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CPR Exam 2 > Lecture 4: Asthma and COPD Drugs > Flashcards

Lecture 4: Asthma and COPD Drugs Flashcards

1
Q

Which 3 major drug classes are used as bronchodilators in the tx of asthma and COPD?

A
  • β2-agonists
  • Anti-cholinergic
  • Methylxanthines
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2
Q

2 most common AE’s assocaited with β2-agonists?

A

Muscle tremor and palpitations

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3
Q

What is the only β2 drug available for SQ injection?

A

Terbutaline

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4
Q

What are the indications for use of Terbutaline?

A

Tx or prophylaxis of bronchospasm assoc. with asthma, bronchitis and emphysema in pt’s >12 y/o

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5
Q

What is the black-box warning for Terbutaline?

A

Not recommended as a medication for tocolysis

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6
Q

Which β2-agonist for asthma is not recommended for pt’s with sulfa allergies?

A

Terbutaline

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7
Q

What are some of the more serious maternal AE’s associated with Terbutaline?

A
  • Cardiac or cardiopulmonary arrhythmias
  • Pulmonary edema
  • MI
  • Hypotension
  • Tachycardia
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8
Q

Albuterol may have interactions with what 5 other drug classes?

A
  • β-blockers (duh)
  • Digoxin
  • Diuretics
  • MAO inhibitors
  • Tricyclic antidepressants
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9
Q

Which life-threatening AE can occur after tx w/ Albuterol?

A

Paradoxical bronchospasm

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10
Q

What are 2 indications for the use of the β2-agonist Metaproterenol?

A
  • Bronchodilator for bronchial asthma
  • Reversible bronchospasm which may occur in assoc. w/ bronchitis and COPD
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11
Q

Which drug class should not be used concomitantly with Metaproterenol?

A

Beta-adrenergic aerosol bronchodilators due to additive effects

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12
Q

What are 2 cautions/warnings associated with the use of Metaproterenol?

A
  • Can produce significant cardiovascular effect in some pt’s, as measured by pulse, BP, sx’s and/or ECG changes
  • Can produce paradoxical bronchospasm (can be life threatening)
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13
Q

Which β2-agonist may be used with or without concurrent theophylline and/or corticosteroid therapy?

A

Pirbuterol

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14
Q

What are the indications for the use of the β2-agonist, Levalbuterol?

A

Tx or prevention of bronchospasm in pt’s > 4 y/o with reversible obstructive airway disease

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15
Q

What are the 4 long-acting β2-agonists?

A
  • Fomoterol
  • Salmeterol
  • Indacaterol
  • Olodaterol
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16
Q

What are the 3 indications for use of the LABA, Fomoterol?

A
  • Add-on for tx of asthma in pt’s ≥5 y/o in combo w/ long-term asthma control med such as an inhaled corticosteroid
  • Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥5 y/o
  • Maintenance tx of bronchoconstriction in pt’s with COPD
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17
Q

What are cautions/warnings for the use of LABA’s in asthma and COPD?

A
  • ↑ risk of asthma-related death and asthma-related hospitlizations
  • MUST be used concomitantly with an inhaled corticosteroid for asthma (fomoterol and salmeterol)
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18
Q

What is the indication for the use of the LABA, Indacaterol?

A

Used to tx breathing problems caused by COPD, including chronic bronchitis and emphysema

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19
Q

What are the 3 indications for use of the LABA, Salmeterol?

A
  • Add-on for tx of asthma in pt’s ≥4 y/o in combo w/ long-term asthma control med such as an inhaled corticosteroid
  • Prevention of exercise-induced bronchospasm (EIB) in pt’s ≥4 y/o
  • Maintenance tx of bronchoconstriction in pt’s with COPD
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20
Q

What are the most common AE’s of the LABA, Indacaterol?

A
  • Cough + oropharyngeal pain + nasopharyngitis
  • HA and nausea
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21
Q

What is the indication for use of the LABA, Olodaterol?

A

Used as LONG-term, 1x/daily maintenance bronchodilator in pt’s with COPD, including chronic bronchitis and emphysema

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22
Q

Which anticholinergic drug is indicated for use as a bronchodilator for maintenance tx of bronchospasm associated with COPD, including chronic bronchitis and emphysema?

A

Ipratropium

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23
Q

Which anticholinergic drug is indicated for long-term, 1x/daily, maintenance tx of bronchospasm associated with COPD, and for reducing COPD exacerbations?

A

Tiotropium

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24
Q

Caution should be used when co-administering tiotropium or ipratropium with what drug classes, due to additive interactions?

A

Anticholinergic-containing drugs

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25
Q

What is the indication for use of the anticholinergic drug, Aclidinium?

A

LONG-term, maintenance tx of bronchospasm associated with COPD, including chronic bronchitis and emphysema

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26
Q

What are 3 major AE’s associated with the anticholingeric, Aclidinium?

A
  • Paradoxical bronchospasm
  • Worsening of narrow-angle glaucoma
  • Worsening of urinary retention
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27
Q

What is a caution/warning related to the use of the anticholingeric, Aclidinium for COPD?

A

NOT for acute use or initial tx of bronchospasm

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28
Q

What are the Methylxanthines, Theophylline and Dyphylline used for?

A

Tx of airways obstruction caused by conditions such as asthma, chronic bronchitis, or emphysema

29
Q

What are the 2 distinct actions of Theophylline in the airways of pt’s w/ reversible obstruction?

A
  • Smooth m. relaxation (bronchodilation)
  • Suppression of airways response to stimuli (non-bronchodilator prophylactic effects)
30
Q

What are some of the AE’s associated with Theophylline?

A
  • CNS excitation + irritability + insomnia + restlessness + seizure
  • HA + diarrhea + N/V + urinary retention
31
Q

Theophylline should be used with extreme caution in pt’s with what 3 underlying clinical conditions?

A
  • Active peptic ulcer disease
  • Seizure disorders
  • Cardiac arrhythmias (NOT including bradyarrhythmias)
32
Q

What is given as the first-line therapy for persistent asthma; if sx’s are not controlled at low doses you may add what?

A

Inhaled corticosteroids (ICS); can add LABA as next step

33
Q

What are the 2 indications for the use of the ICS, Beclomethasone?

A
  • Maintenance tx and prophylactic for asthma in pt’s ≥5 y/o
  • Tx of asthma in pt’s who require ORAL corticosteroid therapy to reduce or eliminate the need for systemic corticosteroids
34
Q

Which 2 ICS’s require special care if used in pt’s who are transferred from systemically active drugs to less systemically active drugs due to potential for death by adrenal insufficiency?

A
  • Beclomethasone
  • Triamcinolone
35
Q

What is the indication for use of the ICS, Budesonide?

A

Maintenance or prophylactic tx of asthma in adults and pediatric pt’s ≥ 6 y/o

36
Q

Which CYP is responsible for the metabolism of corticosteroid?

A

CYP3A4

37
Q

Which pt’s should the ICS, Budesonide not be used in?

A
  • For primarytx ofstatus asthmaticusor otheracute episodesofasthmanecessitatingintensive measures
  • Pts with severe hypersenitivity to milk proteins
38
Q

What is the indication for use of the ICS, Ciclesonide?

A

Maintenance or prophylactic tx of asthma in adult and adolescents ≥12 y/o

39
Q

When is the ICS, Ciclesonide not indicated for use and should be avoided in the presence of what infection?

A
  • Not indicated for the relief of acute bronchospasm
  • Not recommended in presence of Candida albicans infection of the mouth and pharynx, tuberculosis, fungal, bacterial, or parasitic infections
40
Q

What are the 2 indication for use of the ICS, Flunisolide?

A
  • Maintenance and prophylactic tx of asthma in adults and pt’s ≥6 y/o
  • Asthma pt’s requiring oral corticosteroid therapy, where adding flunisolide may ↓ or eliminate the need for other oral corticosteroids
41
Q

Use of the ICS, Flunisolide is contraindicated for use in which pt’s?

A

Primary tx of status asthmaticus or other acute episodes of asthma where intensive measures are required

42
Q

The use of strong CYP3A4 inhibitors (i.e., ritonavir, ketoconazole) should not be used in conjuction with what ICS?

A

Fluticasone

43
Q

Which ICS for asthma is associated with potential Candida infection of the mouth and required pt to rinse his/her mouth with water after inhaling the drug?

A

Fluticasone

44
Q

Which 2 ICS used for asthma are contraindicated in pt’s with status asthmaticus or other acute episodes of asthma where intensive measures are required + pt’s with a known hypersensitivity to milk proteins?

A
  • Budesonide
  • Mometasone
45
Q

What are the 2 indications for the use of the ICS, Triamcinolone?

A
  • Maintenance and prophylactic tx of asthma
  • Asthmatic pt’s who require systemic corticosteroid administration, where adding this agent may reduce or eliminate the need for the systemic corticosteroid
46
Q

Which ICS has AE’s including oral candidiasis, dysmenorrhea, MSK/back pain, and dyspepsia?

A

Mometasone

47
Q

Which ICS has AE’s including oral monilia, toothace, weight gain, bursitis, myalgia, rash, and voice alteration?

A

Triamcinolone

48
Q

Which antimuscarinic used in asthma/COPD provides temporary blockade of the receptor?

A

Atropine

49
Q

What are the 3 combos of ICS + LABA available as inhalers?

A
  • Fluticasone + Salmeterol
  • Mometasone + Formoterol
  • Budesonide + Formoterol
50
Q

When are oral corticosteroids used for asthma and in conjunction with what other drug class?

A

With short-acting β-agonists for moderate-severe asthma flare-ups

51
Q

What is the oral corticosteroid which may be used for moderate to severe asthma flare ups in combo with a short acting beta-agonist?

A

Prednisone

52
Q

What are 6 of the common AE’s associated with Prednisone?

A
  • Fluid retention
  • Alteration in glucose tolerance
  • ↑ in BP
  • Behavioral and mood changes
  • ↑ appetite —> weight gain
53
Q

What should patients of Prednisone be monitored for?

A
  • Cushing’s syndrome due to HPA-axis suppression
  • Hyperglycemia w/ chronic use (doses must be tapered gradually)
54
Q

What are the 3 leukotriene antagonists used for asthma?

A
  • Montelukast
  • Zafirlukast
  • Zileuton
55
Q

What is the MOA of Montelukast?

A

Binds w/ high affinity and selectivity to the CysLT1 receptor; INHIBITING the physiologic actions of LTD4

56
Q

Montelukast is primarily prescribed for what?

A

Treat allergies and prevent asthma attacks

57
Q

Which leukotriene receptor antagonist used for asthma is associated with hepatotoxicity as an AE?

A

Zafirlukast

58
Q

What is Zafirlukast prescribed for?

A

Prophylaxis and chronic tx of asthma in pts ≥5 y/o

59
Q

Patients on which other drug need to be monitored clinically if taking Zafirlukast for asthma?

A

Warfarin –> need to monitor PTT

60
Q

What is the MOA of Zileuton?

A

Inhibitor of 5-lipoxygenase and thus inhibits leukotriene (LTB4, LTC4, LTD4, and LTE4) formation

61
Q

3 most common AE’s associated with Zileuton?

A
  • Sinusitis
  • Nausea
  • Pharyngolaryngeal pain
62
Q

What is the indication for the use of Zileuton?

A

Prophylaxis and chronic tx of asthma in pt’s ≥12 y/o

63
Q

Zileuton is not indicated for use in pt’s with what underlying disease/abnormalities?

A

- Active liver disease

or

- Persistent hepatic function enzymes ≥3x upper limit of normal

64
Q

What are the 2 indications for the use of Omalizumab?

A
  • Moderate to severe persistent asthma in pt’s ≥6 y/o w/ (+) skin test for perennial aeroallergen and sx’s inadequately controlled w/ ICS
  • Chronic idiopathic urticaria in pt’s ≥12 y/o who remain symptomatic despite H1 antihistamine tx
65
Q

What is the MOA of Omalizumab?

A
  • Binds to free IgE and blocks binding to FCεRI
  • Causes ↓ release of mediators from mast cells, basophils, and eosinophils
66
Q

What is a black box warning for Omalizumab?

A

Administer only in a healthcare setting prepared to manage anaphylaxis that can be life threatening

67
Q

What are some of the most common AE’s associated with Omalizumab?

A
  • Arthraliga + pain (general) + fracture
  • Pruritus + dermatitis
  • Earache
  • Fatigue + dizziness
68
Q

Which pt’s may benefit from triple therapy with ICS + LABA + LAMA?

A

Pt’s w/ features of both asthma + COPD

CPR Exam 2 (21 decks)

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