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PHARM II TEST 2 > Pulmonary Meds > Flashcards

Pulmonary Meds Flashcards

1
Q

For all stages of COPD, an FEV1/FVC < 0.7 indicates what?

A

To make the diagnosis of COPD, must be below that number.

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2
Q

Two COPD factors that determine which med to use?

A

Risk and Symptoms

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3
Q

The pharm start for COPD management is to begin with…

A

SA B2 agonists (SABA) or SA anticholinergic (SA)

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4
Q

After the short acters, we can move to which classes of meds?

A

LA B2 agonists or LAMA (long acting muscarinic antagonist)

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5
Q

Inhaled corticosteroids are now reserved for who?

A

High risk patients, and are not recommended for long-term monotherapy

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6
Q

One other class of meds we can use for COPD?

A

Phosphodiesterase-4 (PDE4) inhibitors

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7
Q

Four principal bronchodilator treatments

A

B2 agonists
Anticholinergics
Theophylline
Combo therapy

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8
Q

B2 agonists MoA?

A

Act locally on B2 receptors in the bronchial to cause bronchodilation

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9
Q

Anticholinergics MoA?

A

Block stimulation of muscarinic receptors by ACh released from vagus nerves = attenuates reflex bronchoconstriction

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10
Q

PDE3 inhibitors MoA?

A

Inhibits PDE isozymes and blocks degradation of cAMP to 5’-AMP

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11
Q

Three SABA meds

A

Albuterol
Levalbuterol
Pirbuterol

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12
Q

4 LABA meds?

A

Formoterol
Arformoterol
Salmeterol
Olodaterol

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13
Q

Ultra long-acting B2 agonists (2)

A

Indacaterol capsule

Indacaterol and glycopyrrolate capsule

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14
Q

B2 Agonists MoA results:

A

Relaxation of bronchial SMs and inhibition of the release of mediators from mast cells

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15
Q

DPI, MDI, SMI what they stand for?

A

DPI: dry powder inhaler
MDI: metered dose inhaler
SMI: soft mist inhaler

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16
Q

LABA for long-term maintenance of airflow obstruction in patients w/COPD including chronic bronchitis and emphysema, uses a SMI, like other LABA may increase risk of asthma related death…which med?

A

Olodaterol

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17
Q

Olodaterol CIs?

A

Asthma

Also, not for acute symptoms, don’t use with BBs, don’t use when COPD gets too bad

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18
Q

SAMA drug that inhibits vagally-mediated reflexes by antagonizing the action of ACh, used for maintenance of treatment of bronchospasm assisted w/COPD, but not for acute relief…USEFUL IN PREGNANCY

A

Ipratropium Bromide (Atrovent)

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19
Q

LAMA drug that does the same stuff as Ipratropium, very much for long term and NOT INDICATED FOR TREATMENT OF ACUTE EPISODES OF BRONCHOSPASMS, and preg cat C instead of B

A

Tiotropium Bromide (Spiriva)

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20
Q

AEs of these anticholinergic drugs are what?

A

Slight risk of systemic anticholinergic AEs, sensitivity reactions, paradoxical bronchospasm

21
Q

3 other LAMA drugs besides tiotropium

A

Aclidinium bromide

Glycopyrronium bromide

Umeclidinium

22
Q

Inhaled CSs improve what 3 things?

A

Symptoms, lung function, quality of life…

But can see increased risk of pneumonia, associated with thrush, don’t modify declining FEV1 or decrease mortality

23
Q

More effective than individual components, improve lung function and health status, reduce exacerbation in moderate to very severe COPD?

A

Inhaled CS plus LABA

Again, rinse mouth to avoid OROPHARYNGEAL CANDIDIASIS (thrush)

24
Q

Methylxanthine drugs that block PDE, increase tissue concentrations of cAMP, used as adjuncts to the others b/c not as effective or well tolerated, lots of monitoring

A

Theophylline and Aminophylline

25
Q

PDE-4 inhibitors that reduces inflammation through inhibitor of intracellular cAMP, no direct bronchodilator activity, for pts w/SEVERE COPD (FEV1 <50% OF PREDICTED)/COPD GOLD 3 AND 4 PTs with history of exacerbation, chronic bronchitis…

A

Roflumilast (Daliresp)

CI in severe liver impairment, nursing mothers…lots of AEs and drug interactions

26
Q

Empiric Abx may be considered in COPD for poorly controlled/high risk pts, particularly which two drugs?

A

Azithromycin and Erythromycin

27
Q

We are moving away from inhaled CSs b/c we found that most exacerbation are caused by what?

A

Infections of the tracheobronchial tree, and steroids hurt the immune system’s ability to fight those

28
Q

COPD exacerbation pharm treatment steps…

A

Bronchodilator (increase dose/frequency, SABA preferred) ->

Corticosteroid (inhaled not beneficial at this point, give short course (9-14 days) systemic corticosteroid, PREDNISONE 40mg once daily for 5 days is reasonable…if used for longer than 14 days, taper off ->

Antibiotics (if 2/3 cardinal symptoms present: dyspnea, sputum volume, sputum purulence) for 7-10 days

29
Q

> 12y/o with acute asthma, DOC?

A

Inhaled B-agonist (SABA) - albuterol/levalbuterol

30
Q

> 12y/o for persistent asthma, DOC?

A

Inhaled CS are first line anti-inflammatory agents in asthma, with or without the B-agonist (mod/severe)

31
Q

Every asthma patient, no matter what step they are, requires what?

A

SABA PRN

32
Q

EIB can usually be prevented with one of the following therapy options:

A

SABA (albuterol) 15min before exercise (DOC)

LABA (salmeterol/formoterol) 30-60min before exercise

Leukotriene modifiers daily for EIB daily, but not PRN

33
Q

DOC for acute bronchospasm and preventative treatment for exercise-induced bronchospasm (EIB)

A

SABAs (albuterol, levalbuterol)

Use greater than 2days/wk for symptom relief indicates inadequate control

34
Q

BB warning for LABAs

A

Increased risk of asthma-related death

Formoterol
Salmeterol

35
Q

Corticosteroid (Glucocorticoids) are the most potent/effective anti-Inf meds available…for long-term prevention of symptoms…reduce need for oral corticosteroid…AEs are?

A

Cough, dysphasia, oral thrush (use a spacer)

36
Q

1st line anti-inflammatory therapy for mild-severe persistent asthma in both adults and children?

A

ICSs…but should not be used alone to treat serious acute exacerbation

37
Q

Systemic corticosteroids used for what here?

A

Rapid response during an exacerbation

38
Q

For moderate or severe exacerbations, we used these to prevent progression/exacerbation, reverse inflammation, speed recovery, reduce rate of relapse…short term?

A

Systemic Corticosteroids

39
Q

AEs associated w/longer term use of systemic corticosteroids in terms of associated conditions?

A

TB, HTN, peptic ulcer, DM, osteoporosis can all be made worse

40
Q

Know the corticosteroid comparison table

A

Slide 83

41
Q

Combined corticosteroid/LABA…reduce need for oral corticosteroid, but what’s he BB warning?

A

LABA have a slightly increased risk of asthma-related death

42
Q

Alternative, not preferred meds for treatment of mild persistent asthma?

A

Cromolyn Sodium…less effective but very safe (mast cell stabilizer)

43
Q

Anti-IgE monoclonal Ab used for long-term control/prevention of symptoms in adults w/moderate-severe persistent allergic asthma inadequately controlled with ICSs?

A

Omalizumab (Xolair) SQ…so need injections and they’re expensive

44
Q

Two leukotriene inhibitors?

A

Montelukast (Singulair)
Zafirlukast (Accolate) - hepatitis and haptic failure reported, so use the first one

Caution in pts w/behavioral/suicidal thoughts, also not the most effective agents but they do work

45
Q

5-lipoxygenase inhibitor/leukotriene modifier 2nd line agent for long-term control/prevention of symptoms in mild persistent asthma, main DI?

A

Increased effect of warfarin

46
Q

Bronchodilation via competitive inhibition of muscarinic cholinergic receptors, alternative for those who don’t tolerate SABAs, but not the preferred agents? Good for older patient and those with COPD, not good for EIB?

A

Anticholinergics like Tiotropium (Spirivia) and Ipratropium (Atrovent)

47
Q

Asthma exacerbations classifications chart probably good to know

A

Slide 95

48
Q

Dopamine and NE reuptake inhibitor w/ minimal activity on serotonin, use for smoking cessation, less sexual dysfunction than other anti-depressants, BB warning for suicidal thinking/behavior (in psych uses) and neuropsych effect in smoking cessation + seizure risk, what is it?

A

Bupropion (Wellbutrin)

49
Q

Partial neuronal a4 B2 nicotine’s receptor agonist used for smoking cessation, depresses SNA and warning for somnambulism (harmful behavior to self, others, property have been reported), what drug?

A

Varenicline (Chantix)

PHARM II TEST 2 (7 decks)

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