Pharmocology Asthma And COPD - Dr. Izsard Flashcards
3 types of bronchodilators
- B2 agonist
- Muscarinic antagonist (Anticholinergic)
- Methylxanthines
2 drugs increasing cAMP to bronchodilate
B2 blocker albuterol
Theophylline
Albuterol is what and clinical use
SABA
Asthma and COPD, acute bronchitis, Bronchiolitis
Albuterol contraindications
Paradoxical bronchospasms
Deterioration of asthma
CV effects
Hypersensitivity reactions
Terbutaline is what and clinical use
SABA (Oral or subQ*) 1. Prophylaxis bronchospasm from asthma 2. Bronchitis 3. Emphysema
Terbutaline not given to what pt
Super allergy
Pregnancy
Pre-contractions in pregnancy
Metaproterenol is what and clinical use
SABA
- Asthma
- Bronchospasm from COPD or bronchitis
Metaproterenol side effects
Paradoxical bronchospasm
Pirbuterol is what and clinical use
SABA
1. Prevent and reverse bronchospasm
Pirbuterol side effects
Significant cardiovascular effects* like in HTN pts
Levabuterol is what and clinical use and side effects
SABA
1. Tx or prevent bronchospasm is any reversible obstructive airway disease
Can cause paradoxical bronchospasm
Beclomethasone is what and clinical use
ICS
= asthma maintenance (before sx)
= can be to help patients get off oral steroids
Beclomethasone side effects
Can shrink adrenal gland during oral steroids so need to start Beclomethasone carefully so hypothalamic pituitary pathway can heal
ICS is given how and functions to do what in asthma pts
- 2 x day usuall
- Prevent asthma sx and exercise-induced asthma
- Prevent airway changes
Tx asthma persistent
ICS
Then LABA if needed
Budesonide is what and clinical use
ICS
1. Maintenance asthma (before sx)
Budesonide contraindications
- Status asthmaticus
2. Acute asthma episode
Ciclesonide is what and clinical use
ICS
= maintenance asthma (before sx)
Ciclesonide contraindications
= acute bronchospasm
= candida present
Ciclesonide advantage
Less candidiasis (PRODRUG activated by bronchial Esterases**)
Flunisonide is what and clinical use
ICS
= maintenance asthma
= help eliminate oral steroids slowly
Flunisonide contraindications
Asthma attack
Fluticasone is what and clinical use
ICS
= maintenance asthma
Fluticasone risks
Candida is higher risk
- wash mouth with water
Mometasome is what and clinical use
ICS
= maintenance asthma
Mometasome contraindications
Milk hypersensitivity (lactose)
Triamcinolone is what and clinical use
ICS
= maintenance asthma
= decrease oral steroids
Triamcinolone contraindications and warning for risk
Acute asthma
Adrenal insufficiency death can happen if not gradual change to this drug from oral steroids
Prednisone is what and clinical use
ORAL corticosteroids (OCS) = WITH SABA to tx asthma flareup = also used for endocrine and other anti inflammatory needed conditions
Prednisone can cause
Hypothalamic-pituitary adrenal pathway insufficiency
Prescribing pt with asthma what
- ICS everyday.
- OCS and SABA when needed
- If that doesn’t work add LABA + ICS every day
Fomoterol is what and clinical use
LABA (used with ICS)
- Asthma control
- COPD
Fomoterol risk
Asthma problems if not given with ICS
Salmeterol is what and clinical use
LABA
= prevent exercise bronchospasm
= maintain COPD
Indacaterol and Vilanterol is what and clinical use
LABA
= breathing problems from COPD
= bronchitis and emphysema from COPD
Olodaterol is what and clinical use
LABA
= maintenance 1x day for COPD, chronic bronchitis, emphysema
LABA only given with
ICS
4 anticholinergic drugs used for COPD
- Atropine (shirt lasting)
- Ipratropium (maintenance)
- Tiotropium (long term maintenance)
- Aclidinium (long term maintenance)
Atropine is what and clinical use
Anticholinergic
= X life threatening COPD or asthma attacks
Atropine max dose
No more then 2-3mg
Ipratropium is what and clinical use
Anticholinergic
=maintenance bronchospasm for COPD
= less systemic effect then atropine
Tiotropium is what and clinical use
Anticholinergic
= 1x day maintenance bronchospasm from COPD
Aclidinium is what and clinical use
Anticholinergic
= maintenance bronchospasm long term from COPD
3 Methylxanhines (from plants and animals)
- Theophylline
- Theobromine (chocolate)
- Caffeine
= asthma, chronic bronchitis, emphysema (COPD) tx
Theophylline does what 2 things and contraindications
- Bronchodilate by increasing cAMP
- Inhibit bronchoconstriction
= PUD, seizures, cardiac problems cautious use needed
Non-hormone anti inflammatory
Leukotriene atagonists and Lipoxygenase inhibitors
Zafirlukast and Montelukast are what and clinical use
Reversible antagonist of Cysteinyl LEUKOTRINE receptors ( CysLT1 receptors)
= bronchodilator not as effective as ICS (ORALLY)
Zafirlukast and Montelukast and Pranlukast do what and advantage
BLOCK Leukotrienes binding to CysLT1 Rs
Anti-inflammatory and bronchodilator
= no glucocorticoid effects *
Zileuton is what and clinical use
BLOCK 5-LO (lipoxygenase = making leukotrines that bind to CysLT1 R)
Zafirlukast and Monelukast and Pranlukast and Zileuton are used when
- DM (prevent glucocorticoid effects)
- Prophylaxis in asthma
- Prevention of asthma prophylaxis (anti-inflammatory + bronchodilator)
(Except monelukast can tx ongoing prophylaxis however can also tx allergies)
Zafirlukast risk
Hepatotoxicity
Zileuton used when and risks
Prophylaxis and chronic asthma
= hepatotoxic
Omalizumab is what and clinical use
Monoclonal antibody drugs
= severe asthma persistent (with + skin test or no other drug works)
= chronic idiopathic urticaria (even after anti-H1 tx)
Omalizumab works how
- Bind to IgE
- Decrease R bound by IgE
- Decrease mast cell mediator release
- Decreasing allergic inflammation
Omalizumab risks
Anaphylaxis ** (should be given in hospital only)
Asthma tx steps
SABA ALWAYS
ICS —> LABA —> LAMA
COPD Tx steps
SABA ALWAYS
LAMA —> LABA —> ICS
Chronic Idiopathic Urticaria
Hives from unknown cause usually autoimmune hyperreactive immune system
