Respiratory Drugs Flashcards

1
Q

Classification of Asthma based on Severity

Severity;Symptom Frequency; Nighttime awakening

A

Intermittent; < 2 per week; < 2 per month

Mild Persistent; > 2 but not daily; 3-4 times per month

Moderate Persistent; Daily; > 1 time a week but not daily

Severe Persistent; Throughout the day; 4-7 times/week

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2
Q

Drugs used to manage Asthma

A

Bronchodilators: acute management

  • b2 agonist
  • anticholinergics
  • methylxanthines

Anti-Inflammatory Drugs: Long term therapy

  • corticosteroids
  • Release inhibitors
  • immunomodulators
  • Leukotriene-modifying agents
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3
Q

b2 adrenergic agonist Drugs

A

Inhaled SABA’s

  • Albuterol
  • Terbutaline
  • Pirbuterol

Inhaled LABA’s

  • Salmeterol
  • Formoterol
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4
Q

Inhaled b2 agonist MOA

A

1) Binds b2 receptors in airway smooth muscle cells
2) activates Adenylyl cyclase
3) increase cAMP production
4) cAMP activates PKA and phosphorylation of MLCK occurs (inactivation)
5) Results in bronchodilation

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5
Q

Inhaled SABA’s Uses

A

DOC for relief of acute asthma symptoms and prevention of exercised-induced bronchospasm1

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6
Q

Inhaled LABA’s Uses:

A

LABA’s combined with inhaled corticosteroids (ICS) for long term control in moderate and sever persistent asthma

Should not be used as mono therapy (no anti-inflammatory actions)

LABA’s are not used in the treatment of acute symptoms or exacerbations

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7
Q

b2 agonist AE

A

Administration via inhalation minimizes AE.

AE: Tachycardia, tremor, and Hypokalemia

LABA’s increase risk of serious asthma related events (hospitalization, intubation, and death)

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8
Q

Anticholinergics Drugs

A

Inhaled SAMA’s
- Ipratropium

Inhaled LAMA’s
- Tiotropium

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9
Q

Anticholinergics MOA

A

Block Muscarinic (M3) receptors on the airways causing bronchodilation and reduction of respiratory secretions

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10
Q

Anticholinergic Uses

A

Ipratropium less effective than SABA’s

Ipratropium paired with SABA’s (addictive effect) to manage moderate-severe exacerbations of asthma

Ipratropium: DOC for b-blocker induced bronchospasm
Tiotropium may be added to ICS for long-term control of severe persistent asthma

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11
Q

Anticholinergic AE

A

Quaternary Ammoniums: (not very lipophilic)

Low access to systemic circulation (low systemic AE)

Minor anticholinergic effects
- xerostomia

May be safer than SABA’s in patients with CVD

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12
Q

Mehylxanthines Drugs

A

Theophylline

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13
Q

Theophylline MOA

A

inhibits PDE

Inc. cAMP evokes Bronchodilation

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14
Q

Theophylline Uses:

A

can be given orally or IV

Alternative therapy for patients with persistent asthma

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15
Q

Theophylline AE

A

Replaced by b2 agonist b/c Narrow Therapeutic Window, AE, and potential for drug interactions

Most Common AE:
headache, N/V, abdominal discomfort, and restlessness

** at high concentrations: cardiac arrhythmias and seizures

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16
Q

ICS and Systemic Corticosteroid drugs

A

ICS:

  • Beclomethasone
  • Budesonide
  • Flunisolide
  • Fluticasone

Systemic Corticosteroids

  • prednisolone
  • dexamethasone
17
Q

Corticosteroids MOA

A

Inhibits phospholipase A2 and the transcription of COX-2
- results in decrease in leukotrienes and prostaglandins

Note: prolong use of SABA’s results in b2 receptor desensitization
- steroids prevents this or reverses the desensitization

18
Q

Corticosteroid Uses

A

ICS are the most effective long-term control medication in the management of persistent asthma

oral prednisolone may be added to ICS for long term control of severe persistent asthma

A short course of systemic corticosteroids is used for moderate and severe acute exacerbations of asthma to speed recovery and to prevent recurrence of exacerbations.