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Pulm > Tx for Asthma and COPD > Flashcards

Tx for Asthma and COPD Flashcards

1
Q

Albuterol:

Drug Class
Use
MOA
AE/Contras

A
  1. Beta2 Agonist (quick onset, short duration)
  2. For acute exacerbation
  3. Increases cAMP lvls (bronchiodilation), inhibit macrophage-mediate inflammation and vasc. permeabilty, increased cilia motion
  4. AEs: N/V, Tachycardia (=> tremors), arhythmias, Hypokalemia, CNS tox, dry mouth/throat
    Contra: w/ Rx => hypokalemia (beta-blockers, loop and thiazide diuretics, w/ Rx => Prolonged QT
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2
Q

Levabuterol:

Drug Class
Use
MOA
AE/Contras

A
  1. Beta2 Agonist (quick onset, short duration)
  2. For acute exacerbation
  3. Increases cAMP lvls (bronchiodilation) inhibit macrophage-mediate inflammation and vasc. permeabilty, increased cilia motion
  4. Same as albuterol but Less likely to cause Tachycardia
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3
Q

Terbutaline

Drug Class
Use
MOA
AE/Contras

A
  1. IV Beta2 Agonist (quick onset, short duration)
  2. For acute exacerbation
  3. Increases cAMP lvls (bronchiodilation), inhibit macrophage-mediate inflammation and vasc. permeabilty, increased cilia motion
  4. AEs: N/V, Tachycardia (=> tremors), arhythmias, Hypokalemia, CNS tox, dry mouth/throat
    Contra: w/ Rx => hypokalemia (beta-blockers, loop and thiazide diuretics, w/ Rx => Prolonged QT
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4
Q

Long-acting Beta2-agonists:

Name
Use
MOA
AE/Contras

A

Salmeterol; Formoterol (+steriods!)

  • Prophylaxis for exacerbation
  • Increases cAMP lvls (bronchiodilation), inhibit macrophage-mediate inflammation and vasc. permeabilty, increased cilia motion
  • AEs: N/V, Tachycardia (=> tremors), arhythmias, Hypokalemia, CNS tox, dry mouth/throat
    Contra: w/ Rx => hypokalemia (beta-blockers, loop and thiazide diuretics, w/ Rx => Prolonged QT
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5
Q

Anti-cholinergics

Name
Use
MOA
AE/Contras

A

Atropine, Ipratropium, Tiotropium (long-acting and selective)

  • competitively block ach from muscarinic receptors => inhibiting bronchoconstriction, decreasing mucus, enhance beta2-bronchodilation, and reduce airway remodeling (Tiotropium)
  • AEs: Pupillary dilation, cycloplegia (paralysis of ciliary eye muscles), urinary retention, constipation, dry mouth,
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6
Q

Combivent

Class
Use
MOA
AE/Contras

A

Anticholinergic and B2-agonist combo

  • Indicated for COPD
  • Combo of two drugs
  • AEs: Combo
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7
Q

Methylxanthines

Name
Use
MOA
AE/Contras

A

Theophylline and Aminophylline (caffeine family)

  • 2nd line bronchodilators
  • Phosphodiesterase inhibitors (less cAMP degradation), block adenosine receptors (CV effects)
  • AEs; 20ug/ml - Hypokalemia, Hyperglycemia, Tachycardia, other CV and CNS tox
  • *CYP interactions
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8
Q

Cromolyn Sodium

Use
MOA
AE/Contras

A

Exercise and antigen-inhaled asthma (reduces bronchial hyperactivity)

  • Inhibits: mast cell degranulation, eosinophil inflamm response, cough (suppresses nerve impulses)
  • AE: Taste bad, irritates trachea => bronchospasm and cough, Rarely - chestpain, restlessness, N/V, CNS depression, seizures
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9
Q

Glucocorticoids
Name
Use

A

Budesonide, fluticasone, mometasone, belcomethasone, Prednisone (PO), Prednisolone, Methylprednisolone, Dexamethasone (PO or IV)

  • for both short term and long term tx of Asthma
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10
Q

Glucocorticoids

MOA

A
  • Decrease production of inflammatory cytokines (inhibit NF-kB and Phospholipase A2)
  • activate anti-inflammatory genes (Via GRE activation); reduce bronchial hyperactivity, enhance effect of B2-agonists
  • Decrease mucus
  • Inhibit IL-5 and GATA-3 => inhibition of Th2 differentiation
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11
Q

Glucocorticoids

AEs and Contras:

A

Inhaled AEs:

  • Orophararngeal Candidiasis! Hoarseness and dry mouth
  • decrease bone density in young women and growth rate in children

Oral AEs:

  • Glucose intolerance
  • Inc BP and weight
  • Cataracts
  • Immunosuppression!
  • Cushingoid syndrome (abdom weight gain, moon face, neck buffalo hump)
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12
Q

Leukotriene Blockers

Name
Use
MOA
AEs

A

Montelukast, Zafirlukast (Receptor blockers)

  • effective in asprin-induced asthma (more AA goes down LT pathway)
  • block LTD4 receptors => dec bronchial reactivity and bronchoconstriction; dec mucosal secretion; dec airway inflammation
    AEs
    M- GI distress, laryngitis/pharyngitis, sinusitis, viral infections
    Z- GI, HA, elevated liver enzymes
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13
Q

Leukotriene synthesis inhibitor
Name
MOA
AEs

A

Zileuton

  • inhibit 5-lipooxygenase (AA –> LTs)
  • AEs: Increased liver enzymes, CYP inhibitor
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14
Q

Anti-IgE drugs

Use
Name
MOA
AEs

A

Omalizumab

  • long term asthma control when resistant to steroids and LABA
  • prevent mast cell degranulation (binds IgE and preventing recognition by FceRI
  • AEs: Allergic rxns, CV complications
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Pulm (14 decks)

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