Asthma and COPD Drugs Flashcards
(43 cards)
1
Q
Precipitating or Aggravating Factors
A
- Exercise
- Endocrine
- Drugs
- Weather changes
- Allergens
- Emotional expression
- Food additives
- ETC
2
Q
Components of Asthma Management
A
- routine monitoring of symptoms and lung function
- Patient education to create a partnership between clinician and patient
- controlling environmental factors and co-morbid conditions that contribute to asthma severity
- pharmacologic therapy
3
Q
Goal of Asthma management
A
- Reduction in impairment
- Reduction of risk
4
Q
Asthma Drug Categories
A
- Anti-inflammatory
- Bronchodilators
5
Q
Anti-inflammatory Drugs
A
- Hormone containing (Corticosteroids)
- Abs
- Leukotriene receptor modifiers
6
Q
Bronchodilators Classes
A
- Beta-2 agonists
- Anticholinergic drugs
- Methylxantines
7
Q
B2 agonists
A
- relax airway smooth muscle cells of all airways
- act as functional antagonists, reverse and prevent contraction by bronchoconstrictors
8
Q
List of B2 Agonists
A
- Albuterol
- Terbutaline
- Metaproterenol
- Pirbuterol
- Levalbuterol
- Fomoterol
- Salmeterol
- Indacaterol and Vilanterol
- Olodaterol
9
Q
Albuterol
A
- SABA
- Indications: asthma, acute bronchitis, COPD, bronchiolitis
- Adverse Effects: headache, dizziness, insomnia, dry mouth, cough
- Contraindications/Warnings: Paradoxical bronchospasm, deterioration of asthma, CV effects, immediate hypersensitivity
10
Q
Terbutaline
A
- SABA
- ONLY subcutaneous B2 drug
- Indications: prophylaxis of bronchospasm associated w/ asthma, bronchitis and emphysema in pts. 12+ years
Cautions: Not recommended for tocolysis (uterine contractions) - Adverse effects: headache, nausea, tachycardia and palpitations
11
Q
Metaproterenol
A
- SABA
- Indications: bronchial asthma for reversible bronchospasm that may occur in association w/ bronchitis and COPD
- Cautions: can produce CV effects in some, can cause paradoxical bronchospasm
12
Q
Pirbuterol
A
- SABA
- Indications: prevention and reversal of bronchospasm. 12+ years. Used w/ or w/o concurrent theophylline and/or corticosteroid therapy
- Cautions: CV - can produce CV effects in some.
13
Q
Levalbuterol
A
- SABA
- treatment or prevention of bronchospasm
- 4+ years
Cautions: paradoxical bronchospasm
14
Q
Fomoterol
A
- LABA
- 5+ years
- add on to long-term asthma control med such as inhaled corticosteroids
- maintenance treatment of bronchoconstriction in pts w/ COPD
- Contraindications: do not use w/o use of a long term medication such as an inhaled corticosteroid. Use increases risk of asthma-related deaths and hospitalizations
15
Q
Salmeterol
A
- LABA
- 4+ years
- Prevent exercise-induced bronchospasm
- maintenance treatment of bronchospasm associated w/ COPD
16
Q
Indacaterol and Vilanterol
A
- LABA
- treat breathing problems caused by COPD
17
Q
Olodaterol
A
- LABA
- long-term, once daily maintenance bronchodilator of airflow obstruction in pts w/ COPD
18
Q
LABA
A
- use w/ long-term control med like an inhaled corticosteroid
- increase risk of asthma related deaths and hospitalizations
19
Q
Anticholinergic Drugs
A
- block Ach
- inhibit parasympathetic nerve impulses
20
Q
Atropine
A
- muscarinic antagonist
- used to temporarily block severe or life threatening muscarinic effects
- Cautions: in pts with CAD, the total dosage should be restricted to 2-3 mg in order to avoid detrimental effects of atropine induced tachycardia
- Temporary block
21
Q
Ipratropium
A
- maintenance treatment of bronchospasm
- mAchR antagonist
- potent atropine analog that is poorly absorbed after aerosol administration
- relatively free of systemic atropine like effects
22
Q
Tiotropium
A
- long term, once daily maintenance
23
Q
Aclidinium
A
- long term maintenance
24
Q
Methylxanthines
A
- derived from xanthine (produced by plants and animals)
- treats airway obstruction by asthma, chronic bronchitis or emphysema
- Theophylline
- Theobromine
- Caffeine
25
Theophylline
- smooth muscle relaxation (bronchodilation)
- suppression of airway response to stimuli
- Cautions: pts w/ active peptic ulcer disease, seizure disorders and cardiac arrhythmias
26
Inhaled corticosteroids
- most effective controllers for asthma
- most effective anti-inflammatory agents used for asthma therapy
- reduce eosinophils in airway and sputum, and # of activated T cell and mast cells in airway mucosa
- major effect: switch off transcription of multiple activated genes that encode inflammatory proteins
27
ICS Drugs
- Beclomethasone
- Budesonide
- Ciclesonide
- Flunisolide
- Fluticasone
- Momestasone
- Triamcinolone
28
Beclomethasone
- ICS
- maintenance and prophylactic treatment
- 5+
- used when oral is required to reduce or eliminate the need
- Cautions: take care when transferring from oral corticosteroids
29
Budesonide
- prophylactic
- 6+
- Caution: do not use as primary treatment for status asmaticus or other acute episodes
30
Ciclesonide
- prophylactic
- 12+
- Cautions: not for acute bronchospams. Not recommended w/ Candida infections, Tb, fungal, bacterial, viral or parasitic infection
31
Flunisolide
- maintenance
- adult and 6+
- for patients requiring oral corticosteroids to reduce or eliminate need for them
- Contraindicated: acute and status asmaticus
32
Fluticasone
- prophylactic
- 4+
- Cautions: Candida infection of the mouth and pharynx may occur. monitor patients
33
Mometasone
- prophylactic
- 4+
- Contraindicated: pts w/ milk protein allergies
34
Triamcinolone
- phophylactic
- indicated in pts on oral corticosteroids
- not for acute relief
- Cautions: transferring from systemic corticosteroids. Deaths due to adrenal insufficiency
35
Oral and Parenteral Corticosteroids
- used in combination w/ SABA to treat moderate to severe asthma flare ups
- more likely to cause side effects than ICS
36
Prednisone
- OCS
- anti-inflammatory or immunosuppressive agent
- used to treat certain endocrine conditions
- Cautions: may lead to HPA axis suppression
- Monitor for Cushing's and hyperglycemia
37
Leukotriene Receptor Antagonists
- Zafirlukast and Montelukast
- selective reversible antagonists of CysLT1 receptors
- taken orally
- brochodilators
- anti-inflammatory action
- less effective than ICS
- glucocorticoid sparing effect
38
Montelukast
- inhibits physiologic actions of LTD4 at the CysLT1 receptor w/o agonist activity
- Treat allergies and prevent asthma attacks
- not indicated for treatment of acute attacks
39
Zirfirlukast
- Selective and competitive antagonist for Leukotriene D4 and E4: components of slow reacting substance of anaphylaxis
- Cautions: hepatotoxicity
40
Zileuton
- 5-LO inhibitor
- used as prophylaxis and chronic treatment of asthma
- adults and 12+
- Cautions: not recommended when active acute liver disease or persistent hepatic function enzyme elevations are >/= 3x upper limit of normal
41
Monoclonal Ab Drugs
Work in 4 ways
- binds to free IgE, decreasing cell bound IgE
- decreases expression of high-affinity receptors
- decreases mediator release
- decreases allergic inflammation and prevent exacerbation of asthma and reduces Sx
42
Omalizumab
- anti-IgE
- moderate to sever persistant asthma
- 6+
- with positive skin test or in vitro reactivity to a perennial aeroallergen
- chronic idiopathic urticaria in adults and 12+
- Caution: anaphylaxis: give only in the healthcare setting
43
Asthma-COPD Overlap
- different clinical presentations and underlying inflammatory mechanisms
- some pts w/ asthma have features of COPD
- some pts w/ COPD have features of asthma w/ more reversibility and icreased airway and blood eosinophils
