PHARMA Flashcards
Chronic disease characterized by hyperresponsive airways
Asthma
Includes emphysema and chronic bronchitis
COPD
An extremely common condition that significantly decreases pt reported quality of life
Allergic rhinitis
Allergic Rhinitis characterized by:
-Itchy
-Watery eyes
-Runny Nose
-Non-productive cough
An effective defensive respiratory response to irritants
Coughing
Cited as number one reason why patients seek medical care
Coughing
May present several etiologies such as:
-Common cold
-Sinusitis
-Underlying chronic respiratory disease
Medication Management for Cough
-Given topically to the nasal mucosa
-Inhaled into the lungs
-Orally or parentally for systemic absorptic
Preferred to target affected tissues while minimizing systemic side effects
Nasal Sprays or Inhalers
-To decrease the intensity and frequency of asthma symptoms and the degree to which the patient is limited by these symptoms.
-All patients need to have a “quick-relief” medication to treat acute asthma symptoms.
-Drug therapy for long term control of asthma is designed to reverse and prevent airway
inflammation.
Goal of Therapy
Leukotriene Modifiers
-Montelukast (Asthma, Allergic Rhinitis)
-Zafirlukast (Asthma)
-Ziluetion (Asthma)
Anthistamine (H1-Receptor Blockers)
-Azelastine
-Cetirizine
-Desloratadine
-Fexofenadine
-Loratadine
Adrenergic Agonists
-Oxymetazoline
-Phenylephrine
-Pseudoephedrine
Agents for cough
-Benzonatate
-Codeine (with guaifenesin)
-Dextromethorphan
-Guaifenesin
Other Agents:
-Cromolyn
-Omalizumab
-Roflumilast
-Theophylline
Short- Acting B2 Adrenergic Agonists (ends with terol)
-Albuterol
-Levalbuterol
Long-Acting B2 Adrenergic Agonists (ends with terol)
-Arformoterol
-Formoterol
-Indacaterol
-Salmeterol
Inhaled Corticosteroids
-Beclomethasone
-Budesonide
-Ciclesonide
-Fluticasone
-Mometasone
-Triamcinolone
Long-Acting B2 Adrenergic Agonist/Corticosteroid Combination
-Formoterol/budesonide
-Formoterol/mometasone
-Salmeterol/fluticasone
-Vilanterol/fluticasone
Short-acting Anticholinergic
-Ipratropium
Long-Acting Anticholinergic
-Aclidinium bromide
-Tiotropium
Long-Acting Anticholinergic
-Aclidinium bromide
-Tiotropium
A chronic disease with an underlying infammatory pathophysiology
Asthma
Goals of chronic asthma therapy
2 Categories
-Reduction in impairment
-Reduction of risk
Means decreasing the intensity and frequency of asthma symptoms and the degree to which the patient is limited by these symptoms
Reducing Impairment
Means decreasing the adverse outcomes associated with asthma and its tx
Reducing risk
3 asthma phenotype
-Homozygous glycine
-Heterozygous glycine/arginine
-Homozygous arginine
May be risk for worsening sx with long acting b2 agonist
Homozygous arginine
Removal of seven metered-dose inhalers (MDI)
-Nedocromil
-Metaproterenol
-Tiramcinolone
-Cromolyn
-Flunisolide
-Albuterol/ipratropium
-Pirbuterol
Acute sx may resolve spontaneously with nonpcol relaxation exercise or use of “quick relief” medications
Short acting b2 adrenergic agonist
Is the first line bronchodilators in acute asthma attacks
-Albuterol
-Terbutaline
-Formoterol
-Metaproterenol
-Pirbuterol
-Rapid onset of action (5-10 minutes)
-Provide relief for 4 to 6 hours
-Provide quick relief of acute bronchoconstriction
Short Acting B2 Agonist
May be appropriate for px identified as having intermittent asthma/exercise-induced bronchospasm
Monotherapy of SABA
Adverse effect of SABA
-Tachycardia
-Hyperglycemia
-Hypokalemia
-Hypomagnesemia
Adverse effect of SABA may minimized with delivery via
inhalation vs systemic routes
-Acute anaphylaxis
-Status epilepticus
Epinephrine
Long acting b2 agonists
-Formoterol
-Salmeterol
-Bambuterol
-Indacaterol
Are considered to be useful adjunctive therapy for attaining asthma control
LABA
Inhibit the release of arachidonic acid through phospholipase A2 inhibition, thereby producing direct anti-inflammatory properties in the airways
Corticosteroids
Severe persistent asthma may require the addition of
Require the addition of a short course of oral glucocorticoid treatment
In order to be effective in controlling inflammation, glucocorticoids must be used
REGULARLY
Inflammatory Process begins with
chemical “ALARM”
Inflammatory Process releases
Histamines
Kinins
Inflammatory causes
-BVs dilatation
-Capillaries leakage
-Activate pain receptors
-Attract phagocytes and WBCs
Corticosteroids actions on lung:
-Inhaled Corticosteroids do not directly affect the airway smooth muscle
-It directly targets underlying airway inflammation by decreasing the inflammatory cascade (eosinophils, macrophages, and T lymphocytes)
-reversing mucosal edema
-Decreasing the permeability of capillaries, and inhibiting the release of leukotrienes
What happens to corticosteroids after several months of regular use?
-ICS reduces the hyperresponsiveness of the airway smooth muscle o a variety of bronchoconstrictor stimuli, such as:
Allergens
Irritants
Cold air
Exercise
Corticosteroids routes of administration
a. inhalation
b. oral/systemic
Patients with a severe exacerbation of asthma are advised to
Use intravenous methylprednisolone or oral prednisone to reduce airway inflammation
Management of Bronchial Asthma
Relievers-?
SABA/ bronchodilators
Management of Bronchial Asthma
Controllers-?
LABAs + inhaled corticosteroids
If acute exacerbations occurs used:
SABA
Prevention of exacerbations used
LABA
4th most common cause of preventable deaths in US
COPD
Clinically useful drugs mitigate the specific pathology such as
-Relaxation of bronchial smooth muscle
-Modulating the inflammatory response
Less than 2 days per week
Intermittent
More than 2 days per week, not daily
Mild Persistent
Daily
Moderate Persistent
Continual
Severe Persistent
Intermittent results of peak flow or spirometry
Near normal
Mild persistent results of peak flow or spirometry
Near normal
Moderate persistent results of peak flow or spirometry
60% to 80% of normal
Severe persistent results of peak flow or spirometry
Less than 60% of normal
Long-term control of intermittent
No daily medication
Long-term control of mild persistent
Low-dose ICS
Long-term control of moderate persistent
Low-dose ICS + LABA or Medium-dose ICS
Long-term control of severe persistent
Medium-dose ICS + LABA or High-dose ICS + LABA
Episodes of acute bronchitis causing
-SOB
-Cough
-Chest Tightness
-Wheezing
-Rapid Respiration
How many percentages of the PT population is affected by asthma
16-20%
