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PC 707 Pharmacology > Module 6: Unit B: Asthma and COPD > Flashcards

Module 6: Unit B: Asthma and COPD Flashcards

1
Q

Beta 2-agonists example

A 
Short-acting (SABA)
Albuterol
Levalbuterol 
Xopenex
Ventolin
Long-acting (LABA)
Formoterol
Perforomist
Serevent
salmeterol
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2
Q

Indications Beta-2 agonists

A

Bronchodilator for the treatment of reversible airway obstruction due to asthma or COPD

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3
Q

MOA beta-2 agonists

A

Activation of beta-adrenergic receptors leads to relaxation of smooth muscle in the lung and dilation and opening of the airways.

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4
Q

Safety/D2D/Cautions with beta-2 agonists

A

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

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5
Q

side effects beta-2 agonists

A

Can cause bronchospasm

The most common complaint from individuals is nervousness, tremor, and palpitations.

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6
Q

Inhaled Glucocorticoids (ICS) example

A

Flovent (fluticasone propionate)
Arnuity (fluticasone furoate)
Budesonide
Qvar (beclomethasone dipropionate)

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7
Q

Inhaled Glucocorticoid indication

A

Asthma

Off label:
COPD
Eosinophilic esophagitis

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8
Q

MOA inhaled glucocorticoids

A

The exact mechanism of anti-inflammatory action is unknown; it inhibits multiple inflammatory cytokines; produces multiple glucocorticoids and mineralocorticoid effects.

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9
Q

Caution/D2D inhaled glucocorticoids

A

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

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10
Q

Inhaled glucocorticoids monitoring and reactions

A

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)

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11
Q

Oral Glucocorticoids example

A

Prednisone

Dexamethasone

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12
Q

Prednisone and Dexamethasone Indication

A

Anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases, including allergic, hematologic, dermatologic, GI, inflammatory, etc.

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13
Q

MOA prednisone and dexamethasone

A

The exact mechanism of anti-inflammatory action is unknown; it inhibits multiple inflammatory cytokines; produces multiple glucocorticoids and mineralocorticoid effects

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14
Q

Safety/D2d/Cautions with oral glucocoritcoids (prednisone and dexa)

A

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

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15
Q

Oral glucocorticoid monitoring and long term use implications

A

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

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16
Q

Methylxanthines example

A

Theophylline

Theo-24

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17
Q

Indication Theophylline and Theo-24

A

Reversible airflow obstruction

18
Q

MOA Theo-24

A

The exact mechanism of action is unknown; increases cAMP; antagonizes adenosine receptors (methylxanthine)

19
Q

Safety/D2D/Caution with Theo-24

A

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

20
Q

Monitoring and side effects Theo-24

A

Monitor therapeutic drug levels
Seizures, arrhythmia, hypotension, shock, exfoliative dermatitis
An old drug that has been around forever but can be difficult to find.

21
Q

Immunomodulators example

A 
Xolair omalizumab
Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab
Dupixent dupilumab
22
Q

Indication Xolair omilzumab

A

Asthma
Chronic idiopathic urticaria
Nasal polyps

23
Q

MOA immunomodulators (xolair)

A

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.

24
Q

Caution/D2D immunomodulators (xolair)

A

Not a rescue inhaler
Caution if anaphylaxis history
D2D: None

25
Q

BBW immunomodulators (xolair)

A

Anaphylaxis

26
Q

Side effects and process with immunomodulators (xolair)

A

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

27
Q

Indications: Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab

A

Asthma
Eosinophilic granulomatosis with polyangiitis
Hypereosinophilic syndrome

28
Q

MOA:
Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab

A

Binds to and interferes with interleukin-5 cytokine, reducing eosinophil production and survival

29
Q

Safety:
Nucala mepolizumab
Fasenra benralziumab
Cinqair reslizumab

A 
Not rescue inhaler
D2D: None
No routine tests recommended
Hypersensitivity reaction
Anaphylaxis
Must have an elevated IgE level positive RAST test to get approved
30
Q

Indication Dupixent dupilumab

A

Asthma
Atopic dermatitis
rhinosinusitis

31
Q

MOA Dupixent dupilumab

A

Binds to and inhibits interleukin-4 receptor alpha subunit, interfering with interleukin-4 and interleukin-13 cytokines, reducing inflammation and altering the immune response

32
Q

Safety/D2D Dupixent dupilumab

A

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

33
Q

Anticholinergics/

Antimuscarinics: Short-acting and Long-acting

A

Long-acting (LAMA)
Spiriva (tiotropium)
Incruse (umeclidinium)

Short-acting (SAMA)
Atrovent (ipratropium)

34
Q

Indication anticholingerics

A

Asthma

COPD

35
Q

MOA anticholingerics

A

Antagonizes acetylcholine receptors, producing bronchodilation

36
Q

Safety/D2D anticholingerics

A

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

37
Q

Phosphodiesterase-4 Inhibitors example

A

Daliresp roflumilast

38
Q

Indication Daliresp roflumilast

A

COPD: to reduce the risk of COPD exacerbations in patients with severe COPD

39
Q

Daliresp roflumilast MOA

A

The exact mechanism of action is unknown; it selectively inhibits phosphodiesterase type 4 (PDE4), leading to increased intracellular cAMP levels.

40
Q

BBW Reslizumab (Cinaquir)

A

Anaphylaxis

41
Q

Side effects LABAs

A

tachycardia, palpitations, QT prolongation, hypokalemia, tremors, cramping, headaches, insomnia, and increase in serum glucose levels. increased occurrences of angina and myocardial infarctions reported.

PC 707 Pharmacology (39 decks)

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