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Pharm MSU NUR909 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Long-term asthma management medication classes

A

-Inhaled corticosteroids
-Long-acting inhaled beta-2 agonists (LABA)
- Leukotriene modifiers
- Tiotropium (12 yrs and older)
- Injectable monoclonal antibodies

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2
Q

Quick Asthma Relief medication classes

A
  • Short-Acting inhaled beta-2 agonist (SABA)
  • Systemic corticosteroids
  • Inhaled, short-acting anticholinergics (ipratropium)
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3
Q

SABAs for asthma

A

albuterol (Ventolin, Proventil, ProAir), levalbuterol (Xopenex)

  • Bronchodilator
  • Onset: 5-15 mins, DOA: 3-4 hrs
  • Should not need > 2x/week for asthma
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4
Q

SABA Adverse Effects

A

-Tachycardia (not HTN), tremors
- overuse can cause hypokalemia and hypomagnesemiaE

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5
Q

Epinephrine aerosol inhalation

A

Primatene Mist
-Bronchodilator
-Does not address underlying inflammation which can lead to airway remodeling

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6
Q

LABAs - for asthma

A

salmeterol (Serevent) onset: ~ 30 mins
formoterol (Foradil) onset: ~ 3-5 mins

MUST be combined with an inhaled corticosteroid when used in patients with asthma

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7
Q

Inhaled Corticosteroid Medications

A
  • beclomethasone (QVAR)
  • budesonide (Pulmicort)- only inhaled corticosteroid that also comes as neb solution
  • ciclesonide (Alvesco) - prodrug (decreased adverse effects)
  • fluticasone furoate (Arnuity)
  • fluticasone propionate (Flovent)
  • mometasone (Asmanex)
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8
Q

Inhaled Corticosteroids Use

A

Prevent and treat inflammation and bronchial hyper-responsiveness, thereby reducing symptoms and preventing exacerbations
- Used as daily treatment

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9
Q

Inhaled Corticosteroids Adverse Effects

A
  • Oral candidiasis
  • Hoarseness, cough - ciclesonide less likely
  • Impaired growth rate in children
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10
Q

Combined inhaled corticosteroids/LABAs

A

BID:
Fluticasone propionate/salmeterol (Advair)
Budesonide/formoterol (Symbicort)
Mometasone/formoterol (Dulera)

Daily:
Fluticasone furoate/vilanterol (Breo, Ellipta)

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11
Q

Leukotriene Modifiers

A
  • Decrease levels of circulating blood eosinophils
  • Bronchodilation occurs within hours of first dose
    -DOA ~ 24 hrs
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12
Q

Leukotriene Modifier Medications

A
  • zafirlukast (Accolate) - rarely used, potential for hepatotoxicity
  • zileuton (Zyflo) - only for 12 yrs of age or older
  • montelukast (Singulair) - most common, well tolerated, small chance for neuropsychiatric symptoms
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13
Q

Monoclonal Antibodies

A
  • used for allergic asthma
  • prescribed with epi pen due to risk for anaphylaxis
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14
Q

SABAs for COPD

A
  • may be used as monotherapy or in addition to other meds
  • utilize max daily dose as needed (unlike for asthma)
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15
Q

Short-acting inhaled muscarinic antagonists/ anticholinergic combo

A
  • help decrease secretion
  • ipratopium - comes alone or in combo with albuterol in Combivent Respimal inhaler
  • May need to schedule doses due to longer onset of action
  • max 12 puffs/day
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16
Q

Long-acting muscarinic antagonist (LAMA)

A
  • tiotropium (Spiriva), umeclidinium (Incruse, Ellipta) - daily
  • aclidinium bromide (Tudorza, Pressair) - BID
17
Q

LAMA Adverse Effects

A
  • anticholinergic effects - constipation, urinary retention, blurred vision, and dry mouth
  • dry mouth is common
18
Q

LABA for COPD

A
  • salmeterol and formoterol can be used alone and may be added to an anticholinergic.
  • olodaterol (Striverdi Respimat) - ultra-long acting beta-2 agonist, daily
  • arformoterol (Brovana) - administered via NEB
19
Q

LABA/LAMA for COPD

A

vilanterol/umeclidinium (Anoro, Ellipta), olodaterol/tiotropium (Stiolto, Respimat)

20
Q

Role of inhaled corticosteroids in COPD

A

To prevent exacerbation
- the higher the eosinophil count, the better the ICS response

  • oral steroids are contraindicated due to the risk of myopathy
21
Q

ICS Adverse Effects

A
  • Oral candidiasis
  • Hoarseness, cough
  • Increased risk of pneumonia
22
Q

ICS/LABA for COPD

A
  • salmeterol/fluticasone (Advair), formoterol/budesonide (Symbicort) - BID
  • vilanterol/fluticasone furoate (Breo, Ellipta) -daily
23
Q

ICS/LAMA/LABA for COPD

A
  • fluticasone furoate/vilanterol/umeclidinium (Trelegy, Ellipta) - daily
  • budesonide/glycopyrrolate/formoterol (Breztri Aerosphere) - BID
24
Q

Phosphodiesterase-4 inhibitor

A
  • roflumilast (Daliresp)
  • decrease inflammation by inhibiting breakdown of intracellular cAMP; NO bronchodilator
  • indicated for pts with SVR COPD associated with chronic bronchitis and a history of repeated exacerbations
25
Q

Phosphodiesterase-4 Inhibitor Adverse Effects

A
  • Primarily Gi - nausea, appetite suppression, abdominal pain, weight loss
  • psychiatric effects - sleep disturbances, increased anxiety, depression
26
Q

What NOT to do for COPD

A
  • Chronic, daily oral corticosteroids
  • Antitussives
  • Mucolytics - no harm but no benefit
  • Prophylactic, continuous abx- study showed daily azithromycin decreased exacerbations at expense of decline in auditory function and increased bacterial resistance
27
Q

Exacerbation Treatment Plan for Asthma

A

Adults: oral prednisone 40-60 mg daily for 5-10 days

Children: oral prednisone (or equivalent) 1-2 mg/kg/day for 3-10 days

28
Q

Exacerbation Treatment Plan for COPD

A

Initial oral prednisone 30-40 mg/day for 5 days
- May also require abx

Pharm MSU NUR909 (9 decks)

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