Wheeze/Stridor Pharm Flashcards
What is the GOLD treatment recommendation for COPD
Self-manage education and smoking cessastion
Bronchodialators
Inhaled corticosteroids
Pulm rehab, oxygen, surgery pretty low on list
REcommended meds for low risk, less symptomatic COPD
Short acting anticholinergic or short acting B2-agonist
Tx option for Low risk, more symptoms COPD
Long acting anticholinergic, Long acting B2 agonist
Tx option for higher risk, less symtpoms COPD
Inhaled corticosteroid + long acting B2agonist
OR
Long acting anticholinergic
Tx for High risk, symptomatic COPD
Inhaled corticosteroid + long act B2 agonist
OR
Long acting anticholinergic
What is albuterol?
What about Ipratropium bromide?
albuterol = SABA
Ipratropium Bromide = short acting anticholinergic antagonist
What are two Long acting beta2 adrenergic agonist (LABA)
Sotolol and Formoterol
What type of drug is tiotropium
Long acting anticholinergic antagonist
Beclomethasone, Fluticasone and Budesonide are all:
Inhaled corticosteroids
What meds are recommended to manage acute exacerbations of COPD?
bronchodialators: SABA (Albuterol), Short acting anticholingergic agonists (ipratropium bromide)
Systemic corticosteroids (oral prednisone)
Antibiotics or O2 therapy
What is the mechanism of theophyline
inhibits PDE so we can increase levels of cAMP which promotes Bronchodialation
What effects does theophyline have throughout the body?
Decreases: eosinophils, mast cells, macrophages
cause bronchodialation, and decrease leaky vessels
what can happen with high conc of theophyline?
At high concentrations, cardiac arrhythmias may occur as a consequence of inhibition of cardiac PDE3 inhibition and antagonism of cardiac A1 receptors.
Where do the majority of inhaled corticosteroids go?
60-90% lands in mouth and is swallowed–> to GI adn metabolized by liver with 10-40% getting to lungs
thus get systemic side effects from use
What happens to the HPA axis with prolonged corticosteroid use?
- Corticosteroids inhibit ACTH and cortisol secretion by a negative feedback effect on the pituitary gland
- Hypothalamic-pituitary-adrenal (HPA) axis suppression depends on dose
- Significant suppression after short courses of corticosteroid therapy is not usually a problem, but prolonged suppression may occur after several months or years.
What are side effects of long term oral corticosteroid use?
- fluid retention
- increased appetite
- weight gain
- osteoporosis
- capillary fragility
- hypertension
- peptic ulceration
- diabetes
- cataracts
- psychosis.
- frequency tends to increase withage.
What is steroid withdrawl syndrome?
after long use, need to get off them slowly: see lethargy, musckuloskeletal pains, fever, HPA suppresion see when use more then 2000mg a day
What are systemic side effects seen with inhaled corticosteroids?
dermal thinning, cataracts, osteoporosis, concern with growth in children
What are local side effecs seen from inhaled steroids?
- Dysphonia (hoarse voice)
- Topical candidiasis (thrush)
- Contact hypersensitivity
- coug
What is the most likely reason that inhaled anticholinergic drugs are effective in COPD?
Block vagally mediated airway tone
• Anticholinergic drugs may be as effective as or even superior to____
drugs inhibit vagally mediated airway tone, thereby producing _____
β2 agonists.
Role of vagal tone in the airways
causes release of Ach to control tone in bronchioles, but in pt with COPD, they become highly constricted thus vagal tone decreases airway = bad
use a muscarininc antagonist to counteract this
What are COPD pts more sensitve to vagal input to the bronchi?
This effect is small in normal airways but is greater in airways of patients COPD
which are structurally narrowed and have higher resistance to airflow because airway resistance is inversely related to the fourth power of the radius (r).
reduce air trapping and improve exercise tolerance in COPD patients.
Anticholinergic drugs
