Pharm: Pulmonary Obstructive Diseases (COPD & Asthma)

Question 1

What are the 2 therapeutic goals in tx of obstructive lung diseases?

Answer 1

1. Decrease Bronchoconstriction

2. Decrease Inflammation

Question 2

What are the 3 categories of Bronchodilator drugs?

Answer 2

1. Methylxanthines
2. Anticholinergics/ Antimuscarinics
3. Sympathomimetics

Question 3

What medication is a methylxanthine?

Answer 3

Theophylline

Question 4

What medications are anticholinergics/ antimuscarinics?

Answer 4

Tiotropium, Ipratropium, Umeclidinium

Question 5

What are the 3 subcategories of sympathomimetics?

Answer 5

1. Short Acting Beta Agonists (SABA)
2. Long-Acting Beta Agonists (LABA)
3. Ultra-Long Acting Beta Agonists (Ultra LABA)

Question 6

What medications are SABA?

Answer 6

Albuterol, Terbutaline, Metaproterenol, Pirbuterol

Question 7

What medications are LABA?

Answer 7

Salmeterol, Formoterol

Question 8

What medications are Ultra LABA?

Answer 8

Indacaterol, Vilanterol, Olodaterol

Question 9

What are the 5 categories of Anti-Inflammatory drugs?

Answer 9

1. Chromones
2. Glucocoritcoids
3. Leukotriene Receptor Antagonists
4. Leukotriene Synthesis Inhibitor
5. Anti-IgE

Question 10

What medications are Chromones?

Answer 10

Cromolyn

Question 11

What medications are Glucocorticoids?

Answer 11

Inhaled:
Beclomethasone, Fluticasone, Budesonide, Mometasone
Oral:
Prednisone, Prednisolone

Question 12

What medications are Leukotriene Receptor Antagonists?

Answer 12

Zafirlukast, Montelukast

Question 13

What medications are Leukotriene Synthesis Inhibitor?

Answer 13

Zileuton

Question 14

What medications are Anti-IgE?

Answer 14

Omalizumab

Question 15

What is the MOA of Theophylline?

Answer 15

1. Blocks adenosine A1 receptor -> inhibiting bronchoconstriction
2. Blocks PDE -> increases cAMP -> stimulates bronchodilation

Question 16

Does Theophylline have a wide or narrow therapeutic index?

Answer 16

Narrow, therefore it is easy to obtain a TOXIC dose and is NOT used often.

Question 17

Adverse Effects of Theophylline at plasma [ ]’s > 20 mg/L

Answer 17

1. Tachycardia
2. Agitation, Restlessness
3. Anxiety, Fear & Panic

Question 18

Adverse Effects of Theophylline at plasma [ ]’s > 40 mg/L

Answer 18

Convulsions & Death

Question 19

Why should we beware of Theophylline rapid infusion?

Answer 19

Sudden death can occur w/cardiac arrhythmias!

Question 20

What is the MOA of antimuscarinics?

Answer 20

Block M1 & M3 receptos -> decreases stimulatory effect of acetylcholine -> airway smooth m relaxes and mucus gland secretion decreases

Question 21

The prototype antimuscarinic drug is…

Answer 21

Tiotropium

Question 22

What are the adverse effects of antimuscarinics?

Answer 22

1. Dry mouth
2. Blurred vision/mydriasis
3. Tachycardia
4. Skin rash, hives, itching
5. Angioedema

Question 23

What is the MOA of sympathomimetics?

Answer 23

Binds to B2 agonist receptor -> bronchial smooth m relaxation & inhibits the release of mediators

Question 24

The prototype SABA drug is…

Answer 24

Albuterol

Question 25

SABA medications are used for...

Answer 25

Rapid Relief - - PRN - - Mild to Intermittent Asthma

Question 26

What are the adverse effects of SABA meds?

Answer 26

1. Skeletal M Tremor 2. Tachycardia 3. Cardiac Arrhythmias 4. Receptor Desensitization

Question 27

What Ultra LABA meds are NOT indicated for tx of asthma?

Answer 27

Indacaterol & Olodaterol -> ONLY for COPD!

Question 28

Vilanterol can be used for the tx of asthma when administered with what other med?

Answer 28

Fluticasone

Question 29

Vilanterol can be used for the tx of COPD when administered with what other med?

Answer 29

Umeclidinium

Question 30

What is the MOA of Salmeterol?

Answer 30

It binds to a lipophilic portion of the receptor that acts as an anchor allowing the albuterol head of the drug molecule to associate and dissociate with the receptor binding site that stimulates activity.

Question 31

What is the MOA of Formoterol?

Answer 31

Intercalates w/in the lipid membrane from which it is slowly released to bind to the Beta2 receptor.

Question 32

What are the adverse effects of LABA and Ultra LABA meds?

Answer 32

1. Tachycardia, Arrhythmias 2. Does NOT decrease bronchial hyper-responsiveness 3. Ass w/asthma-related deaths

Question 33

What medication must be administered with a LABA?

Answer 33

Inhaled corticosteroid

Question 34

What is the MOA of Cromolyn?

Answer 34

Activates a "turn-off" switch linked to a chloride current that opens calcium channels -> decreases calcium -> decreases degranulation of mast cells -> decreases release of cytokines, chemokines, histamine, & leukotrienes mediators.

Question 35

Cromolyn is only available as a _____ for _____.

Answer 35

solution, nebulization

Question 36

Is Cromolyn well tolerated or cause severe adverse effects?

Answer 36

Well tolerated

Question 37

What is Cromolyn used for, and what is the benefit of it's regular use?

Answer 37

It is used prophylactically to prevent attacks, and regular use of the med decreases bronchial reactivity. Therefore, it allows a decrease in the use of a bronchodilator.

Question 38

What is the protocol for withdrawal of tx of systemic glucocorticoids once symptoms are controlled?

Answer 38

MUST be withdrawn slowly to avoid adrenal insufficiency!

Question 39

Zileuton decreases the need to use what?

Answer 39

Beta 2 Agonist Inhaler

Question 40

Omalizumab is ONLY used as add on therapy for...

Answer 40

Asthmatics w/HIGH IgE levels

Question 41

What are the adverse effects of Omalizumab?

Answer 41

It is well tolerated, however, it is possible to develop anaphylaxis

Question 42

What is the use of Inhaled Glucocorticoids?

Answer 42

Prophylactic use for Moderate to Severe Asthma that is capable of being used alone. **It takes several weeks of tx for improvement of sx to be observed

Question 43

What are the adverse effects of Inhaled Glucocorticoids?

Answer 43

1. Oropharyngeal Candidiasis 2. Dysphonia -> laryngitis & hoarse voice 3. Decreased bone mineral density 4. Resistance can dvlp

Question 44

Systemic Glucocorticoids are used for...

Answer 44

1. Asthma exacerbations 2. Acute asthma 3. Severe asthma * **Oral

Question 45

The adverse effects of Glucocorticoids are...

Answer 45

1. Disturbances of mood 2. Increased appetite 3. Impaired glucose control 4. Susceptibility to infections

Question 46

The MOA of Montelukast & Zafirlukast?

Answer 46

Competitive antagonists at the cys-Leukotriene 1 receptor (cys-LT1) **stimulated cys-LT1 receptors are responsible for bronchoconstriction, edema and eosinophil activation

Question 47

The adverse effects of Montelukast & Zafirlukast?

Answer 47

Rare dvlp of Churg-Strauss Syndrome (Vasculitis) from possibly uncovering a pre-existing condition.

Question 48

The MOA of Zileuton?

Answer 48

Inhibition of the enzyme 5-Lipoxygenase -> inhibits formation of cys-LTs -> decreases amount of cys-LTs available to stimulate production of chemotactic autocoids -> decreases the attraction and migration of leukocytes into the area of inflammation.

Question 49

The adverse effects of Zileuton?

Answer 49

Elevation of serum liver enzymes, therefore, liver function tests are recommended

Question 50

What is the MOA of Omalizumab?

Answer 50

Binds to IgE antibody -> IgE is unable to bind to Mast Cells -> No allergen-induced activation -> decreases the release of histamine, leukotrienes and cytokine mediators

Question 51

What is the route of administration of Omalizumab?

Answer 51

Subcutaneous every 2-4 weeks