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CPR Exam 2 > Pharm: Asthma & COPD > Flashcards

Pharm: Asthma & COPD Flashcards

1
Q

What is the goal of asthma management?

A

Control symptoms

Prevent remodeling

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2
Q

What two broad drug catergories are used for asthma treatment?

A

Anti-inflammatory drugs

Bronchodilators

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3
Q

What drug classes are included under the umbrella of anti-inflammatory drugs used to treat asthma?

A

Homone containing (corticosteroids) –> inhaled or oral

Antibodies

Non-hormone containing leukotriene receptor modifiers –>lipoxygenase inhibitors or receptor blockers

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4
Q

What drug classes are included under the umbrella of bronchodilators drugs used to treat asthma?

A

Beta-2 agonists (short or long acting)

Anticholinergic

Methylxanthines

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5
Q

What class of drugs excites bronchial B2 receptors?

A

Beta agonsits

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6
Q

What class of drug improves bronchial inflammation?

A

Inhaled corticosteroids

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7
Q

What class of drugs inhibits receptors in the bronchi?

A

Muscarinic antagonists

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8
Q

Which route of administration is the most effective when administering corticosteroids or B2 agonists?

A

Inhaled

More effective but minor route of administration

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9
Q

What is the major route of administration of corticosteroids/B2 agonists?

A

Orally

Less effective, have first pass metabolism (liver)

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10
Q

What is the drug treatment plan for asthma?

A

ICS –> LABA –> LAMA

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11
Q

What is the drug treatment plan for COPD?

A

LAMA –> LABA –> ICS

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12
Q

What are the short acting B2 agonist medications (SABA)?

A

Albuterol

Terbutaline

Metaproterenol

Pirbuterol

Levalbuterol

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13
Q

What is the MOA of B2 agonists?

A

Relax airway smooth muscle cells

Reverse bronchoconstriction asthma causes

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14
Q

What is important to know about B2 agonists compared to other asthma meds?

A

They are the most commonly used

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15
Q

What are indications for SABAs?

What are some additional indications for albuterol?

A

Treat or prevent acute bronchospasm

Albuterol used in:

asthma

acute bronchitis

COPD

bronchiolitis

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16
Q

What are some adverse effects of albuterol?

A

HA, dizziness, insomnia, dry mouth, cough

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17
Q

What are some warnings of SABAs?

A

paradoxical bronchospasm (esp metaproterenol)

deterioration of asthma

CV effects (esp. pirbuterol)

Immediate hypersensitivey reactions

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18
Q

What is unique about terbutaline?

A

It’s the only B2 drug available subQ

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19
Q

What is a contraindication to terbutaline injection?

A

sulfa allergy

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20
Q

What are the inhaled corticosteroids?

A

“-one” & “ide”

Beclomethasone

Fluticasone

Mometasone

Triamcinolone

Budesonide

Ciclesonide

Flunisolide

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21
Q

What is a warning unique to beclomethasone?

A

death due to adrenal insufficiency after transfer from oral corticosteroids

Months are required for recovery of hypothalamic-pituitary adrenal function

22
Q

What is the most effective controller of asthma?

A

ICS

Also the most effective anti-inflammatory used in asthma therapy

23
Q

What is the MOA of ICSs?

A

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

24
Q

What are some effects of ICS use?

A

rapidly improves sx of asthma

prevents sx of exercise induced asthma

reduce airway hyperresponsiveness

Prevent airway remodeling

25
Q

What is important to know when stopping ICS?

A

Withdrawl results in slow deterioration of asthma control

Do not tx underlying condition!

26
Q

What are some cautions/warnings of ICS?

A

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)

27
Q

What is a benefit specific to flunisolide?

A

Adding this med may reduce or eliminate need for oral corticosteroids

28
Q

What is your oral corticosteroid?

A

Prednisone

29
Q

When do you use an oral corticosteroid?

A

in combo with SABAs to tx moderate to severe asthma flairs

30
Q

What are your LABAs?

A

Fomoterol

Salmeterol

Indacaterol

Vilanterol

Olodaterol

31
Q

When is it appropriate to use LABAs?

A

Only in addition to a long-term asthma control medication such as a corticosteroid

For bronchospasm associated with COPD

32
Q

What is a warning for LABAs?

A

Increases risk of asthma related death and hospitalizations

33
Q

What are the anticholenergic drugs used for COPD?

A

Atropine

Ipratropium

Tiotropium

Aclidinium

34
Q

What anticholinergic drugs are used temporarily, for maintenance, and for long term maintenance?

A

Atropine - temporary

Ipratropium - maintenance

Tiotropium & aclidinium - long term maintenance

35
Q

What is the MOA of anticholinergic drugs?

A

block Ach from binding muscarinic receptors therefore preventing PSN impulses responsible for bronchoconstriction

36
Q

What is important to remember about atropine?

A

total dose should be restricted to 2-3 mg when used recurrently to avoid effects of atropine-induced tachycardia

Lots of side effects

37
Q

What is unique about ipratropium?

A

Relatively free of systemic anticholinergic effects

38
Q

What drugs are in the methylxanthine class?

A

Theophylline

Theobromine

Caffeine

39
Q

What is the MOA of methylxanthines?

A

Smooth muscle relaxation (bronchodilation)

Supression of airway response to stimuli

40
Q

What group of patients should you use extreme caution in when giving methylxanthines?

A

active peptic ulcer dz

seizure disorders

cardiac arrhythmias

41
Q

What are the leukotriene receptor antagonists/ lipoxygenase inhibitors?

A

Zafirlukast

Montelukast

42
Q

What is the MOA of LT antagonists?

A

Block cysteinyl leukotriene rectptors (CysLT1 receptors) reversibly

Decrease subsequent inflammatory cascade therefore decreasing airway edema & relaxing SM

43
Q

What is an indication for LT antagonists?

A

Tx and prevention for acute asthma attacks

Most prescribed drugs for management of asthma

44
Q

What specific LT does montelukast inhibit?

A

LTD4

45
Q

What specific LTs does Zafirlukast block?

A

LT D4 and E4

46
Q

What is a warning specific to zafirlukast?

A

Hepatotoxicity - life threatening hepatic failure

47
Q

What is the MOA of Zileuton?

A

Inhibits 5-lipoxygenase and thus inhibits LTB4, C4, D4 and E4

48
Q

When do you use Zileuton?

A

Prevent asthma attack, not to tx acute attack

49
Q

What is a warning of Zileuton?

A

Not recommended in cases of active liver dz or persistant hepatic enzympe elevations >3 times the upper limit of nl

50
Q

What monoclonal Ab is used in asthma?

A

Omalizumab

51
Q

What is the MOA of Omalizumab?

A

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

52
Q

What is a caution to take when administering omalizumab?

A

only administer in healthcare setting due to life threatening anaphylactic reaction, make sure you observe pts after administration

CPR Exam 2 (8 decks)

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