PHARMA Flashcards by Kate Carmie

Chronic disease characterized by hyperresponsive airways

Asthma

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Includes emphysema and chronic bronchitis

COPD

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An extremely common condition that significantly decreases pt reported quality of life

Allergic rhinitis

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Allergic Rhinitis characterized by:

-Itchy
-Watery eyes
-Runny Nose
-Non-productive cough

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An effective defensive respiratory response to irritants

Coughing

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Cited as number one reason why patients seek medical care

Coughing

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May present several etiologies such as:

-Common cold
-Sinusitis
-Underlying chronic respiratory disease

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Medication Management for Cough

-Given topically to the nasal mucosa
-Inhaled into the lungs
-Orally or parentally for systemic absorptic

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Preferred to target affected tissues while minimizing systemic side effects

Nasal Sprays or Inhalers

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-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

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Leukotriene Modifiers

-Montelukast (Asthma, Allergic Rhinitis)
-Zafirlukast (Asthma)
-Ziluetion (Asthma)

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Anthistamine (H1-Receptor Blockers)

-Azelastine
-Cetirizine
-Desloratadine
-Fexofenadine
-Loratadine

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Adrenergic Agonists

-Oxymetazoline
-Phenylephrine
-Pseudoephedrine

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Agents for cough

-Benzonatate
-Codeine (with guaifenesin)
-Dextromethorphan
-Guaifenesin

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Other Agents:

-Cromolyn
-Omalizumab
-Roflumilast
-Theophylline

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Short- Acting B2 Adrenergic Agonists (ends with terol)

-Albuterol
-Levalbuterol

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Long-Acting B2 Adrenergic Agonists (ends with terol)

-Arformoterol
-Formoterol
-Indacaterol
-Salmeterol

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Inhaled Corticosteroids

-Beclomethasone
-Budesonide
-Ciclesonide
-Fluticasone
-Mometasone
-Triamcinolone

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Long-Acting B2 Adrenergic Agonist/Corticosteroid Combination

-Formoterol/budesonide
-Formoterol/mometasone
-Salmeterol/fluticasone
-Vilanterol/fluticasone

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Short-acting Anticholinergic

-Ipratropium

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Long-Acting Anticholinergic

-Aclidinium bromide
-Tiotropium

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Long-Acting Anticholinergic

-Aclidinium bromide
-Tiotropium

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A chronic disease with an underlying infammatory pathophysiology

Asthma

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Goals of chronic asthma therapy

2 Categories

-Reduction in impairment
-Reduction of risk

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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%