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CPR Exam 2 > Allergies and COPD Drugs > Flashcards

Allergies and COPD Drugs Flashcards

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1
Q

What are the 2 categories of drugs used to treat asthma?

A
  1. Anti-inflammatory drugs
  2. Bronchodilators
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2
Q

What type of anti-inflammatory drugs are used to treat asthma?

A
    1. Corticosteriods (inhaled and oral)
    1. Antibodies
    1. Drugs that modify leukotriene receptor (DO NOT CONTAIN HORMONES)
      * ​lipoxygenase inhibitors
      * leukotriene receptor blockers
      • —DO NOT CONTAIN HORMONES—-
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3
Q

What types of bronchodilators are used to treat asthma?

A
  1. B-agonists (most effective)
  2. Anti-cholinergics
  3. Methylxanthines
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4
Q

Name the SABA

A
  • 1. Albuterol
  • 2. Terbutaline
  • 3. Metaproterenol
  • 4. Pirbuterol
  • 5. Levalbuterol
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5
Q

Name the LA-BA

A
  1. Fomoterol
  2. Salmeterol
  3. Indacaterol
  4. Vilanterol
  5. Oldaterol
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6
Q

Name anti-cholinergic drug

A
  • 1. Atropine
  • 2. Ipatropium
  • 3. Tiotripium
  • 4. Aclidinium
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7
Q

Name the methylxanthines

A
  1. Theophylline
  2. Theobromine
  3. Caffeine
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8
Q

Name the inhaled corticosteroids

A
  1. Beclamethasone
  2. Budesonide
  3. Ciclesonide
  4. Flunisolide
  5. Fluticasone
  6. Mometasone
  7. Triamcinolone
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9
Q

Oral and Parenteral Corticosteroids (OCS)

A

1. Prednisone

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10
Q

Monoclonal Ab drugs

A

1. Omalizumab

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11
Q

Leukotriene receptor ANT

A
  • 1. Zafirlukast
  • 2. Montelukast
  • 3. Pranulukast

Both are reversible

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12
Q

Lipooxygenase inhibitor

A

1. Zileuton

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13
Q

MOA of B2-AGO?

A

+ AC => ↑ cAMP => bronchodilation.

  • relax airway smooth muscle, where they act as functional ANT and reverse constriction.
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14
Q

MOA of theophylline

A

2 mechanisms on airways with reversible obstruction:

    1. Inhibit PDE, preventing the breakdown in cAMP => ↑ in CAMP => bronchodilate
    1. Inhibits adenosine, which is a bronchoconstricts => suppresses response of airway to stimumi (prophlactic)
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15
Q

MOA of muscarinic ANT (anticholinergics)

A
  1. Prevent binding of ACh, which usually bronchoconstricts => inhibit parasympathetic inpulse => prevent bronchoconstriction
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16
Q

What is the major route of inhaled corticosteroids and B2-agonists, and what type of effect does it have?

What is the minor route?

A
  • Major route (80%): swallow, but produces a minor effect
  • Minor route: inhaled, but produces a MAJOR effect.
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17
Q

For inhaled drugs, why is swallowing the major route, but the effect is less?

A

Absorbed from GI tract => liver, where it undergoes 1st pass metabolism.

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18
Q

Bronchodilators act on airway smooth muscle to do what?

A

reverse bronchoconstriction

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19
Q

What is the most commmonly used drug to treat asthma/COPD?

A

B2-AGO

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20
Q

What is the only β2 drug available for SQ injection?

A

Terbutaline

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21
Q

What are the indications for use of Terbutaline?

A

Ppl over 12 YO to treat and prophalax against bronchospams in [asthma, bronchitis and emphysema]

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22
Q

What is the black-box warning for Terbutaline?

A

Not recommended as a medication for tocolysis (utermine contractions/preterm labor)

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23
Q

Which β2-agonist for asthma is not recommended for pt’s with sulfa allergies?

A

Terbutaline

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24
Q

What are side effects of Terbutaline?

A
  • 1. HA
  • 2. N
  • 3. Palpitations
  • 4. Tachycardia
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25
What are indications for **Albuterol**?
**1. Asthma** **2. Acute bronchitis** **3. Bronchilitis** **4. COPD**
26
Which life-threatening AE can occur after tx w/ **Albuterol**?
1. Paradoxical bronchospasm 2. make asthma worse 3. CV 4. immediate hypersensitivity reactions
27
AE of **Albuterol**
* **1. HA** * **2. Dizziness** * **3. Insomnia** * **4. Dry mouth** * **5. Cough**
28
What are 2 indications for the use of the β2-agonist **Metaproterenol**?
- Bronchodilator for _**bronchial** asthma_ - **Reversible bronchospasm** which may occur in assoc. w/ **_bronchitis_** and **_COPD_** --
29
What are 2 cautions/warnings associated with the use of **Metaproterenol**?
- Can produce **significant cardiovascular effect** in some pt's, as measured by pulse, BP, sx's and/or ECG changes - Can produce ***paradoxical bronchospasm***(can be life threatening) bc **aersol**
30
Which drug class should not be used concomitantly with **Metaproterenol**?
Beta-adrenergic **aerosol** bronchodilators due to **additive** effects
31
Which β2-agonist may be used **with** or **without** **concurrent theophylline** and/or **corticosteroid** therapy?
**Pirbuterol**
32
What are the indications for **Pirbuterol**?
* **Pts 12 YO** or older to prevent and **reverse bronchospasms** with **reversible bronchospasms (inc asthma)**
33
What are significant AE of **Pirbuterol**?
**CV affects**, like other inhaled B adrenergic AGO
34
What are the indications for the use of the β2-agonist, **Levalbuterol**?
* **4 YO or older** to treat or prevent bronchospams in **reversible obstructive airways disease**
35
Signifiant AE of **Levalbuterol**?
Life-threatening **paradoxical bronchospasms**
36
What are the 4 long-acting β2-agonists?
* **1. Fomoterol** * **2. Salmeterol** * **3. Indacterol** * **4. Vilanterol** * **5. Oldaterol**
37
What are the 3 indications for use of the **LABA, Fomoterol?**
1. **Asthma** * Pts over 5 YO as an add on with a med that contorls asthma long-term (inhaled corticosteroids) 2. Prevention of **exercise-induced bronchospasm** (EIB) in pt's ≥5 y/o 3. **COPD**: Maintain/prevent bronchoconstriction
38
What are cautions/warnings for the use of **LABA'**s in **asthma**?
- ↑ risk of asthma-related death and asthma-related hospitlizations - MUST be used concomitantly with an **inhaled corticosteroid for asthma** (**fomoterol** and **salmeterol**)
39
What are the 3 indications for use of the LABA, **Salmeterol**?
1. Asthma * Pts over **4 YO** as an add on with a med that contorls asthma long-term (inhaled corticosteroids) 2. Prevention of exercise-induced bronchospasm (EIB) in pt's ≥**4 y/**o 3. COPD * Maintenance tx of bronchosapsm in pt's with COPD SAME THING AS FOMOTEROL, BUT CAN BE USED IN **4 YO** OR YOUNGER
40
What is the indication for the use of the LABA, **Indacaterol** and **Vilanterol**?
Used to tx **breathing problems** caused by **COPD**, including **chronic bronchitis** and **emphysema**
41
What is the indication for use of the LABA, **Olodaterol**?
Used as **LONG-term,** **1x/daily** to help **bronchodilate** in pt's with **COPD**(chronic bronchitis and emphysema)
42
What 4 **[ICS +LABA} combination inhalers** can we have?
1. ICS + LABA 2. Fluticasone + Salmeterol 3. Formoterol + Mometasone 4. Formoterol + Budensonide
43
If pt has **mild intermittant** breathing problems, what do you prescribe? What about **mild persistant**? **Very severe persistant?**
* SABA * SABA + Low dose ICS * SABA + High dose ICS + LABA + **_OCS_**
44
Which anticholinergic drug is indicated for use as a bronchodilator for **maintenance tx** of **bronchospasm** associated with **COPD**, including **chronic bronchitis** and **emphysema**?
**Ipatropium**
45
Which anticholinergic drug is given **1/day** for **long-term maintenance** tx of **bronchospasm** associated with **COPD**, and for **reducing COPD exacerbations**?
**Tiotroprium**
46
What is the indication for use of the anticholinergic drug, **Aclidinium**?
**LONG-term**, **maintenance of bronchospasm** associated with **COPD**, including chronic bronchitis and emphysema
47
Which anti-cholinergic drug is a potent **ATROPINE ANALOG** that is **poorly absorbed,** thus, does **not** have all of the **systemic effects** of atropine?
Ipratropium
48
Anti-cholinergic drugs are used mainly to treat what?
**_COPD_** **Ipratropium + Aclidinium** treats COPD + chronic bronchitis + emphysema
49
What are the **Methylxanthines** (Theobromine, Theophylline) used to treat for? What is **theobromine** present in?
- **Airway obstruction** caused by * **asthma** * **chronic bronchitis** * **emphysema** Chocholate
50
What **methylxanthine** is used to in a lot of _prophylactic measures?_
**Theophylline**
51
**Theophylline** should be used with extreme caution in pt's with what 3 underlying clinical conditions?
1. **- Active peptic ulcer disease** 2. - **Seizures** 3. - **Cardiac arrhythmias** (NOT including bradyarrhythmias)
52
What is given as the first-line therapy for **persistent asthma**; if sx's are not controlled at **low doses** you may add what?
**Inhaled corticosteroids (ICS);** can add **LABA** as next step
53
How do **corticosteroids** work as anti-inflammatory meds?
**Stop transcription** of genes that encode **inflammatory cells**
54
What are the **BEST controllers/supressors** for **_asthma_** but do NOT correct the problem?
**ICS**
55
How does **ICSs** work as **anti-inflammatory meds?**
* 1. **Reduce eosinophils** in airway and sputum * 2. **Reduce activated T cells** and **mast cells** in mucosa.
56
* How often is **ICS** administered? * How quickly do they work in improving asthma symptoms? * What are 3 other effects of ICS?
1. **2x/day** 2. Improve asthma symptoms and lung function in **DAYS** 3. Other effects 1. Prevent **excericse-induced asthma** and n**octurnal exacerbations** 2. **Reduce AHR** (airway hyperresponsiveness) over months 3. If given early, can **prevent irreversible damage** to airways that occur in chronic asthma.
57
**Withdrawal of ICS** results in what and what does this imply?
**Control of asthma slowly deteriorates,** thus, implying that they SUPRESS inflammation and symptoms, but do NOT cure,
58
Are **ICS** for immediate/MRGNT use?
NO.
59
What are the 2 indications for the use of the ICS, **Beclomethasone**?
- **Pts 5YO or older** to **maintain** and **prophylact** against asthma - Tx of **asthma** in pt's who require **ORAL corticosteroid therapy** to reduce or eliminate the need for systemic corticosteroids
60
Which 2 ICS's require special care if used in pt's who are transferred from **systemically active drugs** to less **systemically available inhaled drugs** which can cause death d/t adrenal insufficiency?
**- Beclomethasone** **- Triamcinolone**
61
What happens after the withdrawal for systemic corticosteroids?
**It takes months for HPA to recover function**
62
What is the indication for use of the ICS, **Budesonide**?
**Pediatric and adults 6YO older** to maintenance tx of asthma prophylactic
63
Which pt's should the ICS, **Budesonide** not be used in?
For primary tx of **status asthmaticus** or other acute episodes of asthma, where intensive measures are needed - Pts with severe **hypersenitivity to milk proteins**
64
What is the indication for use of the ICS, **Ciclesonide**?
Adolescents and adults **12YO older** to maintain tx of asthma prophylactic
65
When is the ICS, **Ciclesonide** not indicated for use and should be avoided in the presence of what infection?
- Not indicated for the relief of acute bronchospasm - Not recommended in presence of **Candida albicans infection** of the mouth and pharynx, **tuberculosis**, **fungal**, **bacterial**, or **parasitic** infections
66
What are the 2 indication for use of the ICS, **Flunisolide**?
- Maintenance and prophylactic tx of asthma in adults and pt's **≥6 y/o** - Asthma pt's needed **oral corticosteroid therapy**. **Adding** flunisolide may **↓ or eliminate the need for** other oral corticosteroids
67
Use of the ICS, **Flunisolide** is contraindicated for use in which pt's?
Primary tx of **status asthmaticus** or other **acute episodes of asthma** where intensive measures are required * like **Budesonide**
68
Indications for Flutacisone
- Maintain and prophylact against asmtha in pts 4 YO or older - not indicated for
69
**Fluticasone** is not indicated for whom? Can cause what?
- Acute bronchospasms - Candida albican infection, so monitor pt and tell to wash mouth
70
ICS are used to maintain asthma and prophalyx in patients ____ old. * **1. Beclamethosone** * **2. Budesonide** * **3. Ciclesonide** * **4. Flunisolide** * **5. Flutacasone** * **6. Mometasone** * **7. Triamcinolone** **Mark which ones have another use**
* **1. Beclamethosone: 5 YO and older \*** * 2. Budesonide: 6 YO and older * 3. Ciclesonide: 12 YO and older * **4. Flunisolide: 6 YO and older \*** * 5. Flutacasone: 4 YO and older * 6. Mometasone: 4 YO and older * **7. Triamcinolone: \_\_\_\_. \***
71
Which **ICS** is also used in patients who are require a systemic corticosteroid, where adding could reduce the need for the systemic corticosteroid?
**Triamcinelone**
72
Which ICS is also used in patients who are require a **oral corticosteroid**, where adding could reduce the need for the **oral corticosteroid?**
Flunisolide
73
Which ICS is also used in patients who are require a **oral** corticosteroid, where adding could reduce the need for a **systemic** corticosteroid?
**Beclamethasone**
74
Which 2 ICS used for asthma are contraindicated in pt's with: - **status asthmaticus** or other **acute episodes of asthma** where intensive measures are required - + pt's with a known **hypersensitivity** to **milk proteins**?
* **-Budesonide** * **-Mometasone**
75
What **systemically less available drugs** need to be watched when they are **switched to from a systemically available,** because the patient can **die** from adrenal insuffiency?
**1. Beclamethosone** **2. Triamcinolone**
76
When are **oral corticosteroids** used for **asthma** and in conjunction with what other drug class?
With **SABA** for **moderate-severe asthma flare-ups**
77
Which is most lilkely to cause sxs: oral or inhaled corticosteroids?
**oral**
78
What is the **oral corticosteroid** which may be used for moderate to severe asthma flare ups in combo with a short acting beta-agonist?
**Prednisone** * **-Anti-inflamm/immunosupressive agent** * **-Tx endocrine conditions**
79
What should patients of **Prednisone** be monitored for?
**HPA axis supressions** * -Cushings * -Hyperglycemia * If sx come about, taper off
80
What are the 3 leukotriene antagonists used for asthma?
- **Monte**lukast - **Zafir**lukast - **Pranulu**kase
81
**Leukotrient ANT** are taken through which hole? Are ______ and have ________ action. More or less effective than ICS? WHAT IS KEY TO THEIR USE?
* Oral * Bronchodilate and anti-inflammatory action * Less * Glucocorticoid sparing; meaning that they potentiate the actions of corticosteroids *
82
Why are **Leukotriene receptor ANT** prescribed for? how
**TREATMENT** and **PREVENTION** of **_acute asthmatic attacks_** bind to receptor and prevent inflammatory cascade.
83
What is the MOA of Montelukast?
Binds w/ high affinity and selectivity to the CysLT1 receptor; INHIBITING the physiologic actions of LTD4
84
Montelukast is primarily prescribed for what?
Treat allergies and prevent asthma attacks
85
Which leukotriene receptor antagonist used for asthma is associated with **hepatotoxicity** as an AE?
**Zafirlukast**
86
What is **Zafirlukast** prescribed for?
**Prophylaxis** and chronic tx of **asthma** in **pts ≥5 y/o**
87
What is **Zafirlukast** MOA?
Selective and COMPETITIVE leukotriene receptor ANT to **LD4** and **LE4**, components of SRSA (slow-reacting substance anaphalayxis)
88
What is the MOA of **Zileuton**?
Inhibitor of **5-lipoxygenase** and thus **inhibits leukotriene (**LTB4, LTC4, LTD4, and LTE4) formation
89
What is the indication for the use of **Zileuton**?
**Prophylaxis and chronic tx of asthma in pt's ≥12 y/o**; ***_NOT_*** acute asthmatic attacks
90
**Zileuton** is not indicated for use in pt's with what underlying disease/abnormalities?
**- Active liver disease** or - Persistent hepatic function **enzymes ≥3x upper limit of norma**
91
What is the MOA of **Omalizumab**, a monoclonal AB?
* **Binds to free IgE, decreasing binding to cell** * **Blocks** binding to FCεRI, decreases exporesson of these receptors * - Causes **↓ release** of **mediators** from **mast cells, basophils,** and **eosinophils** * Decrease allergic inflammationa and prevents exacerbation of asthma and reduces symptoms
92
What are the 2 **indications** for the use of **Omalizumab**?
- **Moderate** to **severe persistent asthma** in pt's **≥6 y/o** w/ (+) skin test or invitro reactivity to perennial aeroallergen and sx's inadequately controlled w/ ICS - **Chronic idiopathic urticaria** in **pt's ≥12 y/o** who who dont respond to H1 antihistamine tx
93
What is a black box warning for Omalizumab?
Administer only in a h**ealthcare setting** prepared to manage **anaphylaxis** that can be life threatening
94
Pt's w/ features of both asthma + COPD may benefit from what treatment?
**ICS** + **LABA** + **LAMA**?

CPR Exam 2 (29 decks)

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