Pulmonary Medications

Question 1

Benefits of administering via inhalation (3)

Answer 1

1) TE enhanced by delivering directly to site of action
2) systemic effects are minimized
3) rapid onset of relief particularly in acute attacks

Question 2

Two main pharmacologic classes for COPD and asthma

Answer 2

1) anti-inflammatory

2) bronchodilators

Question 3

Preferred route for chronic treatment

Answer 3

1) inhalation - inhalers or nebulizers

2) exacerbations may require more potent oral therapies (short and long term side effects)

Question 4

Four types of inhalation devices

Answer 4

1. metered dose inhaler (mdi)
2. respimats
3. dry powder inhalers
4. nebulizers

Question 5

Metered dose inhalers definition

Answer 5

small hand held pressurized devices that deliver a measured dose of drug with each activation (puff)

Question 6

Dosing of Metered dose inhalers

Answer 6

typically 1-2 puffs with an interval of at least 1 minute between puffs

Question 7

Spacers are recommended because

Answer 7

they attach directly to the MDI too increase the delivery of the drug

• they increase the amount of the drug to the site of action (10-50%)
• some are fitted with an apparatus that makes a sound when inhalation is too rapid
• can prevent bronchospasm of sudden intake of drug

Question 8

Respimats definition

Answer 8

• another form of inhaler that delivers the drug as a very fine mist
• requires actuation of the dose by the user; however, the device does NOT use propellants

Question 9

delivery of respimats

Answer 9

delivers the actuation about 1-1.5 seconds vs. 1/10th of a second for MDI
- extremely small particle size ensures greater delivery of drug to the lungs

Question 10

Dry-powder inhalers definition

Answer 10

deliver drugs in the form of a dry micronized powder directly to the lungs

Question 11

how are Dry-powder inhalers activated

Answer 11

they are breath activated

- do not require as much coordination as MDIs or even respimats

Question 12

how much do Dry-powder inhalers deliver

Answer 12

deliver about 10% more active drug to the lung tissue than an MDI without a spacer (these do not use spacers)

Question 13

Nebulizers definition

Answer 13

a small machine used to convert a drug solution into a mist - finer droplets than inhalers

Question 14

Nebulizers benefits and usage

Answer 14

• face mask or handheld mouthpiece can be used to deliver the nebulized medication
• requires NO coordination as nebulized medications are deliver with each breath

Question 15

uses of nebulizers

Answer 15

used commonly in office or at home settings and can even be portable
- particularly useful in children and end-stage diseases

Question 16

Anti-inflammatory drugs use

Answer 16

foundation of asthma and COPD therapy for long term control

Question 17

anti-inflammatory drug classes for COPD or asthma

Answer 17

1) glucocorticoids
2) leukotriene modifiers
3) omalizumab
4) roflumilast

Question 18

Glucocorticoids

• what are they used for?
• route?

Answer 18

aka steroids

• these are the most effective drugs for long term control of airway inflammation
• typical route of administration is inhaled but IV and oral may be used in severe disease/ exacerbations

Question 19

Leukotriene modifiers uses

Answer 19

used as a secondary line therapy when glucocorticoids cannot be used or as add-on when therapy is inadequate (oral therapy)

Question 20

Omalizumab

Answer 20

second line agent indicated ONLY FOR ALLERGY RELATED ASTHMA

- subQ injection

Question 21

Roflumilast

Answer 21

ONLY USED IN COPD
- last line, add-on therapy
(oral)

Question 22

Glucocorticoids indications

Answer 22

first line agent in asthma (also can use in COPD)

Question 23

MOA Glucocorticoids

Answer 23

1) SUPPRESS INFLAMMATION AND REDUCE BRONCHIAL HYPERREACTIVITY
a) decreases synthesis and release of inflammatory mediators (leukotrienes, histamine, prostaglandins)
b) decreased infiltration and activity of inflammatory cells (eosinophils, leukotrienes)
c) decreased edema of the airway mucosa

Question 24

Routes Glucocorticoids

Answer 24

1) inhalation- must be on a fixed schedule- NOT PRN (do not abort an ongoing attack)
2) oral- used in moderate to severe acute exacerbation- as brief of therapy as possible

Question 25

Glucocorticoids ADR for ICS

Answer 25

1) dependent on route and duration of therapy
- inhaled = minor and much more rare - OP candidiasis (oral thrush) and hoarseness
- MAKE SURE YOU RINSE AFTER USE

Question 26

Oral glucocorticoids indications

Answer 26

a lot!

but right now just ACUTE EXACERBATIONS OF REACTIVE AIRWAY DISEASES FOR SHORT COURSE (10 days or less)

Question 27

ADR for chronic use of oral glucocorticosteroids

Answer 27

1) adrenal suppression
2) hyperglycemia
3) PUD - inhibition of gastroprotective prostaglandins
4) growth suppression/ bone loss
5) CV effects –> increased BP, fluid retention
6) CNS and psychiatric/ behavioral effects -psychosis
7) cushingoid features- truncal obesity, moon face, thinning of skin
8) infections- weakens IS
9) glaucoma/cataracts

Question 28

Fluticasone indications

Answer 28

asthma maintenance and control

Question 29

contraindications to fluticasone

Answer 29

HSN to milk proteins or lactose (not intolerances)

- diskus only

Question 30

fluticasone routes

Answer 30

1) MDI- HFA

2) DPI- diskus

Question 31

Beclomethasone indications

Answer 31

maintenance and prophylactic treatment of asthma in patients 5 and OLDER

Question 32

Contraindications to beclomethasone

Answer 32

status asthmaticus or other acute asthma episodes requiring intensive measures

Question 33

Beclomethasone routes

Answer 33

1) MDI
- QVAR- hand activated
- QVAR redihaler- breath acutuated

Question 34

Budedsonide indications

Answer 34

asthma maintenance and contorl

Question 35

Contraindications for budedsonide

Answer 35

severe HSN to milk proteins (flexhaler only)

primary treatment of status asthmaticus or other acute asthma episode requiring intensive measures

Question 36

Routes budedsonides

Answer 36

1) FDI (flexhaler)

2) nebulized solution (respules)

Question 37

Mometasone indications

Answer 37

asthma maintenance

Question 38

contraindications for mometasone

Answer 38

HSN to milk proteins,
primary treatment of status asthmaticus
other acute episodes of asthma requiring intensive measures

Question 39

Which age group is best for budedsonide?

Answer 39

Kids with asthma- this is the only ICS with a nebulized solution