Treatment for Asthma and COPD Flashcards
what are the main 2 pharmacologic targets in asthma
tone of bronchial smooth muscle
inflammation of airways
Short-acting beta 2 agonists
Short-acting anti-cholinergic agents
Oral corticosteroids
rescue medications for asthma
Inhaled corticosteroids
Long-acting Beta 2 agonists
Long-acting muscarinic antagonists
Mast cell inhibitors
Leukotriene inhibitors
Phosphodiesterase inhibitors
Antibodies against IgE
controller medications for asthma
MoA of beta2 adrenergic agonists
-K+ out of cell (hyperpolarization; smooth m relaxation)
-increases cAMP and decreases PLC/IP3/Ca2+; smooth muscle relaxation
short acting beta2 agonist (SABA) used in mild intermittent asthma and mild COPD
Albuterol
long acting beta2 agonists (LABA) used in moderate-severe asthma and >mild COPD
Salmeterol
Formoterol
classic non-selective beta agonist
Isoproterenol
key drug to use in mild-intermittent asthma
SABA (Albuterol)
this drug is added to ICS in patients with poorly controlled mild-persistent asthma
LABA (Salmeterol or Formoterol)
SE’s of this type of drug include:
muscle tremor
tachycardia
hypokalemia
restlessness
Beta2 agonists
in asthma, ____ should only be used with ICS, never alone
LABA
-sones and budesonide are what type of drug
corticosteroids
moa of corticosteroids
anti-inflammatory (goes into nucleus and stops inflammatory gene expression)
eosinophil apoptosis
____ can cause oral candidiasis (rinse after using this)
inhaled corticosteroids
1st line therapy for all patients with persistent asthma
ICS
hair loss
bone loss
mood changes
infections
systemic SE’s of corticosteroids
prolonged use of ____ causes HPA axis suppression
oral corticosteroids
use lowest dose of ____ to control asthma
ICS
combination inhalers (LABA + ICS) used for persistent asthma
Advair
Symbicort
salmeterol/fluticasone
Advair
formoterol/budesonide
Symbicort
small changes in airway ______ have important impacts in changing airflow resistance
radius
this drug is used to reduce airway constriction and first line in COPD
muscarinic antagonist
this drug competitively inhibits Ach pathway of bronchoconstriction
muscarinic antagonist
short acting muscarinic antagonist
Ipratropium
long acting muscarinic antagonist
Tiotropium
this drug is generally well-tolerated
muscarinic antagonist
little evidence that ______ are helpful in asthma
anti-histamines
used as an add-on to treat bronchoconstriction and inflammation in asthma
anti-leukotrienes
LOX inhibitor
Zileuton
leukotriene receptor inhibitors
Monteleukast
-lukasts
zaprinast
no benefit in using these in COPD, used as an add-on maybe in asthma
anti-leukotrienes
used in both asthma and COPD but not as common
PDE inhibitor (allows cAMP to function)
Theophylline
has small therapeutic window and toxicity w/ other meds that block CYP function
Theophylline
not used often to treat asthma but stabilizes mast cells
Cromolyn
-mab against _____ can be used to treat all 3 types of asthma
TSLP
Rx mild intermittent asthma
SABA prn
Rx mild-persistent asthma
low dose ICS
Rx moderate-persistent asthma
medium dose ICS + LABA
Rx severe-persistent asthma
high dose ICS + LABA (+ oral corticosteroid)
consider: Omalizumab for patients who have allergies
_____ causes epithelial cell injury and stimulation of macrophages
cigarette smoking, air pollutants, indoor wood cooking
fibrosis
increase in proteases that lead to alveolar wall destruction (emphysema) and mucus hypersecretion (chronic bronchitis)
pathogenesis of COPD
first line drug for COPD
anti-cholinergic/muscarinic antagonist
can use LABA by itself here, but do not use ICS by itself, only as an add on
COPD
most important thing to do for COPD
stop smoking
Rx mild COPD
SABA (Albuterol)
Rx >mild COPD
long acting muscarinic antagonists
LABA
(ICS if above do not work)
