Drugs for Asthma and COPD (Iszard) Flashcards
What are the two broad categories of drugs used to treat Asthma/COPD?
What are the 3 categories within each broad category?
- Anti-Inflammatory Drugs
- corticosteroids (ICS and Oral)
- Antibodies
- Leukotriene Receptor Mods (receptor/lipoxygenase)
- Bronchodilators
- Beta 2 Agonists
- Anticholinergic drugs
- Methylxanthines
What are the 5 Short Acting Beta Agonists (SABA) drugs that can be used to treat Asthma? (A/T/M/P/L)
albuterol, terbutaline, metaproterenol, pirbuterol, levalbuterol
Short Acting Beta Agonists (SABA)
What are the indications and warnings for these drugs:
- Albuterol (3 CIs)
- Terbutaline (2 CIs)
- Metaproterenol
- Pirbuterol
- Levalbuterol
- Albuterol - asthma, bronchitis, COPD
C: paradoxical bronchospasm, CV, hypersensitivity - Terbutaline - asthma, bronchitis, emphysema (12 yo+)
C: NOT for tocolysis, do NOT give to sulfa pts.- ONLY drug for SubQ injection
- Metaproterenol - asthma, bronchitis, COPD
C: paradoxical bronchospasm, CV effects - Pirbuterol - prevent/reverse bronchospasm in asthma (12 yo+)
C: CV effects - Levalbuterol - prevention/reverse bronchospasm in 4yo+ pts with reversible obstructive disease
C: paradoxical bronchospasm
What are the 7 Inhaled Corticosteroids (ICS) drugs used to treat Asthma and COPD? (B/B/C/F/F/M/T)
- beclomethasone
- budesonide
- ciclesonide
- flunisolide
- fluticasone
- mometasone
- triamcinolone
Inhaled Corticosteroids (ICS)
What are the indications and warnings for these drugs:
- beclomethasone (1 CI)
- budesonide (4 CIs)
- ciclesonide (2 CIs)
- beclomethasone - maintenance/prophylactic for pts. 5 yrs+ or to eliminate need for systemic corticosteroids
C: death due to adrenal insufficiency after switch- takes time to recover hypothalamic-pituitary-adrenal
- budesonide - prophylactic maintenance of asthma in pts. 6 yrs+
C: do NOT use for status asthmaticus or acute episodes of asthma; severe milk/drug hypersensitivity - ciclesonide - prophylactic maintenance of asthma in pts. 12 yrs+
C: acute bronchospasm relief, or in presence of Candida Albicans or other infections
Inhaled Corticosteroids (ICS)
What are the indications and warnings for these drugs:
- flunisolide (2 CIs)
- fluticasone (1 CI)
- mometasone (4 CIs)
- triamcinolone (4 CIs)
- flunisolide - prophylactic maintenance in 6 yrs+ pts or those needing oral therapy therapy (can reduce need)
C: status asthmaticus, intense acute asthma - fluticasone - prophylactic maintenance in 4 yrs+ pts but not for acute bronchospasm relief
C: candida albicans infection can occur (wash mouth) - mometasone - prophylactic maintenance in 4 yrs+ pts
C: status asthmaticus, acute asthma, milk or drug hypersensitivity - triamcinolone - prophylactic maintenance, pts who require systemic (reduces need)
C: status asthmaticus, acute asthma, acute bronchospasm, death from adrenal insufficiency
What 2 ICS drugs for Asthma and COPD can lead to death by adrenal insufficiency? (B/T)
beclomethasone and triamcinolone
When are Oral Corticosteroids used with Asthma pts and what are they commonly given with?
What is the common Oral Corticosteroid used for Asthma pts? (P)
- used in combination with short acting beta agonists to treat moderate to severe asthma flare-ups
- more likely to cause side effects than inhaled corticosteroids
Prednisone is commonly used
Prednisone
What is its indication and what are its 3 warnings of use (HPA/CS/HG)?
I: anti-inflammatory/immunosuppressive agent that can also be used for certain endocrine conditions
W: hypothalamic-pituitary-adrenal axis suppression and potential Cushings syndrome/hyperglycemia in chronic use pts.
What are the 5 Long Acting Beta Agonists (LABA) drugs used to treat patients with Asthma and COPD? (F/S/I/V/O)
When should these drugs be used?
fomoterol, salmeterol, indacaterol, vilanterol, olodaterol
- should ONLY be used with concomitant use of long-term asthma control medication such as ICS
Long Acting Beta Agonists (LABA)
What are the indications and warnings for these drugs:
- fomoterol
- salmeterol (EIB)
- indacaterol
- vilanterol
- olodaterol
- fomoterol - asthma in pts 5+ as ADD-ON to long-term control medication (ICS); maintenance in COPD
C: ONLY prescribed with ICS also (all LABAs) - salmeterol - asthma in pts 4+ and preventing exercise-induced EIB; maintenance in COPD
- indacaterol - treat emphysema/bronchitis from COPD
- vilanterol - treat emphysema/bronchitis from COPD
- olodaterol - once daily maintenance bronchodilator treatment for airflow obstruction with COPD
- bronchitis and emphysema
What are the 4 Anticholinergic drugs used to treat pts. with Asthma and COPD? (A/I/T/A)
What kinds of situations are these drugs used for and how do they work?
- atropine –> temporary block
- ipratropium –> maintenance
- tiotropium –> long-term maintenance
- aclidinium –> long-term maintenance
- block acetylcholine from binding to receptors thus inhibiting parasympathetic nerve impulses
Anticholinergic Drugs
What are the indications and warnings for these drugs:
- atropine
- ipratropium
- tiotropium
- aclidinium
- temporary block of severe/life-threatening muscarinic
C: restrict to 2-3 mg in recurrent CAD - maintenance of bronchospasm in COPD
- relatively free of atropine-like effects
- long-term, once daily, maintenance of bronchospasm associated with COPD
- long-term maintenance of bronchospasm associated with COPD
What are the 3 Methylxanthines that can be used to treat patients with Asthma and COPD? (T/T/C)
What are their 2 methods of action?
What are 3 pts populations that should be extremely cautious when using Theophylline? (PUD/S/CA)
theophylline, theobromine (chocolate), caffeine (coffee) –> produced naturally in both plants and animals
MOA: smooth muscle relaxation (bronchodilation) and suppression of response of airways to stimuli
C: active peptic ulcer disease, seizures, cardiac arrhythmias
Leukotriene Antagonists
What is their MOA and what are the 3 drugs of this class? (M/Z/Z)
MOA: binds to cysteinyl leukotriene (CysLT) receptors and block their activation –> subsequent inflammatory cascade
Drugs: Montelukast, Zafirlukast, Zileuton
