Treatment of COPD, Asthma B&B

Question 1

what kind of drug is albuterol and what is its mechanism of action?

Answer 1

short-acting bronchodilator used to treat COPD and asthma (prn for acute attacks)

beta2 agonist - activates adenylate cyclase —> cAMP —> relaxed bronchiole smooth muscle

Question 2

what kind of drugs are salmeterol and formoterol, and what is its mechanism of action?

Answer 2

long-acting bronchodilators used to treat COPD and asthma

beta2 agonist - activates adenylate cyclase —> cAMP —> relaxed bronchiole smooth muscle

Question 3

what kind of drugs are ipratropium and tiotropium, and what are their mechanisms of action?

Answer 3

muscarinic antagonists (bronchodilators) used to treat COPD and asthma

block Ach-mediated bronchoconstriction

short acting: Ipratropium (Instantaneous)
long acting: Tiotropium (Time)

Question 4

how do steroids work in the treatment of COPD and asthma?

Answer 4

bind to glucocorticoid receptor and inhibit cytokine synthesis —> decreased IFNy, TNFa, GM-CSF

inactivated NFkB

ex: beclomethasone, fluticasone, budesonide, prednisone, methylprednisolone

Question 5

what are patients who inhale steroids for the treatment of COPD and asthma instructed to do?

Answer 5

common side effect of inhaled steroids is oral candidiasis (“thrush”) - instructed to rinse after inhalation

Question 6

what kind of drug is montelukast (singulair) and what is it used to treat?

Answer 6

leukotriene receptor antagonist (PO) used to treat asthma

esp. useful in aspirin sensitive asthma

Question 7

what kind of drug is zileuton (PO) and what is it used to treat?

Answer 7

5-lipoxygenase inhibitor - blocks conversion of arachidonic acid to leukotrienes

used to treat asthma

[recall lipids from cell membranes —> arachidonic acid via phospholipase A2 —> leukotrienes via lipoxygenase OR thromboxanes/prostaglandins via cyclooxygenase)

Question 8

what kind of drug is omalizumab and what is it used to treat?

Answer 8

IgG mAb that binds IgE receptor on mast cells and basophils

used to treat asthma (injection)

Question 9

what kind of drug is Cromolyn and what is it used to treat?

Answer 9

inhibits mast cell degranulation, blocking release of histamine and leukotrienes

inhaled/nebulizer

Question 10

what kind of drug is theophylline and what is it used to treat?

Answer 10

theophylline: type of methylxanthine (bronchodilatory agents)

increase cAMP levels by inhibiting its hydrolysis

used to treat asthma and refractory COPD

Question 11

why must theophylline use be closely monitored?

Answer 11

theophylline: bronchodilatory agent to treat asthma and refractory COPD

narrow therapeutic index, dose must be titrated - metabolized by P450 with many drug-drug interactions

Question 12

what toxicities are associated with theophylline (3)?

Answer 12

theophylline: bronchodilatory agent to treat asthma and refractory COPD

toxicity: 1. GI (N/V), 2. neurotoxicity (seizures), 3. cardiotoxicity (blocks adenosine receptors —> increased HR and arrhythmias)

clinical scenario: patient on theophylline for COPD/asthma goes into SVT and adenosine fails to slow heart rate (blocked receptors)

Question 13

what kind of drug is roflumilast (PO) and what does it treat?

Answer 13

roflumilast: phosphodiesterase 4 (PDE4) inhibitor —> decreased inflammation and relaxed airway smooth muscle

used to treat refractory COPD

Question 14

how are acute exacerbations of COPD treated? (4)

Answer 14

1. oxygen
2. nebulized albuterol
3. corticosteroids
4. antibiotics for severe/hospitalized patients (fluoroquinolones and amoxicillin/clavulante)

Question 15

what criteria is used to grade the severity of COPD?

Answer 15

GOLD Criteria (Global Initiative for Chronic Obstructive Lung Disease)

mild to very severe (4 stages) based on FEV1 percentage of normal

Question 16

bullectomy

Answer 16

lung volume reduction surgery for end stage COPD - remove diseased lung tissue to allow healthy lung tissue more room to expand