Iszard Asthma and COPD Drugs Flashcards
How do inhalers work?
- Beta agonists excite receptors
- ICS for inflammation
- Muscarinic antagonists Inhibit receptors
How does a drug treatment plan for asthma go as it worsens?
- SABA →ICS →LABA →LAMA
How does a drug treatment plan go for a COPD patient as their condition worsens?
- SABA → LAMA → LABA→ ICS
What do bronchodilators B2 agonists, act on?
Airway smooth muscles to reverse bronchoconstriction of asthma
Albuterol (SABA) indications?
- asthma
- acute bronchitits
- COPD
- broncholitits
Albuterol AE?
- HA
- Dizzy
- Insombia
- Dry mouth
- Cough
Albuterol contraindications?
- Paradoxical bronchospasm
- Deterioration of asthma
- CV effects
- Immediate hypersensitivity
Terbutaline MOA?
- beta adrenergic agonist with preferential effects on Beta 2 recceptors and can be given subcutaneous injection
- Sulfur allergy not recommended
Indications of terbutaline?
- Prophylaxis of brochospasm associatedd with asthma
- broncholitits
- emphysema
Cautions for terbutaline
Not recommended for tocolysis
AE for Terbutaline?
- HA
- Nausea
- Tachycardia
- Palpitations
Indications for Metaproterenol (SABA)?
- Asthma
- Reversible bronchospasm which may occur in bronchitits and COPD
Cautions for Metaproterenol
- can produce significant cardiovascular effects
- paradoxical bronchospasms (life threatening)
Pirbuterol (SABA)?
- Used in prevention and reversal of bronchospasm
Cautions for Pirbuterol (SABA)?
- clinical significant cardio effects
- BP and pulse rate
Levalbuterol (SABA) indications? Warnings
- treatment or prevention of bronchospasm in 4+
- life threatening paradoxical bronchospasm
Beclomethasone (ICS) indications?
- maintenance treatment for asthma and prophylactic therapy 5+ yo
Beclomethasone cautions?
- deaths due to adrenal insufficiency have occurred in asthmatic patients during/after the transition from systemic corticosteroids to inhaled
- After withdrawl from systemic corticosteroids a few months are required for recovery of hypothalamic pituitary adrenal function
Effects of ICS?
- given twice daily
- rapidly improves symtpoms
- effective in preventing asthma sx
- Reduce airway hyperresponsiveness
- prevent irreversible changes in airway
- withdrawal of ICS results in slow deterioration of asthma control
- First line therapy for patients with persistent asthma
Budesonide (ICS) Indications and warnings?
- Maintenance treatment of asthma as prophylactic therapy
- should not be used during an asthma attack
- severe hypersensitivity to milk proteins is contraindicated
Ciclesonide (ICS) indications and warnings?
- Prophylactic asthma agent, not used in acute situations
- Don’t use in presence of candida albicans infections
- associated with less frequent candidiasis as it is a prodrug
Flunisolide (ICS) indications and contraindications?
- Prophylactic therapy
- also used for asthma patients requiring oral corticosteroid therapy
- not used for status asthmaticus or other acute episodes
Fluticosone (ICS) indications and contraindicatons?
- Prophylactic therapy of asthma
- Not used for acute bronchospasm
- candida albicans infection risk increases
Mometasone (ICS) use and cautions?
- Prophylactic therapy
- not used for acute situations
- not used if hypersensitivity to milk proteins
Triamcinolone (ICS) indications and warnings?
- prophylactic therapy asthma
- also used for those who require sytemic corticosteroid administration which could reduce or eliminate the need for these
- not used for acute situations
- deaths due to adrenal insufficiency have occurred during/after transition from systemic to inhaled steroids
When are oral and parenteral corticosteroids used?
In combination with short acting beta agonists to treat moderate to severe asthma
Prednisone use? (OCS)
- anti-inflammatory or immunosuppressive agent for many diseases and endocrine conditions
Cautions for prednisone?
- May lead to hypothalamic pituitary adrenal axis suppression
- Monitor for cushing and hyperglycemia and taper doses for withdrawal
Uses for LABA’s?
- treatment of asthma as an add on to long term asthma control meds
- Maintenance tx of bronchoconstrictio with COPD
Contraindications/warnings for LABA’s?
- increases risk of asthma related deaths and hospitalizations
- don’t use without ICS or other long term control meds
Salmeterol (LABA) uses?
- Prevention of exercise induced bronchospasm
- maintenance of bronchospasm in COPD
Indacaterol and Vilanterol (LABA) indications?
Treat breathing problems due to COPD, including chronic bronchitis and emphysema
Olodaterol (LABA) uses?
long term once daily maintancne bronchodilator treatment of airflow obstruction in patients with COPDS, chronic bronchitis and emphysema
Ipratropium (anticholinergic) uses?
bronchodilator for maintenance of bronchospasm
Potent atropine analog poorly absorbed so it is free of systemic atropine like effects
Tiotropium (anticholinergic) uses?
- Long term once daily maintenance of bronchospasm associated with COPD
- also reduces COPD exacerbations
Aclidinium (anticholinergic) uses?
- long term maintenance of bronchospasm associated with COPD
What are Methylxanthines?
- class of dugs that are derived from purin base xanthine
- used in treatment of airway obstruction caused by asthma, bronchitis or emphysema
- includes
- theophylline
- theobromine
- caffeine
What are the two actions that theophylline has in the airways of patients with reversible obstruction?
- Smooth muscle relaxation
- suppression of response of airways to stimuli
Theophylline warnings?
extreme caution in patients with PUD seizure disorders and cardiac arrhythmias
What class do Zafirlukast and Montelukast fall under?
Selectively reversible antagonissts of Cysteinyl Leukotriene receptors
Zafirlukast and Montelukast effects?
- Have anti inflammatory actions
- Glucocorticoid sparing effect (potentiates them)
Montelukast indications?
- treat allergies and prevent asthma attacks
- not indicated for reversal of bronchospasm in acute asthma attacks
Zafirlukast uses and cautions?
- prophylaxis and treatment of asthma
- Hepatotoxicity
- monitor ALT AST
Zileuton uses?
- used as prophylaxis and chronic asthma treatment
- not recommended for acute asthma attacks
- not used in patients with active liver disease or persistent hepatic function enzyme elevations 3x ULN
What are the four methods Monocolonal Ab drugss work?
- binds free IgE
- Decreases expression of high affinity receptors
- decreases mediator release
- Decreases allergic inflammation prevents exacerbation of asthma and reduces symptoms
Omalizumab uses?
- anti IgE used for moderate to severe persistent asthma in patients with postive skin test or in vitro reactivity to perennial aeroallergens
- also used for chronic idiopathic urticaria in patients who are still symptomatic with H1 inhibitors
Omalizumab cautions?
- need to be given in hospital setting due to risk of anaphylaxis
