Module 6: Unit B: Asthma and COPD Flashcards
Beta 2-agonists example
Short-acting (SABA) Albuterol Levalbuterol Xopenex Ventolin
Long-acting (LABA) Formoterol Perforomist Serevent salmeterol
Indications Beta-2 agonists
Bronchodilator for the treatment of reversible airway obstruction due to asthma or COPD
MOA beta-2 agonists
Activation of beta-adrenergic receptors leads to relaxation of smooth muscle in the lung and dilation and opening of the airways.
Safety/D2D/Cautions with beta-2 agonists
MAO inhibitor use within 14 days
TCA use within 14 days
Caution in individuals with ischemic heart disease, HTN, arrhythmias, hypokalemia, diabetes, seizure disorder, hyperthyroidism, elderly individuals
D2D: Can lead to hyperglycemic events, HTN events, and hypokalemia
side effects beta-2 agonists
Can cause bronchospasm
The most common complaint from individuals is nervousness, tremor, and palpitations.
Inhaled Glucocorticoids (ICS) example
Flovent (fluticasone propionate)
Arnuity (fluticasone furoate)
Budesonide
Qvar (beclomethasone dipropionate)
Inhaled Glucocorticoid indication
Asthma
Off label:
COPD
Eosinophilic esophagitis
MOA inhaled glucocorticoids
The exact mechanism of anti-inflammatory action is unknown; it inhibits multiple inflammatory cytokines; produces multiple glucocorticoids and mineralocorticoid effects.
Caution/D2D inhaled glucocorticoids
Severe hypersensitivity to milk protein
Don’t use as rescue inhaler
Caution in pediatric or adolescent patients
Caution in individuals with hepatic impairment, immunosuppressed, active infection, glaucoma, cataracts, osteoporosis
D2D: CYP3A4 substrate & immunosuppressive effects
Inhaled glucocorticoids monitoring and reactions
BMD if osteoporosis risk factors; height in children/adolescents; oral cavity exam; consider ophthalmic exam if long-term use, change in vision, IOP/glaucoma/cataracts hx
Advise individuals to rinse their mouth after each use to avoid developing thrush
Can cause hypersensitivity reaction, anaphylaxis, bronchospasms, eosinophilia, Churg-Strauss syndrome
In long-term use, individuals may develop: adrenal suppression, hypercorticism, immunosuppression, glaucoma, cataracts, osteoporosis, growth suppression (peds pts)
Oral Glucocorticoids example
Prednisone
Dexamethasone
Prednisone and Dexamethasone Indication
Anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases, including allergic, hematologic, dermatologic, GI, inflammatory, etc.
MOA prednisone and dexamethasone
The exact mechanism of anti-inflammatory action is unknown; it inhibits multiple inflammatory cytokines; produces multiple glucocorticoids and mineralocorticoid effects
Safety/D2d/Cautions with oral glucocoritcoids (prednisone and dexa)
Systemic fungal infection
Don’t use for Cerebral malaria
Caution in individuals with HTN, CHF, recent MI, diabetes, PUD, ulcerative colitis, diverticulitis, psychiatric disorders, thyroid disorders, osteoporosis, cirrhosis
D2D: 11-beta-hydroxysteroid dehydrogenase type 1 substrate, CYP3A4 substrate, CYP3A4 inducer, affects growth hormone, hyperglycemic effects, hypertensive effects, hypokalemia, immunosuppressive effects, lowers the seizure threshold
Oral glucocorticoid monitoring and long term use implications
Electrolytes; BP; weight; 2h postprandial glucose, height (peds), chest x-ray if prolonged tx; ophthalmic exam if tx >6 wk; BMD if prolonged tx or in pts 65 yo and older; consider upper GI x-ray if PUD history or significant dyspepsia
Avoid abrupt withdrawal (high-dose or long-term use)
Can cause Cushing syndrome
Can cause diabetes
Long-term use can lead to osteoporosis, glaucoma, cataracts, immunosuppression, Kaposi sarcoma
Methylxanthines example
Theophylline
Theo-24
Indication Theophylline and Theo-24
Reversible airflow obstruction
MOA Theo-24
The exact mechanism of action is unknown; increases cAMP; antagonizes adenosine receptors (methylxanthine)
Safety/D2D/Caution with Theo-24
Caution if: PUD (active), seizure disorder, arrhythmias, CHF, pulmonary edema, cor pulmonale, renal impairment, hepatic impairment, hypothyroidism, smoking habits change
D2D: CYP1A2 substrate, CYP3A4 substrate, hypokalemia, lowers the seizure threshold
Monitoring and side effects Theo-24
Monitor therapeutic drug levels
Seizures, arrhythmia, hypotension, shock, exfoliative dermatitis
An old drug that has been around forever but can be difficult to find.
Immunomodulators example
Xolair omalizumab Nucala mepolizumab Fasenra benralziumab Cinqair reslizumab Dupixent dupilumab
Indication Xolair omilzumab
Asthma
Chronic idiopathic urticaria
Nasal polyps
MOA immunomodulators (xolair)
Inhibits IgE binding to mast cells, basophils, and dendritic cells, down-regulating IgE receptors; in allergic asthma, inhibits IgE-mediated inflammation, decreasing eosinophils and multiple inflammatory mediators.
Caution/D2D immunomodulators (xolair)
Not a rescue inhaler
Caution if anaphylaxis history
D2D: None
BBW immunomodulators (xolair)
Anaphylaxis
Side effects and process with immunomodulators (xolair)
No routine tests recommended
Eosinophilia
Malignancy risk
Subcutaneous injections every 2-4 weeks are given in the office.
Must have an elevated IgE level positive RAST test to get approved
Indications: Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab
Asthma
Eosinophilic granulomatosis with polyangiitis
Hypereosinophilic syndrome
MOA:
Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab
Binds to and interferes with interleukin-5 cytokine, reducing eosinophil production and survival
Safety:
Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab
Not rescue inhaler D2D: None No routine tests recommended Hypersensitivity reaction Anaphylaxis Must have an elevated IgE level positive RAST test to get approved
Indication Dupixent dupilumab
Asthma
Atopic dermatitis
rhinosinusitis
MOA Dupixent dupilumab
Binds to and inhibits interleukin-4 receptor alpha subunit, interfering with interleukin-4 and interleukin-13 cytokines, reducing inflammation and altering the immune response
Safety/D2D Dupixent dupilumab
Patients <12 yo (pen form)
not rescue
Caution if corticosteroid use
D2D: immunosuppressive effects
No routine tests recommended
Hypersensitivity rxn
Anaphylaxis
Serum sickness
Keratitis
Absolute eosinophil count must be 300 or higher, OR the patient be oral steroid-dependent to get approved.
Subcutaneous injections every two weeks, can be done from home
Anticholinergics/
Antimuscarinics: Short-acting and Long-acting
Long-acting (LAMA)
Spiriva (tiotropium)
Incruse (umeclidinium)
Short-acting (SAMA)
Atrovent (ipratropium)
Indication anticholingerics
Asthma
COPD
MOA anticholingerics
Antagonizes acetylcholine receptors, producing bronchodilation
Safety/D2D anticholingerics
do not give with Bronchospasm, acute
Severe hypersensitivity to milk protein
Caution if CrCl <60, glaucoma, angle-closure, urinary retention, prostatic hypertrophy, bladder neck obstruction
D2D anticholinergic effects
Anticholinergic sx if CrCl<60
Hypersensitivity reaction
Phosphodiesterase-4 Inhibitors example
Daliresp roflumilast
Indication Daliresp roflumilast
COPD: to reduce the risk of COPD exacerbations in patients with severe COPD
Daliresp roflumilast MOA
The exact mechanism of action is unknown; it selectively inhibits phosphodiesterase type 4 (PDE4), leading to increased intracellular cAMP levels.
BBW Reslizumab (Cinaquir)
Anaphylaxis
Side effects LABAs
tachycardia, palpitations, QT prolongation, hypokalemia, tremors, cramping, headaches, insomnia, and increase in serum glucose levels. increased occurrences of angina and myocardial infarctions reported.
