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Pharm Exam 3 > Treatment of COPD and Asthma > Flashcards

Treatment of COPD and Asthma Flashcards

1
Q

What is the pathophys of asthma?

A

Airway inflammation-airway hyperresponsiveness-respiratory symptoms-airflow obstruction, bronchial hyperresponsiveness, underlying inflammation.

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2
Q

Goals of asthma therapy:

A

prevent symptoms.
Require infrequent use of SABA
Prevent recurrence, loss of lung function

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3
Q

Intermittent Asthma classification: for Ages 0-11

Treatment step

A

Symptoms: < 2x/month (0 for 01-4)
SABA use: 4yo) FEV1 >80%, FEV1/FVC >85%
Exacerbations: 0-1/year

Treatment step 1

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4
Q

Mild Persistent asthma classification

Treatment step

A

Symptoms: >2days/week but not daily
Nighttime awakenings: 1-2x/month ( 0-4) 3-4x/month (5-11)
SABA use: >ddays/week but not daily
Normal activity interference: Minor limitation
Lung Function: (>4yo) Fev1: >80%, FEV2/FVC >80%

Treatment step 2

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5
Q

Moderate persistent asthma classification for children

Treatment step

A

Symptoms: Daily
Nighttime awakenings: 3-4x/mo (0-4), >1x/week but not nightly (5-11)
SABA use: Daily
Normal activity interference: Some limitation
Lung function: (>4yo) Fev1 60-80%, FEV1/FVC 75-80%

0-4: Step 3 consider short course of oral systemic corticosteroids
5-11: Step 3 Medium dose ICS,consider short course of oral systemic coricosteroids

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6
Q

Severe persistent asthma classification for children

Treatment step

A 
Symptoms: Throughout the day
Nighttime awakenings:(0-4) >1x/week, (5-11) Often 7x/week
SABA Use: Several times/day
Activity: extremely limited
Lung Function (>4yo): FEV1 <75%

0-4: Step 3 and consider short course of oral systemic corticosteroids
5-11: Step 3 Medium dose ICS option OR step 4 and consider short course of oral systemic corticosteroids

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7
Q

Tx for Step 1 asthma in Children 0-4 year

A

SABA PRN

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8
Q

Tx for Step 2 asthma in children 0-4 years

A

SABA + Low dose ICS, alternative Montelukast or cromolyn

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9
Q

Tx for Step 3 asthma in children 0-4 years

A

SABA + Medium dose ICS (if you have done Montelukast as step 2 alternative then try low dose ICS before up to medium dose)

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10
Q

Tx for Step 4 asthma in children 0-4 years

A

SABA + Medium dose ICS AND either Montelucast or LABA

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11
Q

Tx for Step 5 asthma in children 0-4 years

A

SABA + High-dose ICS AND either montelukast or LABA

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12
Q

Tx for Step 6 asthma in children 0-4 years

A

SABA + High-dose ICS AND either Montelukast or LABA AND oral corticosteroids

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13
Q

Tx for Step 1 asthma in children 5-11 years

A

SABA PRN

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14
Q

Tx for Step 2 asthma in children 5-11 years

A

SABA + Low Dose ICS alternative: LTRA cromolyn, nedocromil

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15
Q

Tx for Step 3 asthma in children 5-11 years

A

SABA + Medium-dose ICS OR low-dose ICS + either LABA, LTRA, or theophylline

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16
Q

Tx for step 4 asthma in children 5-11 years

A

SABA + Medium-dose ICS + LABA, alternative Medium-dose ICS + either LTRA or theophylline

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17
Q

Tx for Step 5 asthma in children 5-11 years

A

SABA + High-dose ICS + LABA alternative medium-dose ICS + either LTRA or theophylline

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18
Q

Tx for Step 6 asthma in children 5-11 years

A

SABA + High-dose ICS + LABA + oral corticosteroid Alternative High-dose ICS + either LTRA or theophylline + oral corticosteroid

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19
Q

Asthma classification adult: Intermittent

Tx step

A

Symptoms: < 2x/mo
SABA Use: < 2days/week
Activity interference: None
Lung function: Normal FEV1 between episodes; FEV1 >80%, FEV1/FVC normal

Tx step 1

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20
Q

Asthma classification adult: Persistent Mild

Tx step

A 
Symptoms: >2days/week
Nighttime awakenings: 3-4/mo
SABA use: >2days/week
Activity interference: Minor
Lung function: FEV1>80%, FEV1/FVC normal

Step: 2

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21
Q

Asthma classification adult: Persistent Moderate

Tx step

A 
Symptoms: daily
Nighttime awakenings: >1x/week
SABA use: Daily
Activity interference: some limitation
Lung function: FEV1>60-<80%, FEV1/FVC: reduced 5%

Step 3

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22
Q

Asthma classification adult Persistent Severe:

Tx step

A 
Symptoms: throughout the day
Nighttime awakenings: Often 7x/week
SABA use: Several times/day
Activity interference: extremely limited
Lung function: FEV1< 60, FEV1/FVC: reduced 5%

Step 4 or 5

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23
Q

Step 1 asthma tx adults

A

SABA PRN

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24
Q

Step 2 asthma tx adults

A

Low-dose ICS, alternative cromolyn, nedocromil, LTRA or theophylline

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25
Q

Step 3 asthma tx adults

A

Medium dose ICS OR Low-dose ICS + LABA alternative Low-dose ICS + either LTRA, Theophylline or zileuton

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26
Q

Step 4 asthma tx adults

A

Medium-dose ICS + LABA alternative Medium-dose ICS + either LTRA, Theophylline, or zileuton

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27
Q

Step 5 asthma tx for adults

A

High-dose ICS + LABA AND consider omalizumab for patients who have allergies.

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28
Q

Step 6 asthma tx for adults

A

High-dose ICS + LABA + Oral corticosteroid AND omalizumab for pts with allergies

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29
Q

MOA for step 1 SABA

A

Binds to B receptors on several sites-smooth muscle relaxation
Onset approx 5 minutes

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30
Q

ADE SABA

A

dose-dependent heart palpitations, anxiety, tachycardia, tremor (use of SABA >2days/ week need to change long-term control med)

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31
Q

ex of SABA

A

“OL” albuterol, Levalbuterol,

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32
Q

MOA anticholinergics

A

Inhibits cholinergic and muscarinic receptors on bronchial smooth muscle causing bronchodilation. Onset 5-15 minutes.

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33
Q

ADE anticholinergics

A

Dry mouth and respiratory secretions, Increased wheezing, Less cardiac tim than SABA

34
Q

Low-dose ICS MOA

A
  • decreased number and activity of inflammatory cells,
  • enhances effect of B-adrenergic drugs.
  • inhibits bronchoconstrictor mechanism
  • direct smooth muscle relaxation
35
Q

ADE Low-dose ICS

A
  • Cough, dysphonia, Oral thrush (rinse and spit)
  • In high doses: adrenal suppression, osteoporosis, skin -thinning, bruising, cataracts
  • Low-medium doses: growth suppression in children, velocity may be altered.
36
Q

Inhaled Corticosteroids examples

A

“Ones and Ides” Beclomathasone, Budesonide

37
Q

LTRA definition, ex, MOA

A

Leuoktriene receptor antagonist: Montelukast, Interfere with pathway of leukotriene mediators, which are released from mast cells, eosinophils and basophils.
-Can be adjunct with ICS (not preferred to LABAs for >12yo)

38
Q

Mast cell stabilizers ex and MOA

A

Cromolyn, Stabilizes mast cells, Blockade of chloride changes. may be preventative prior to exercise of unavoidable exposure to allergens

39
Q

ADE LTRAs

A

No specific adverse event have been identified

40
Q

Zileuton MOA

A

Similar to LTRA’s only blocks the enzyme not the recptor

41
Q

Zileuton ADE:

A

Elevation of liver enzymes, not preferred over LTRAs

42
Q

Zafirlukast interactions

A

Food-decreases bioavailability, take at lest 1 hour before or 2 hours after meals, CYP 2C9 Substarte and inhibitor, Increase levels of warfarin!

43
Q

Theophylline MOA

A

mild to moderate bronchodilator
non-selective phosphodiesterase inhibitor
must monitor serum theophylline conc. adjust dose to achieve 8-15mcg/mL at steady state

44
Q

ADE theophylline

A

Usual dose: Insomnia, gastric upset, aggravation of ulcer, increased hyperactivity in children, dysuria.

45
Q

Toxicities of theophylline

A

Tachycardia, N/V, Tachyarrhythmia, CNS stim, HA, Seizure, Hematemesis, Hyperglycema, Hypokalemia

46
Q

DI theophylline

A

Metabolized by CYP 1A2 and CYP3A4 (also induces these!!)
Many DI’s exist!! This is not a first line medication. A lot of older pt’s may be on it-because they don’t like to switch.

47
Q

LABA MOA

A
  • Tail binds to B receoptor at exosite-prevents molecule from dissociating from receptor.
  • Head attaches to same spot as SABA’s.
  • Causes bronchodilation
  • do not use as mono therapy!!
  • Every 12 hour dosing is crucial to maintaining proper control!
48
Q

ADE LABA

A

Tachycardia
tremor
hypokalemia
Unexpected bronchospasm & hyperresponsiveness

49
Q

Black box warning LABA

A

-Increased risk of severe asthma exacerbation and asthma related death with regular use of LABA

50
Q

Omalizumab MoA

A

Recombinant DNA antibody (IgE), Binds to portion of IgE antibody preventing binding to its high-affinity receptor on mast cells and basophils,
-decrease in release of mediators in response to allergen exposure.
Approved for >12yo

51
Q

ADE Omalizumab

A

Urticaria, anaphylaxis (0.1%) , injection site pain and bruising

52
Q

DI oral systemic corticosteroids

A 
Herpes infection
varicella
TB
HTN
peptic ulcer dz
DM
Osteoporosis
53
Q

What time frame tx requires a tapered dose when taking pt off of oral corticosteroids?

A

5days

Healthier younger pt’s > 3-5 days

54
Q

Non-pharm tx for asthma

A 
Avoid triggers,
Remove carpets
Encase mattress pillows
vacuum
close windows 
air filters
 allergen-free zone
55
Q

First line for exercise-induces bronchospasm (EIB)

A

SABA (albuterol)

56
Q

Second line for EIB

A

LTRA’s

57
Q

Last line for EIB

A

Cromolyn

58
Q

Non-Phare techniques for EIB

A

Warm-up

Mask or scarf over mouth in cold weather.

59
Q

Inflammatory mediator of Asthma

A

Eosinophils

60
Q

Inflammatory mediator of COPD

A

neutrophils

61
Q

Pink puffers

A

Emphysema

62
Q

Blue Bloaters

A

Chronic bronchitis

63
Q

R/f for COPD

A

cigarette smoking, Genetics (a1 antitrypsin rare)

64
Q

symptoms of COPD

A

Dyspnea, Chronic smokers cough, Sputum, spirometry

65
Q

FEV1
FEV1/FVC
Mild stage 1 COPD

A

FEV1: >80%
FEV1/FVC: <70%
Mild airflow limit, chronic cough and sputum not always present.

66
Q

FEV1
FEV1/FVC
Moderate stage 2 COPD

A

FEV1: <70%

SOB on exertion, and cough sputum sometimes present *typical stage where pt presents

67
Q

FEV1
FEV1/FVC
Severe stage 3 COPD

A

FEV1: >30% <50%

FEV1/FVC: Greater SOB reduced exercise capacity.

68
Q

FEV1
FEV1/FVC
Very severe stage 4 COPD

A

FEV1: <50% plus presence of chronic respiratory failure

FEV1/FVC: 70%

69
Q

Mild COPD tx

A

SABA

70
Q

Step 2 Moderate COPD tx

A

SABA + Long acting bronchodilators and ADD rehab

71
Q

Step 3 Severe COPD tx

A

SABA + Long acting bronchodilators and rehab, ADD Inhaled glucocorticoids if repeated exacerbations

72
Q

Step 4 Very Severe COPD Tx

A

SaBA + Long acting bronchodilators and rehab ADD inhaled glucocorticoids and ADD long term O2 consider surgical tx.

73
Q

goal of tx for COPD

A

Relieve symptoms. Prevent dz progression

74
Q

Ex; of SABA

A

“OL’s” Albuterol, levalbuterol

75
Q

Ex of anticholinergics

A

“IUM” Iptratropium, iptratropium albuterl

76
Q

What has a longer duration of action SABA or Ipratropium

A

Ipratropium (anticholinergic) has longer duration of action.

77
Q

Black box warning for LABAs Arcapta, Brovana, Presimat, Valanterol,

A

may not apply to patients with COPD

78
Q

Oxygen initiation requirement

A

Stage IV COPD

79
Q

Non-pharm tx for COPD

A

Stop smoking, Avoid triggers, filter air, Adjust ADL’s

80
Q

tx for Exacerbations of COPD

A

Oxygen first (>90%)!!! SABA. 2nd line is short acting anticholinergic, systemic glucocorticosteroids, FEV1<50%

81
Q

ABX for exacerbations of COPD when 3 cardinal symptoms present

A

Increase dyspnea
sputum volume
sputum purulence OR
if 2/3 if sputum and is one of the symptoms

Pharm Exam 3 (4 decks)

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