Pulm: Drugs for Asthma and COPD Flashcards
What are the SABA drugs?
Albuterol Terbutaline Metaproterenol Pirbuterol Levalbuterol
All used in asthma PRN for symptom relief and can be used in COPD
Adverse effects of albuterol
Headache, dizziness, insomnia, dry mouth, cough
Warning when taking the SABA?
paradoxical bronchospasm, deterioration of asthma, CV effects
What is the only B2 agonist available for SubQ injection?
Terbutaline
Which of the SABA are safe in pts 4 years and older?
Levalbuterol
MOA of the inhaled corticosteroids?
Anti-inflammatory as maintenance/prophylaxis of asthma
What is important to remember when changing someone from systemic steroids to inhaled corticosteroids?
Wait a couple of months after stopping systemic to start inhaled
-deaths have occurred due to adrenal insufficiency
What are the most effective drugs for controlling asthma?
ICS
-most potent inhibitors of inflammation
When would budesonide or mometasone be contraindicated
in those with a milk allergy
What are budesonide, flunisolide, or triamcinolone not used to treat?
status asthmaticus
-do not use for this or other acute asthmatic events that require intensive measures
What are the inhaled corticosteroids?
Beclomethasone Budesonide Ciclesonide Flunisolide Fluticansone Mometasone Triamcinolone
if it ends in one or ide..
Should you use ciclesonide in the presence of acute bronchospasm? what about around candida?
No
What is great about flunisolide or triamcinolone, which are ICS?
It reduces/eliminates the need to switch to oral corticosteroids
What is a warning when prescribing fluticasone?
Candida infection of the mouth
MOA of prednisone
it is an Oral corticosteroid used with SABAs for severe asthma flare ups
What is a warning when taking prednisone?
May suppress the Hypothalamic-pituitary-axis
MOA of Fomoterol?
LABA used for moderate to severe asthma not controlled with ICS
or to prevent bronchoconstriction in those with COPD
What should you always give with LABAs?
Inhaled corticosteroids
-deaths have occurred due to the long acting nature, and in acute flare ups the patients were not responsive to SABAs
MOA of Salmetrol?
LABA used to prevent exercise induced bronchospasm
or to prevent bronchoconstriction in those with COPD
What two LABA are used to treat breathing problems caused by COPD?
Indacaterol and vilanterol
What LABA is used as a once a day bronchodilator treatment in COPD?
Olodaterol
MOA of Atropine
Muscarinic antagonist to block the life threatening bronchoconstriction in Asthma and COPD
What is the max dose of atropine given if a patient has CAD?
2-3mgs
Which M3 antagonists are used as maintenance therapy to prevent bronchospasm in COPD?
Ipratroprium and aclidinium
Which M3 antagonist is used as once a day maintenance therapy to prevent bronchospasm in COPD?
Tiotroprium
MOA of methylxanthines (theophylline)?
Prevents PDE, so stops breakdown of cAMP=bronchodilation
When is theophylline used?
Used in management of airway obstruction in asthma and COPD
MOA of Montelukast?
LTD4 blocker, so blocks the CysLT1 receptor
=less bronchoconstriction, mucus, and eosinophils
MOA of Zileuton?
inhibits 5-lipoxygenase, so prevents the production of leukotrienes
=less bronchoconstriction, mucus, and eosinophils
Indications of montelukast?
Mainly in allergies and to prevent asthma attacks
Should montelukast be used to reverse asthma attacks (status asmaticus?)
no
MOA of Zafirlukast?
LTD4 and E4 blocker, so blocks the CysLT1 receptor
=less bronchoconstriction, mucus, and eosinophils
indication for zafirlukast?
Prophylaxis and treatment of asthma
Warning when prescribing zafirlukast?
Hepatotoxicity
-monitor LFTs
Indications of ziluton?
Prophylaxis and treatment of chronic asthma
-NOT FOR ASTHMA ATTACK
Contraindications of ziluton?
Liver disease
-can worsen
What monoclonal antibody is used to treat asthma?
Omalizumab
-binds the FReI portion of mast cells
Indications of omalizumab?
Moderate to severe asthma patients with (+) skin test fo allergen not controlled by ICS
also idiopathic urticaria pts who are symptomatic, dispite taking H1 antihistamines
What caution should there be with omalizumab?
Anaphylaxis
-can be life threatening, so monitor
If pt has Asthma-COPD Overlap, how would you treat?
ICS+LABA+LAMA
