Pharm: Asthma & COPD Flashcards
What is the goal of asthma management?
Control symptoms
Prevent remodeling
What two broad drug catergories are used for asthma treatment?
Anti-inflammatory drugs
Bronchodilators
What drug classes are included under the umbrella of anti-inflammatory drugs used to treat asthma?
Homone containing (corticosteroids) –> inhaled or oral
Antibodies
Non-hormone containing leukotriene receptor modifiers –>lipoxygenase inhibitors or receptor blockers
What drug classes are included under the umbrella of bronchodilators drugs used to treat asthma?
Beta-2 agonists (short or long acting)
Anticholinergic
Methylxanthines
What class of drugs excites bronchial B2 receptors?
Beta agonsits
What class of drug improves bronchial inflammation?
Inhaled corticosteroids
What class of drugs inhibits receptors in the bronchi?
Muscarinic antagonists
Which route of administration is the most effective when administering corticosteroids or B2 agonists?
Inhaled
More effective but minor route of administration
What is the major route of administration of corticosteroids/B2 agonists?
Orally
Less effective, have first pass metabolism (liver)
What is the drug treatment plan for asthma?
ICS –> LABA –> LAMA
What is the drug treatment plan for COPD?
LAMA –> LABA –> ICS
What are the short acting B2 agonist medications (SABA)?
Albuterol
Terbutaline
Metaproterenol
Pirbuterol
Levalbuterol
What is the MOA of B2 agonists?
Relax airway smooth muscle cells
Reverse bronchoconstriction asthma causes
What is important to know about B2 agonists compared to other asthma meds?
They are the most commonly used
What are indications for SABAs?
What are some additional indications for albuterol?
Treat or prevent acute bronchospasm
Albuterol used in:
asthma
acute bronchitis
COPD
bronchiolitis
What are some adverse effects of albuterol?
HA, dizziness, insomnia, dry mouth, cough
What are some warnings of SABAs?
paradoxical bronchospasm (esp metaproterenol)
deterioration of asthma
CV effects (esp. pirbuterol)
Immediate hypersensitivey reactions
What is unique about terbutaline?
It’s the only B2 drug available subQ
What is a contraindication to terbutaline injection?
sulfa allergy
What are the inhaled corticosteroids?
“-one” & “ide”
Beclomethasone
Fluticasone
Mometasone
Triamcinolone
Budesonide
Ciclesonide
Flunisolide
What is a warning unique to beclomethasone?
death due to adrenal insufficiency after transfer from oral corticosteroids
Months are required for recovery of hypothalamic-pituitary adrenal function
What is the most effective controller of asthma?
ICS
Also the most effective anti-inflammatory used in asthma therapy
What is the MOA of ICSs?
Switch off transcription of multiple activated genes that incode inflammatory proteins
Have several effects on the inflammatory process
Reduce eosinophils, number of activated T cells, and surface mast cells in airway mucosa
What are some effects of ICS use?
rapidly improves sx of asthma
prevents sx of exercise induced asthma
reduce airway hyperresponsiveness
Prevent airway remodeling
What is important to know when stopping ICS?
Withdrawl results in slow deterioration of asthma control
Do not tx underlying condition!
What are some cautions/warnings of ICS?
Don’t use as primary tx of status asthmaticus or other acute asthma episodes (budesonide & mometasone)
Severe hypersensitivity rxn in those with milk protein allergies (mometasone & budesonide)
Candida infections
Severe adrenal insufficiency (beclomethasone & triamcinolone)
What is a benefit specific to flunisolide?
Adding this med may reduce or eliminate need for oral corticosteroids
What is your oral corticosteroid?
Prednisone
When do you use an oral corticosteroid?
in combo with SABAs to tx moderate to severe asthma flairs
What are your LABAs?
Fomoterol
Salmeterol
Indacaterol
Vilanterol
Olodaterol
When is it appropriate to use LABAs?
Only in addition to a long-term asthma control medication such as a corticosteroid
For bronchospasm associated with COPD
What is a warning for LABAs?
Increases risk of asthma related death and hospitalizations
What are the anticholenergic drugs used for COPD?
Atropine
Ipratropium
Tiotropium
Aclidinium
What anticholinergic drugs are used temporarily, for maintenance, and for long term maintenance?
Atropine - temporary
Ipratropium - maintenance
Tiotropium & aclidinium - long term maintenance
What is the MOA of anticholinergic drugs?
block Ach from binding muscarinic receptors therefore preventing PSN impulses responsible for bronchoconstriction
What is important to remember about atropine?
total dose should be restricted to 2-3 mg when used recurrently to avoid effects of atropine-induced tachycardia
Lots of side effects
What is unique about ipratropium?
Relatively free of systemic anticholinergic effects
What drugs are in the methylxanthine class?
Theophylline
Theobromine
Caffeine
What is the MOA of methylxanthines?
Smooth muscle relaxation (bronchodilation)
Supression of airway response to stimuli
What group of patients should you use extreme caution in when giving methylxanthines?
active peptic ulcer dz
seizure disorders
cardiac arrhythmias
What are the leukotriene receptor antagonists/ lipoxygenase inhibitors?
Zafirlukast
Montelukast
What is the MOA of LT antagonists?
Block cysteinyl leukotriene rectptors (CysLT1 receptors) reversibly
Decrease subsequent inflammatory cascade therefore decreasing airway edema & relaxing SM
What is an indication for LT antagonists?
Tx and prevention for acute asthma attacks
Most prescribed drugs for management of asthma
What specific LT does montelukast inhibit?
LTD4
What specific LTs does Zafirlukast block?
LT D4 and E4
What is a warning specific to zafirlukast?
Hepatotoxicity - life threatening hepatic failure
What is the MOA of Zileuton?
Inhibits 5-lipoxygenase and thus inhibits LTB4, C4, D4 and E4
When do you use Zileuton?
Prevent asthma attack, not to tx acute attack
What is a warning of Zileuton?
Not recommended in cases of active liver dz or persistant hepatic enzympe elevations >3 times the upper limit of nl
What monoclonal Ab is used in asthma?
Omalizumab
What is the MOA of Omalizumab?
Binds to free IgE, decreasing cell bound IgE
Decreases expression of high affinity receptors on mast cells, basophils & eosinophils that cross react with IgE
Decreases mediatior release
Decreases allergic inflammation/prevents asthma/reduces sx
What is a caution to take when administering omalizumab?
only administer in healthcare setting due to life threatening anaphylactic reaction, make sure you observe pts after administration
