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Pulmonology > Pharm II - Pulm; Lecture 10a > Flashcards

Pharm II - Pulm; Lecture 10a Flashcards

1
Q

Name the 4 Anti-Inflammatory Agents for

this Module

A
  1. Glucocorticoids
  2. Mast Cell Membrane Stabilizers
  3. Leukotriene Receptor Antagonist
  4. Phosphodiesterase-4 Inhibitor
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2
Q

Asthma

A
  • Risks: Genetics, atopy, obesity
  • Sn/Sm:
    • Dyspnea (worse at night and early morning)
    • Reversible bronchospasm
    • Episodic wheezing
    • Cough
      • Worse w/ irritant exposure to allergen/irritant
  • Prolonged Expiratory & inspiratory phases
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3
Q

Asthma Treatment

A
  • Treatment is determined by severity.
  • Response-based; Step-wise Rx
    • If patient is a Step 4 and up, consult an allergist/ENT for management
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4
Q

COPD

A
  • Risks: Tobacco smoking; occupational
  • Sn/Sm: Excessive cough, sputum production, continual dyspnea
  • Prolonged expiratory phase
    • Airway obstruction secondary to airway damage/destruction
  • 2 Types: Chronic Bronchitis & Emphysmea
  • Exacerbations are typically secondary to viral infections
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5
Q

Approach to Bronchospastic D/O’s

A
  • Directly decrease Bronchospasm:
    • Acute:
      • Stimulate B2-agonist receptors
    • Long Term:
      • Increase cAMP levels in smooth muscle (to decrease muscle irritability)
  • Decrease bronchial responsiveness to stimulation:
    • Long term:
      • Decrease IgE levels via allergy tmt
      • Decrease IgE binding to mast cell membrane receptors
      • Stabilize mast cell membrane to prevent degranulation
      • Decrease smooth muscle psym receptor response to stimulation
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6
Q

Anti-Inflammatory Agent

Fluticasone [Flovent]

  • Glucocorticoid*
  • (Indications, MOA, SE/ADRs)*
A
  • Indications: Asthma, COPD
  • MOA: Anti-inflam., immunosuppres, anti-proliferative
  • SE/ADRs: HA, oral thrush!*, URI, throat irritation

*Rinse mouth after use to prevent oral candidiasis!

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7
Q

Anti-Inflammatory Agent

Fluticasone [Flovent]

Glucocorticoid

Contraindications, Dx-Dx, Monitor, Other

A
  • Contras: Hypersensitive, acute bronchospasm, latent TB, glaucoma, cataracts
  • Dx-Dx: Minimal (via inhalation)
  • Monitor: Spirometry (peak flow levels)
  • PG: C; Lact: caution
  • Other: Long-term prophylaxsis of bronchospasm
    • Children: Possible grown slowing, but will “catch up”
    • *RINSE MOUTH AFTER USE!
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8
Q
A
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9
Q

Anti-Inflammatory Agent

Budesonide

(Pulmocort inhaler)

A
  • This drug is another type of glucocorticoid, but is LESS SYSTEMICALLY absorbed
    • Can use with someone who is pregnant
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10
Q

Anti-Inflammatory Agent

Prednisone

Glucocorticoid

Indications, MOA, SE/ADRs

A
  • Indications: Adjuct therapy in exacerbation of bronchospasm; multiple others
  • MOA: Anti-inflam early after admin by decreasing migration of WBCs, reversal capillary permeability, immunosuppresant; later onset of inhibition of protein synthesis
  • SE/ADRs:
    • Short term = minimal
    • Long term (10-14days+) = multiple (supresses hypopituitary adrenal…)
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11
Q

Anti-Inflammatory Agent

Prednisone

  • Glucocorticoid*
  • Contraindications, Dx-Dx, Monitor, Other*
A
  • Contra: Hypersensitive, acute bronchospasm (unless adjunct), latent TB, glaucoma, cataracts
  • Dx-Dx: tNSAIDs, anti-diabetic meds, anti-HTN meds
  • Monitor: Spirometry
  • PG & Lact: Caution
  • Other: Short term oral “burst” therapy in exacerbation of bronchospasm; Asthma & COPD (more recent use); avoid long-term oral use.
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12
Q

Anti-Inflammatory Agent

Cromolyn Sodium [Crolom MDI]

Mast Cell Stabilizer

Indications, MOA, SE/ADRs

A
  • Indications: Childhood asthma
  • MOA: Stabilizes Mast Cell Membrane to prevent degranulatio and release of histamine, leukotrienes, slow-reacting substance of anaphylaxis
  • SE/ADRs: HA, bad taste, hoarseness, cough
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13
Q

Anti-Inflammatory Agent

Cromolyn Sodium [Crolom MDI]

  • Mast Cell Stabilizer*
  • Contraindications, Dx-Dx, Monitor, Other*
A
  • Contra: Hypersensitivity, acute asthma
  • Dx-Dx: NONE! whoohoo
  • Monitor: Spirometry
  • PG: B
  • Other: Works better in children v. adults
    • Inhalation route; PO Route for investigational for food allergy/IBD
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14
Q

Anti-Inflammatory Agent

Zafirlukast [Accolate]

Oral Leukotriene Receptor Antagonist

Indications, MOA, SE/ADRs

A
  • Indications: Asthma, NOT COPD
    • Long-term anti-inflammatory prophylactic
  • MOA: Selective & competitive antagonist of leukotriene receptors D4, E4 & SRSA
  • SE/ADRs: HA, N/D, Hepatitis
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15
Q

Anti-Inflammatory Agent

Zafirlukast [Accolate]

Oral Leukotriene Receptor Antagonist

Contraindications, Dx-Dx, Monitor, Other

A
  • Contra: Hypersensitive, Acute Exacerbation of Asthma, caution: Alcoholic cirrosis
  • Dx-Dx: Taken w/ food decreases bioavailability by 40%
  • Monitor: Spirometry, LFT
  • PG: B; Lact: no recommended
  • Other: Can continue but NOT start Zarfirlukast during acute exacerbation of asthma (long-term prophylactic)
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16
Q

Bronchospasm:

Pertinent Physiology

A
  • Bronchioles: Composed of smooth muscle & elastic fibers w/o cartilage support
    • Smooth muscle innervated by:
      • Sympathetic & Parasympathetic Nerves
        • Parasym = Vagus Nerve
          • Maintains slightly constricted tonic tone
  • Bronchospasm occurs secondary to cholinergic motor neurons responding to ACH stimulation
17
Q

Bronchodilation

Pertinent Physiology

A
  • Sympathetic stimulation (via catacolamines) increase cAMP, causing smooth muscles to RELAX
  • B2-Agonists = selectively stimulate sympathetic nerve receptors in bronical smooth muscle =’s reduce bronchospasm, increase vasodilation, decrease glandular secretion
  • Anti-cholinergics = Inhibit ACH action =’s reduces bronchospasm
  • PDE Inhibitors = decrease cAMP degradation rate =’s promotes bronchdilation
18
Q

Terbutaline

Beta2 Adrenergic Agonist Bronchodilator

A

Not Really in use in US anymore

  • Avoid use in elderly!
  • Lots of contraindications with Heart disorders
19
Q

Bronchdilators:

Albuterol

  • Beta2 Agonist*
  • SABA (short-acting)*

Indications, MoA, SE/ADRs

A
  • Indications: Bronchospasm in Asthma, COPD, & Exercise-Induced Bronchospasm
  • MoA: Bronchial smooth muscle B2-receptor stimulation (sympathetic); Racemic R (active) & S (inactive) mixture
  • SE/ADRs: Angina, Increase or Decrease BP, arrhythmias, palpitation, CNS stimulation, angioedema, restlessnes, wakefulness
20
Q

Bronchdilators:

Albuterol

  • Beta2 Agonist*
  • SABA (short-acting)*

Contraindications, Dx-Dx, Monitor, Other

A
  • Contra: Caution with HTN, CHF, Arrhythmias, seizure d/os, diabetes, glaucoma, hyperthyroidism, low serum K+
  • Dx-Dx: Beta Blockers
  • Monitor: Spirometry
  • PG: C; Lact: Caution
  • Other:
    • Treatment, or prophylaxis; multiple formulations, Use of spacer w/ MDI
    • Use in conjunction w/ anti-inflammatory agent for long-term use for other than mild asthma.
    • Tolerance develops with long term use of B2-agonists!
21
Q

Bronchdilators:

Levalbuterol [Xopenex HFA]

  • Beta2 Agonist*
  • SABA (short-acting)*

Indications, MoA, SE/ADRs

A
  • Indications: Treatment or prevention of bronchospasm in reversible airway disease
  • MoA:

Pulmonology (5 decks)

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