Pharm - Asthma and COPD Flashcards
Which asthma meds are quick relievers?
-SABAs
Which asthma meds are long term controllers ?
-inhaled corticosteroids
SABA MoA
-binds beta2-adrenergic receptors on bronchioles resulting in relaxation of the smooth muscles that surround the airway = bronchodilation
Indication for SABAs
- 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
ADRs for SABAs
- sinus tachycardia
- arrhythmias
- higher doses: somatic tremor
- HA
- dizziness
- cough
- decrease of serum K (esp. w/ other drug that are not K-sparing)
Monitoring parameters for SABAs
- symptom relief
- adverse effects
albuterol
- SABA
- Brand: Proventil
- MDI
- 2 puffs q 4-6 hrs PRN
- duration of action: 4-6 hrs
LABAs MoA
- same as SABA but altered to sit on receptors longer
- controller, NOT rescue
Indications for LABAs
- 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
Contraindications of LABAs
- 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
salmeterol xinafoate
- LABA
- DPI
- 1 inhalation BID
- duration: 12 hrs
Anticholinergics MoA
- 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
indication for anticholinergics
- 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
contraindications for anticholinergics
-hypersensitivity to the drug
ADRs in anticholinergics
- 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
monitoring parameters for anticholinergics
- sx relief for efficacy
- appearance of side effects for safety
ipratroprium
- SAMA
- Atrovent
- MDI
- 2-3 puffs QID
- duration: 6-8 hrs
tiotroprium
- LAMA
- spiriva
- DPI w capsule
- 2 inhalations/ 1 capsule
- duration: 24 hrs
albuterol/ipratropium
- combivent; respimate; duoneb
- very common in COPD
- MDI
- 1 puff QID or 1 vial QID
- duration: 6-8 hrs
phosphodiesterase-4 inhibitor is a treatment only for what?
COPD
phosphodiesterase-4 inhibitor MoA
- reduces inflammation by inhibiting the breakdown of cAMP by phosphodiesterase-4
- not a direct bronchodilator
indication for phosphodiesterase-4 inhibitor
- 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
contraindications of phosphodiesterase-4 inhibitor
moderate to severe liver impairment
ADRs of phosphodiesterase-4 inhibitor
- decreases appetite
- nausea
- abdominal pain
- diarrhea
- sleep disturbances
- HA
- weight loss can occur
- caution in people w/ depression
- do not use w/ theophylline
monitoring parameters of phosphodiesterase-4 inhibitor
- reduction of exacerbations
- adverse effects
phosphodiesterase-4 inhibitor product
roflumilast (Daliresp) 500 mcg PO daily
MDI
- 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
what different techniques can be used when using an MDI
- mouthpiece inside mouth
- can be placed 1-2 fingers width away from mouth
what is the role of spacer devices?
- 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
What medication should a spacer be used with?
inhaled corticosteroid
DPI
- 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
soft mist inhaler
- 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
theophylline (a methylzanthine) MoA
-causes modest bronchodilation d/t nonselective phosphodiesterase inhibition
indication for theophylline
- symptomatic tx
- 3rd tier option for COPD
- alternative bronchodilator
contraindications for theophylline
-hypersensitivity
drug interactions of theophylline
- many
- always review a pts meds
ADRs with theophylline
- think caffeine (it’s also xanthine)
- n/v
- HA
- jitters
- insomnia
- higher serum concentrations: persistent vom., cardiac arrhythmias, intractable seizures
monitoring parameters for theophylline
- **serum concentrations are very important
- symptomatic improvement
- side effects for toxicity
What is the mainstay of asthma tx?
inhaled corticosteroids (ICS)
ICS MoA
- 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
ICS indication
- 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
ICS contraindications
-hypersensitivity to milk proteins for those prescribed advair diskus
ADRs in ICS
- 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
monitoring parameters for ICS
- symptom relief
- adverse effects
fluticasone
- ICS
- flovent
- MDI
- 440 mcg BID
fluticasone and salmeterol
- combo LABA plus ICS
- advair diskus
- DPI
- 1 inhalation BID middle (250/50) inhaler strength
cromolyn sodium inhalation solution MoA
- prevent bronchospasm through mast cell stabilizing
- prevent early and late asthmatic response to inhaled allergens
- inhibits release of mediators of inflammation
indication for cromolyn sodium
- prevention only (controller)
- prevention of exercise induced asthma
- prevention of asthma sx caused by predictable allergic triggers
contraindications for cromolyn sodium
-hypersensitivity
ADRs of cromolyn sodium
-cough
dosing of cromolyn sodium
-must be dosed 3-4 x day
montelukast (Singulair) MoA
- leukotriene receptor antagonists
- blocks action of leukotriene D4 on CysLT1 receptor in lungs and bronchi
- reduces bronchoconstriction caused by leukotrienes resulting in less inflammation
indication for montelukast
- prophylaxis and chronic tx of asthma
- prevention of exercise-induced bronchoconstrction
contraindications for montelukast
-hypersensitivity
ADRs of montelukast
- HA
- abdominal pain
- cough
- flu-like sx
- **do not prescribe to those w/ active, preexisting anxiety, depression or sx of psychiatric disorder
Omalizumab (Xolair) MoA
- monoclonal ab against IgE
- forms complex w/ free IgE and prevents its interaction w/ receptors on mast cells, basophils, and others
indication for Omalizumab
- > 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
side effects of omalizumab
-injection site rxns
What are the 3 anti IL-5 drugs
- mepolizumab
- reslizumab
- benralizumab
Mepolizumab (Nucala) MoA
- humanized monoclonal ab specific for IL-5
- blocks IL-5 binding to receptor complex on eosinophil cell surface (binds the free IL-5)
indication for mepolizumab
-maintenance tx of sever asthma in pts who are 12 or older and have eosinophilic phenotype
ADRs of mepolizumab
- hypersensitivity
- herpes zoster infections
expected clinical outcome of mepolizumab
- reduced exacerbations
- improved quality of life
Reslizumab
- 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
benralizumab
- IL-5 receptor antagonist (actually bind receptor)
- add on therapy for pts >12 w/ sever asthma and an eosinophilic phenotype
ADRs of benralizumab
- HA
- pharyngitis
- hypersentivity rxns more so than other 2
expected clinical outcomes of benralizumab
- reduction in exacerbation rates
- glucocorticoid-sparing effect
