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Foundations of Pharmacy Care > Exam I: Corticosteroids, Asthma and COPD Drugs > Flashcards

Exam I: Corticosteroids, Asthma and COPD Drugs Flashcards

1
Q

Endocrine glands are ductless. What does this mean?

A

Secrete hormones directly into the bloodstream

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2
Q

Corticosteroids used in drugs are derived from or structurally similar to what?

A

Derived from or structurally similar to endogenous hormones from the adrenal cortex portion of the two adrenal glands

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3
Q

Corticosteroid hormone drugs are synthetic versions of what?

A

Synthetic versions of the endogenous steroid hormones in the body

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4
Q

Adrenocorticotropic Hormone (ACTH) is secreted by the?

A

Anterior pituitary gland

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5
Q

Another name for ACTH is what? Is this hormone inhibitory or stimulatory?

A

Corticotropin

Stimulate adrenal gland

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6
Q

ACTH causes what effects in the body?

A

Production and release of corticosteroid hormones which influence:

  1. Carb and electrolyte metabolism
  2. Sex glands associated with estrogenic and androgenic hormones
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7
Q

Name the two glucosteroids. They are secreted by?

A

Cortisol and Cortisone

Cortisone is metabolically converted to Cortisol in the body

Secreted by the adrenal glands

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8
Q

Name the major mineralocorticosteroid. Secreted by?

A

Aldosterone

Secreted by the adrenal cortex

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9
Q

Glucocorticosteroids effects/functions? (3)

A
  1. Regulate glucose (gluconeogenesis)
  2. Lipid and protein metabolism (anabolism and catabolism)
  3. Affect immune response and inflammation.
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10
Q

Mineralocorticoids effect/functions?

A
  1. Water and electrolyte metabolism and balance
  2. Promotes Na+ retention and K+ excretion
  3. Na+/K+ balance - regulates blood volume and pressure
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11
Q

What is the basic structure of corticosteroids? Chemical class - steroids.

A

4-ring structure

3 - 6-membered rings

1 - 5-membered ring

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12
Q

Pharmacological class of corticosteroids.

A

Hormone Replacement Therapy (HRT)

Anti-inflammatory and immunosuppressive effects

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13
Q

What is bursitis?

A

Indication for corticosteroid

Inflammation of fluid filled sacs that help cushion bones and tendons

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14
Q

What is Ankylosing spondylitis?

A

Indication for corticosteroid

Refers to an inflammatory skin condition

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15
Q

What is Rheumatoid arthritis ?

A

Indication for corticosteroid

Serious autoimmune and inflammatory disease of the joints

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16
Q

What is Reyes syndrome?

A

Indication for corticosteroid

Rare but serious condition that causes swelling of the brain and liver after a person acquires a viral infection

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17
Q

What is dermatoses?

A

Indication for corticosteroid

Refers to an inflammatory skin condition

ex. Contact dermatitis, Psoriasis

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18
Q

Corticosteroids are used when the typical anti histamines are not effective. Name three indications.

A

Anti-allergic effects

  1. Erythema multiforme - skin condition that can occur secondary to a hypersensitivity reaction to infection or drugs
  2. Serum Sickness - Reaction that can occur when a nonhuman protein enters the body (ex. Vaccination, monoclonal antibody).
  3. Allergic conjunctivitis - eye inflammation
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19
Q

Name 4 respiratory indications for corticosteroids.

A
  1. Asthma
  2. Status Asthmaticus - asthma attack
  3. Chronic Obstructive Pulmonary Disease (COPD) exacerbations
  4. Allergic Rhinitis
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20
Q

How are corticosteroids immunosuppressive?

A

Glucocorticoids inhibit cell-mediated immunologic functions, especially those dependent on lymphocytes

Delay rejection reactions in patients with organ transplants

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21
Q

Name 4 collagen-related indications for corticosteroids.

A
  1. Systemic Lupus Erythematosus (SLE) - autoimmune, inflammatory disease
  2. Rheumatic Heart Disease - inflammatory disease that affects connective tissue especially in the heart, joints, skin and brain
  3. Tendonitis - inflammation in tendons (tissues that connects muscle to bone)
  4. Polymyostitis - type of inflammatory myopathy (weakness, muscle disease)
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22
Q

How are corticosteroids used in neoplastic diseases?

A

Used primarily in advance stage cancers

  1. Used to reduced spinal cord compression
  2. Help relieve pain such as bone pain
  3. Increase appetite
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23
Q

Corticosteroids affect insulin secretion and muscle protein catabolism.

True/False

A

True

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24
Q

“OLONE” steroids are anabolic or catabolic? ex. Oxandrolone Tablets

A

Anabolic

Involved in the synthesis and build-up of protein

Other steroids are catabolic

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25
Q

Anabolic (“OLONE”) steroids are C-III drugs why?

A

Illicit use by athletes since they mimic the effects of testosterone

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26
Q

Long term adverse effects of corticosteroid therapy.

A
  1. Osteoporosis
  2. Muscular atrophy
  3. Thinning of the skin,
  4. Development of cataracts
  5. Adrenal suppression and insufficiency
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27
Q

Contraindications for steroid use.

A

Avoid use with:

  1. Systemic fungal infections
  2. Administration of live or live attenuated vaccines with immunosuppressive doses
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28
Q

Corticosteroid pregnancy classfication.

A

Category C

Should only be given if the benefits outweigh the risks

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29
Q

Warnings for steroid use:

  • Can mask acute infections
  • Exacerbate a viral infection
  • Cause psychiatric disturbances like euphoria, depression etc.

True/False

A

True

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30
Q

Primary Adrenocortical Insufficiency (deficit in both adrenocorticoids) - name disease.

A

Addison’s Disease

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31
Q

Addison’s Disease symptoms

A
  1. Lethargy
  2. Weight Loss
  3. GI problems
  4. Hyperpigmentation
  5. HYPOnatremia or HYPERkalemia
  6. HYPOtension
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32
Q

How can hypotension be treated in patients with Addison’s disease?

A

Fludrocortisone, an aldosterone substitute to help the retention of sodium in water to increase blood pressure

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33
Q

Metabolic disorder caused by excess secretion of adrenocortical steroids - name the disease.

A

Cushing’s Syndrome

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34
Q

Cushing’s Syndrome symptoms.

A
  1. Hypertension
  2. Weight gain
  3. “Moon Face” – recall that fat deposits in neck, back and shoulder areas
  4. Hirsutism – unwanted hair growth
  5. Hyperglycemia
  6. Osteoporosis
  7. Thinning of the skin
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35
Q

Cushing’s disease vs syndrome

A

Disease - specific type of Cushing’s syndrome that occurs when a pituitary tumor causes the body to make too much cortisol

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36
Q

FDA approved drugs for Cushing’s disease.

A
  1. Pasireotide diaspartate (Signifor®) - SubQ for Cushing’s disease
  2. Osilodrostat (Isturisa®) - po, Cushing’s disease cannot get surgery or unsuccessful surgery
  3. Mifepristone (Korlym®) - control hyperglycemia in patients with Type II diabetes + Cushing’s syndrome
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37
Q

Corticosteroids have a narrow therapeutic index.

True/False

A

False

Most problems are associated with long-term use, not the initial or individual maintenance doses

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38
Q

Why is tapering of steroids necessary?

A

Never discontinue corticosteroid therapy abruptly after long-term therapy

Tapering-down is necessary because abrupt withdrawal → Addison’s syndrome (adrenocorticoid deficit)

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39
Q

Categorize corticosteroids by short-acting, intermediate-acting and long-acting.

A

Short-acting - Cortisone, hydrocortisone

Intermediate-acting - Prednisone/prednisolone, triamcinolone, methylprednisolone

Long-acting - Dexamethasone, betamethasone

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40
Q

Half life increments for short-acting, intermediate-acting, and long-acting corticosteroids.

A

Short-acting – 8-12 hour half life

Intermediate-acting – 12 – 36 hour half life

Long acting – 36-54 hour half life

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41
Q

Name oral corticosteroids. (8)

A
  1. Cortisone
  2. Betamethasone,
  3. Hydrocortisone
  4. Prednisone
  5. Prednisolone
  6. Methylprednisolone
  7. Dexamethasone
  8. Triamcinolone
42
Q

Only soluble versions of drugs can be given IV - how can you determine if a drug is soluble by its name?

A

Sodium within the name

ex. Hydrocortisone Sodium Phosphate

Hydrocortisone Sodium Succinate

43
Q

What is an epidural? (3)

A
  1. Injection into the spaces surrounding the spinal column (epidural spaces)
  2. Useful in treating back pain associated with arthritis
  3. Last resort treatment after a patient has undergone back surgery
44
Q

Common topical uses for hydrocortisone

A

Pruritis (itching), burns, dermatoses

Fungal infections in conjunction with an antifungal

Eczema

45
Q

Hydrocortisone Acetate can be given IV and IM.

True/False

A

False

Not soluble - can be given IM

46
Q

Prednisone vs Prednisolone

A

Prednisone (prodrug) - po only

Prednisolone (active form)

47
Q

Methylprednisolone Acetate vs Dexamethasone Sodium Phosphate (solubility and release effects)

A

Methylprednisolone Acetate (Depo-Medrol) - Not soluble, provides a repository effect (allows it to have a long acting release effect)

Dexamethasone Sodium Phosphate - Soluble, Will not provide a “depot” (repository) effect (due to it being in its soluble form)

48
Q

Corticosteroid that can be given as an Intravitreal injection (into the eye).

A

Triamcinolone

49
Q

Corticosteroid that can come as a rectal foam used in ulcerative colitis.

A

Budesonide

50
Q

One of the strongest topical agents that is a corticosteroid.

A

Halobetasol Propionate

51
Q

Corticosteroids with a dermal formulation. (4)

A
  1. Triamcinolone
  2. Beclomethasone
  3. Fluticasone
  4. Mometasone
52
Q

Fludrocortisone Acetate (Florinef®) - dosage form, indication and effects

A

PO only - 0.1 mg tablets

Very potent mineralocorticoid

Indicated in Addison’s disease - help promote reabsorption of sodium and help provide fluid retention to control blood pressure

53
Q

ADR from prolonged use of a ophthalmic corticosteroid.

A

Can cause glaucoma due to increased intraocular pressure

54
Q

Name Common Ophthalmic and Otic corticosteroids. (6)

A
  1. Dexamethasone
  2. Difluprednate
  3. Fluocinolone acetonide
  4. Fluorometholone
  5. Loteprednol Etabonate
  6. Prednisolone
55
Q

What is asthma?

A

Chronic inflammatory disease

Affects many different cells (ie. leukocytes, epithelial cells)

Partial or complete airway obstruction

56
Q

Asthma is the most common chronic disease.

True/False

A

True

57
Q

Onset of asthma in males vs females.

A

Males - more vulnerable pre-puberty

Females - more vulnerable post-puberty

Other differences are not dramatic

58
Q

Drugs that can triggers asthma symptoms.

A

NSAIDs (including aspirin)

59
Q

Unlike asthma, COPD is fully reversible.

True/False

A

False

Asthma typically goes away in adulthood

COPD is not fully reversible

60
Q

What is COPD?

A

A chronic, progressive disease characterized by airflow limitations

61
Q

What are the two major manifestations of COPD? What damage do these disorders cause?

A

Chronic bronchitis and pulmonary emphysema

Alveoli (the air sacs in the lung) become enlarged and damaged

This results in a reduced surface area and capacity for the exchange of CO2 and O2

62
Q

COPD is usually diagnosed in its early stages.

True/False

A

False

Symptoms for COPD is most evident after the patient has had a severe deterioration

63
Q

COPD can cause cachexia (extreme weight loss and muscle wasting)

True/False

A

True

64
Q

Name the 4 types of delivery devices for asthma medication.

A

Pressurized Metered Dose Inhaler (pMDI) - Uses chemical propellant

Dry Powder Inhaler (DPI)- Capsule or blister foil with powder breaks inside device to release powder

Soft Mist Inhaler (SMI) - “Respimat”, Compressed spring rather than chemical propellant.

Nebulizer - Turns liquid medication into a mist

65
Q

What are National Asthma Education and Prevention Program (NAEPP) Asthma Guidelines?

A

Treatment algorithm to treat asthma – stepwise approach

66
Q

Describe the 2019 Global Initiative for Asthma (GINA) Asthma Guidelines.

A

Stepwise process

For patients 12+

Personalized Asthma Management: Assess, adjust, review response

67
Q

Controller vs reliever medication for asthma

A

Controller - Taken daily to maintain control of asthma

Reliever - “Rescue”, as needed to treat acute symptoms

68
Q

Describe GOLD Guidelines for COPD.

A

Testing measures used to determine the best treatment option for a patient with COPD

Uses CAT (questionnaire) and mMRC (characterize dyspnea)

69
Q

Describe SABA “TEROL” drugs. Onset, peak, full duration, mode of action.

A

Short-acting beta2 agonists (SABA)

Onset ~ 5 minutes
Peak ~ 30 minutes
Duration ~4-6 hours

Cause bronchodilation

70
Q

Are SABA (“TEROL”) typically controller or reliever medications? What is the most common delivery device?

A

Typically reliever medications

All MDI except respiclick and digihalers which are dry powder inhalers

71
Q

Albuterol is a(n) _____ of levalbuterol. (Hint: structure)

A

Isomer

72
Q

Why should patients wait 30-60s between each puff when using an MDI?

A

This gives the medicine and propellant enough time to mix together

73
Q

Common adverse effects of SABA (“TEROL”).

A
  1. Anxiety
  2. Tremors
  3. Hypokalemia and hypomagnesemia
  4. Tachycardia – dose dependent, sympathomimetic type side effect
74
Q

Describe LABA (“TEROL”) drugs. Duration, Safe to use alone?

A

Long-term bronchodilation (Lasts about 12 hours)

Asthma: Only safe for used with Inhaled Corticosteroids (ICS) (“SONE”)

COPD: LABAs can be used alone

75
Q

Name the two SABA (“TEROL”).

A

Albuterol

Levalbuterol

76
Q

LABA side effects, any DDI or food-drug interactions?

A

Similar side effects as SABA

Tachyphylaxis (effectiveness of the drug may diminish after long term continuous use)

No major DDI or food-drug interactions

77
Q

When are LABAs used for asthma?

A

Added to therapy when ICS alone is not effective

78
Q

Usual dose frequency of LABAs and name the exceptions.

A

Usually twice daily

Indacaterol and olodaterol –> dosed once daily

79
Q

What are the muscarinic antagonists mode of action? Name two types?

A

Involves the acetylcholine system at the type III muscarinic receptors located in the bronchial smooth muscle (also referred to as antimuscarinics)

Short-acting muscarinic antagonists –> SAMA

Long-acting muscarinic antagonists –> LAMA

80
Q

LAMAs are mostly used to treat what disorder? What is the exception?

A

Mostly treat COPD

Ipratropium bromide (Atrovent) can treat COPD and asthma

81
Q

ICS are only prescribed for asthma not COPD.

True/False

A

False

Can be used in severe cases of COPD

82
Q

Name the SABA/SAMA combo drug.

A

Albuterol/Ipratropium – Respimat inhaler or Duoneb solution

83
Q

All SABA/SAMA and LAMA/LABA products are BID except?

A

Vilanterol and Olodaterol products - once daily

84
Q

What is the fairly new triple therapy inhaler for COPD?

A

ICS/LABA/LAMA

Fluticasone/Vilanterol/Umeclidinium (Trelegy Ellipta) - once daily

85
Q

Leukotriene Modifiers. Route of admin, m of a. Name the three drugs.

A

Leukotriene Receptor Antagonists (LTRA)

Work by blocking the action of leukotrienes at the cysteinyl leukotriene receptors - anti inflammatory bc leukotrienes promote inflammation

Montelukast, Zafirlukast and Zileuton - po only

86
Q

Are LTRAs better rescue agents than ICS?

A

LTRAs cannot be rescue agents - they are for mild asthma especially when inhalation is not possible

ICS typically produce better outcomes for asthma

87
Q

What type of drugs inhibit action of LTRAs? (name the enzyme these drugs metabolize)

A

Drugs that are metabolized via CYP3A4

88
Q

Warnings for LTRAs.

A

Montelukast - agitation, aggression, depression, sleep disturbances, SI

Zafirlukast and Zileuton - hepatoxicity

89
Q

Name all functions/effects of LTRAs. (Hint: what does it decrease)

A

Decreases inflammation

Decreases edema and mucous secretion

Decreases bronchoconstriction of the airway

90
Q

Are LTRAs indicated for short or long term use?

A

Long term use

91
Q

Monoclonal Antibodies (-LIZUMAB) indication, m of a, high or low cost?

A

Target IgE pathway (allergic asthma) or Interleukin (IL) pathways (relevant to eosinophilic disorders)

For severe, persistent asthma

High cost - can excess $10,000 a year

92
Q

Monoclonal Antibodies (-LIZUMAB) precautions and dangers?

A

May cause an anaphylactic reaction due to foreign antibodies

Dispensed only at specialty pharmacies

Can be given every 2-4 weeks.

93
Q

Phosphodiesterase-4-Inhibitor. Indication, side effects, contraindication?

A

Indicated in severe COPD

Side effects: Headache, dizziness, insomnia, weight loss (discontinue if persists)

Contraindication: Severe hepatic impairment (Child-pugh class B or C)

94
Q

What are the two OTC asthma products

A

Racepinephrine (epinephrine (racemic)) – Asthmanephrin™ inhalation solution

Ephedrine Sulfate + Guaifenesin (Primatene™) Tablets

95
Q

Theophylline & Aminophylline in treating asthma and COPD. Is it a recommended therapy?

A

Narrow therapeutic index

Many adverse effects

  1. Treatment of asthma exacerbation with theophylline is not recommended
  2. Management of acute COPD with IV theophylline is not recommended
96
Q

Steps to use pMDI? (5)

A
  1. Shake
  2. Remove “dust cap”
  3. Prime - 2 puffs in the air, especially after prolonged storage
  4. Press down and inhale slowly and deeply over 5 seconds.
  5. Hold breath for 4-10 secs then exhale gently
97
Q

Why did Hydrofluoroalkane (HFA) propellant replace chlorofluorocarbon (CFC) propellants in inhalers?

A

CFC is bad for the environment and depletes the ozone layer

98
Q

Benefits of spacers for inhalers.

A
  1. Aerosol slowed less need for hand to mouth coordination
  2. Reduces drug impinged on oropharynx. Increases drug inhaled into lower airways.
  3. Reduce side effects caused by oropharyngeal deposition of ICS
99
Q

Spacers can be used with DPIs

True/False

A

False

Cannot use a spacer with a Dry Powder Inhaler

100
Q

Soft mist inhalers are breath-actuated like Dry powder inhalers.

True/False

A

False

Soft mist inhalers are not breath-actuated. They use a compression spring to push out medication.

Foundations of Pharmacy Care (12 decks)

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