Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology 2 > Pharm - Asthma and COPD > Flashcards

Pharm - Asthma and COPD Flashcards

1
Q

Which asthma meds are quick relievers?

A

-SABAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which asthma meds are long term controllers ?

A

-inhaled corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

SABA MoA

A

-binds beta2-adrenergic receptors on bronchioles resulting in relaxation of the smooth muscles that surround the airway = bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indication for SABAs

A
  • drug of choice for acute bronchospasm
  • preferred tx for intermittent asthma and as quick-relief meds for asthma and COPD
  • should be prescribed to all pts w/ asthma for acute symptoms
  • they are rescue meds
  • the DONT tx underlying dz, ONLY symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ADRs for SABAs

A
  • sinus tachycardia
  • arrhythmias
  • higher doses: somatic tremor
  • HA
  • dizziness
  • cough
  • decrease of serum K (esp. w/ other drug that are not K-sparing)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Monitoring parameters for SABAs

A
  • symptom relief

- adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

albuterol

A
  • SABA
  • Brand: Proventil
  • MDI
  • 2 puffs q 4-6 hrs PRN
  • duration of action: 4-6 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

LABAs MoA

A
  • same as SABA but altered to sit on receptors longer

- controller, NOT rescue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Indications for LABAs

A
  • when pts have persistent symptoms and require daily use of SABA
  • used differently in asthma and COPD
  • asthma: only used w/ inhaled glucocorticoid NEVER solo
  • children >5: step 3 and above
  • children 0-4: step 4
  • COPD: LABA w/ SABA appropriate for all stages except mildest sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Contraindications of LABAs

A
  • avoid use w/ CYP3A4 strong inhibitors
  • clarithromycin, ketoconazole, ritonavir
  • if used together can increase serum concentrations of LABA
  • avoid use w/ non-selective beta-blockers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

salmeterol xinafoate

A
  • LABA
  • DPI
  • 1 inhalation BID
  • duration: 12 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anticholinergics MoA

A
  • block effect of Ach on the M2 and M3 muscarinic receptors
  • decreases parasympathetic tone on airways causing bronchodilation
  • slower onset that beta2-agonists but longer lasting
  • SAMAs: 8 hr relief
  • LAMAs: >24 hrs relief
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

indication for anticholinergics

A
  • SAMAs acute bronchospasm; PRN or regular basis for prevention/reduction of sx
  • LAMAs: when pts have persistent sx and require daily use of SABA or SAMAs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

contraindications for anticholinergics

A

-hypersensitivity to the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ADRs in anticholinergics

A
  • poorly absorbed so systemic side effects are limited
  • most common: dry mouth
  • less common: worsening prostatic sx
  • inadvertent spray into eyes has precipitated acute glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

monitoring parameters for anticholinergics

A
  • sx relief for efficacy

- appearance of side effects for safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ipratroprium

A
  • SAMA
  • Atrovent
  • MDI
  • 2-3 puffs QID
  • duration: 6-8 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

tiotroprium

A
  • LAMA
  • spiriva
  • DPI w capsule
  • 2 inhalations/ 1 capsule
  • duration: 24 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

albuterol/ipratropium

A
  • combivent; respimate; duoneb
  • very common in COPD
  • MDI
  • 1 puff QID or 1 vial QID
  • duration: 6-8 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

phosphodiesterase-4 inhibitor is a treatment only for what?

A

COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

phosphodiesterase-4 inhibitor MoA

A
  • reduces inflammation by inhibiting the breakdown of cAMP by phosphodiesterase-4
  • not a direct bronchodilator
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

indication for phosphodiesterase-4 inhibitor

A
  • reduce the risk of exacerbations in pts w/ severe COPD associated w/ chronic bronchitis and a hx of exacerbations
  • important b/c pts are most likely to die during exacerbation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

contraindications of phosphodiesterase-4 inhibitor

A

moderate to severe liver impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ADRs of phosphodiesterase-4 inhibitor

A
  • decreases appetite
  • nausea
  • abdominal pain
  • diarrhea
  • sleep disturbances
  • HA
  • weight loss can occur
  • caution in people w/ depression
  • do not use w/ theophylline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

monitoring parameters of phosphodiesterase-4 inhibitor

A
  • reduction of exacerbations

- adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

phosphodiesterase-4 inhibitor product

A

roflumilast (Daliresp) 500 mcg PO daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

MDI

A
  • metered dose inhalers
  • small devices that have a replaceable cartridge and act as a mouthpiece for delivery of meds into mouth for inhalation
  • cartridge contains medication dissolved in a propellant
28
Q

what different techniques can be used when using an MDI

A
  • mouthpiece inside mouth

- can be placed 1-2 fingers width away from mouth

29
Q

what is the role of spacer devices?

A
  • when pts have trouble w/ proper technique a spacer can be used
  • inhaler fits at the end of it , pt actuates the meter, med is released into chamber and the pt takes slow deep breaths to devliver drug to lungs
30
Q

What medication should a spacer be used with?

A

inhaled corticosteroid

31
Q

DPI

A
  • similar to MDI
  • instead of releasing medication suspended in a propellant mist it releases the medication as a dry powder
  • easier
  • no priming required
  • DO NOT use w/ spacer
32
Q

soft mist inhaler

A
  • release the medication in a soft mist
  • mist lasts in the are about 6x longer than from MDI
  • propellant free
  • about 75% of the aerosolized particles are the size that are inhaled
  • decreased oropharyngeal deposition
33
Q

theophylline (a methylzanthine) MoA

A

-causes modest bronchodilation d/t nonselective phosphodiesterase inhibition

34
Q

indication for theophylline

A
  • symptomatic tx
  • 3rd tier option for COPD
  • alternative bronchodilator
35
Q

contraindications for theophylline

A

-hypersensitivity

36
Q

drug interactions of theophylline

A
  • many

- always review a pts meds

37
Q

ADRs with theophylline

A
  • think caffeine (it’s also xanthine)
  • n/v
  • HA
  • jitters
  • insomnia
  • higher serum concentrations: persistent vom., cardiac arrhythmias, intractable seizures
38
Q

monitoring parameters for theophylline

A
  • **serum concentrations are very important
  • symptomatic improvement
  • side effects for toxicity
39
Q

What is the mainstay of asthma tx?

A

inhaled corticosteroids (ICS)

40
Q

ICS MoA

A
  • anti-inflammatory action reduces airway inflammation
  • glucocorticoids diffuse across cell membrane and bind to receptors in cytoplasm then go to nucleus and bind DNA
  • inhibits synthesis of many inflammatory proteins through suppression of genes that encode them
41
Q

ICS indication

A
  • agent of choice for all pts w/ persistent asthma regardless of severity
  • should be added to bronchodilators and not used as monotherapy
  • inhaled is preferred route
  • long term controller med
42
Q

ICS contraindications

A

-hypersensitivity to milk proteins for those prescribed advair diskus

43
Q

ADRs in ICS

A
  • dysphonia: hoarse voice d/t myopathy of laryngeal muscles, mucosal irritation and laryngeal candidiasis; reversible when tx is stopped
  • topical candidiasis: thrush
  • use spacer and rinse and spit to prevent
  • systemic effects: skin thinning, bruising, increased intraocular pressure, cataracts, growth deceleration, osteoporosis, increased risk of pneumonia, myopathy
44
Q

monitoring parameters for ICS

A
  • symptom relief

- adverse effects

45
Q

fluticasone

A
  • ICS
  • flovent
  • MDI
  • 440 mcg BID
46
Q

fluticasone and salmeterol

A
  • combo LABA plus ICS
  • advair diskus
  • DPI
  • 1 inhalation BID middle (250/50) inhaler strength
47
Q

cromolyn sodium inhalation solution MoA

A
  • prevent bronchospasm through mast cell stabilizing
  • prevent early and late asthmatic response to inhaled allergens
  • inhibits release of mediators of inflammation
48
Q

indication for cromolyn sodium

A
  • prevention only (controller)
  • prevention of exercise induced asthma
  • prevention of asthma sx caused by predictable allergic triggers
49
Q

contraindications for cromolyn sodium

A

-hypersensitivity

50
Q

ADRs of cromolyn sodium

A

-cough

51
Q

dosing of cromolyn sodium

A

-must be dosed 3-4 x day

52
Q

montelukast (Singulair) MoA

A
  • leukotriene receptor antagonists
  • blocks action of leukotriene D4 on CysLT1 receptor in lungs and bronchi
  • reduces bronchoconstriction caused by leukotrienes resulting in less inflammation
53
Q

indication for montelukast

A
  • prophylaxis and chronic tx of asthma

- prevention of exercise-induced bronchoconstrction

54
Q

contraindications for montelukast

A

-hypersensitivity

55
Q

ADRs of montelukast

A
  • HA
  • abdominal pain
  • cough
  • flu-like sx
  • **do not prescribe to those w/ active, preexisting anxiety, depression or sx of psychiatric disorder
56
Q

Omalizumab (Xolair) MoA

A
  • monoclonal ab against IgE

- forms complex w/ free IgE and prevents its interaction w/ receptors on mast cells, basophils, and others

57
Q

indication for Omalizumab

A
  • > 6 yo
  • moderate - severe persistant asthma
  • asthma sx that are inadequately controlled w/ ICS
  • total serum IgE level b/w 30-700
  • positive skin test for IgE to an allergen year round
58
Q

side effects of omalizumab

A

-injection site rxns

59
Q

What are the 3 anti IL-5 drugs

A
  • mepolizumab
  • reslizumab
  • benralizumab
60
Q

Mepolizumab (Nucala) MoA

A
  • humanized monoclonal ab specific for IL-5

- blocks IL-5 binding to receptor complex on eosinophil cell surface (binds the free IL-5)

61
Q

indication for mepolizumab

A

-maintenance tx of sever asthma in pts who are 12 or older and have eosinophilic phenotype

62
Q

ADRs of mepolizumab

A
  • hypersensitivity

- herpes zoster infections

63
Q

expected clinical outcome of mepolizumab

A
  • reduced exacerbations

- improved quality of life

64
Q

Reslizumab

A
  • IL-5 receptor antagonist (also binds free IL-5)
  • add-on maintenance therapy of severe asthma in pts over 18 w/ eosinophilic phenotype
  • need observation after dosing
  • best in pts w/ nasal polyps and high levels of blood and sputum eosinophils
65
Q

benralizumab

A
  • IL-5 receptor antagonist (actually bind receptor)

- add on therapy for pts >12 w/ sever asthma and an eosinophilic phenotype

66
Q

ADRs of benralizumab

A
  • HA
  • pharyngitis
  • hypersentivity rxns more so than other 2
67
Q

expected clinical outcomes of benralizumab

A
  • reduction in exacerbation rates

- glucocorticoid-sparing effect

Pulmonology 2 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions