routes for Cromolyn
Inhalation
Nebulizer
MDI
Adverse effects of Cromolyn
Cough
Bronchospasm
Safest anti-inflammatory asthma medication
Cromolyn
*Function of bronchodilators
Provide symptomatic relief, but do not alter the underlying disease process (inflammation)
What should patient’s using bronchodilators also be taking?
A glucocorticoid for long-term suppression of inflammation
Most effective type of bronchodilators
Beta2-adrenergic agonists
Classes of bronchodilator medications
Beta2 adrenergic agonists
Monoclonal antibodies (new and expensive)
Methylxanthines
Anticholinergics
Types of beta2-adrenergic agonists
Albuterol
Salmeterol
Terbutaline
Use of beta2-Adrenergic agonists bronchodilators
Most effective drugs for relief of acute bronchospasm and prevention of exercise induced bronchospasm
Used for quick relief and long-term control of asthma
Mechanism of action of beta2-adrenergic agonists
Through activation of beta2 receptors in the smooth muscle of the lung
Which promotes *bronchodilation, relieving bronchospasm
There are short acting and long acting beta2 agonists. What are each of them used for?
SABAs (short term) = prn for attack
LABAs (long term) = long term control
Examples of SABAs
Albuterol
Proventil
What are SABAs used for?
Taken prn
Preventive
(Mainly asthma pts)
Adverse effects of SABAs
Tachycardia
Angina
Tremor
Examples of LABAs
Acilidinium bromide (Tudorza)
Salmeterol/Serevent diskus
What are LABAs used for?
Long term control
Fixed dosages, not prn
(Mainly COPD pts, esp with more advanced COPD)
Adverse effects of LABAs
Not a first line
May increase asthma
Contraindicated in asthma alone
Adverse effects of inhaled beta2 adrenergic agonists
Tachycardia
Angina
Tremor
Adverse effects of oral beta2 adrenergic agonists
(From excessive dosage)
Angina pectoris
Tachydysrhythmias
Tremor
Prototype Methylxanthines
Theophylline
How can theophylline be administered?
PO
IV (for COPD in ICU)
Function of theophylline
Bronchodilation
Adverse effects of theophylline
*Narrow therapeutic index
Plasma level 10-20 mcg/mL
Can cause toxicity easily
Other types of Methylxanthines
Aminophylline
Dyphylline
Examples of glucocorticoid/LABA combinations
Fluticasone/Salmeterol (Advair)
Budesonide/Formoterol (Symbicort)
What are glucocorticoid/LABA combinations used for?
Long term maintenance in adults and children with worse respiratory issues
Not for initial therapy since they are a combo product
Adverse effects of glucocorticoid/LABA combinations
May have black box warning because they can increase the risk for asthma (due to LABAs)
How do anticholinergic drugs work?
Block muscarinic receptors in the bronchi
With decreases bronchoconstriction
What are anticholinergic drugs used for?
COPD patients
How are anticholinergic drugs administered?
Inhaled only
Prototype anticholinergic drug
Ipratropium (Atrovent)
Adverse effect of Atrovent
Dry mouth
Sore pharynx
Example of how someone with chronic asthma should be managing it
Long term drug therapy:
- Long term control: inhaled glucocorticoids
- Quick relief of ongoing attack: inhaled SABAs
Goal for someone experiencing an acute severe exacerbation
*Requires immediate attention
Goal = relieve airway obstruction and hypoxemia, and normalize lung function ASAP
Initial therapy for someone experiencing an acute severe exacerbation
*Oxygen
*Systemic glucocorticoid to reduce airway inflammation
*Nebulized high-dose SABA to relive airflow obstruction
(And then nebulized ipatropium/Atrovent to further reduce airflow obstruction)
Drugs for exercise-induced asthma
*SABA = preferred Or *Cromolyn administered prophylactically
When should the drugs for exercise-induced asthma be taken?
Beta2 agonists inhaled immediately before exercise (Albuterol or Proventil)
Cromolyn should be inhaled 15 mins before exercise
Drugs used to manage stable COPD
Bronchodilators
Glucocorticoids
Phosphodiesterase-4 inhibitors
Drugs used to manage acute episode with COPD
SABAs (inhaled) either alone or in combo with inhaled Anticholinergics
Systemic glucocorticoids with antibiotics
Supplemental oxygen
What should a pt with COPD’s expected O2 stats be?
88%-92%
