Asthma and COPD Pharm

Question 1

MOA of beta agonist inhalers

Answer 1

activate adenylyl cyclase–> increase cAMP–> bronchodilation

Question 2

MOA of theophylline

Answer 2

inhibit adenosine–> decreased bronchoconstriction (less)

inhibit PDE–>more cAMP available to cause bronchodilation

Question 3

MOA of muscarinic antagonists

Answer 3

inhibit acetylcholine–> less bronchoconstriction

Question 4

Drug treatment plan for asthma

Answer 4

ICS–> LABA–> LAMA

SABA baseline

Question 5

Drug treatment plan for COPD

Answer 5

LAMA–> LABA–> ICS

SABA baseline

Question 6

MOA of bronchodilators (SABA and LABA)

Answer 6

relax airway smooth muscle cells–>bronchodilation

Question 7

Albuterol

Answer 7

SABA
asthma, acute bronchitis, COPD, bronchiolitis

HA, dizziness, insomnia, dry mouth, cough

warnings–>paradoxical bronchospasm, asthma deterioration, CV effects, hypersensitivity

Question 8

Terbutaline

Answer 8

SABA

asthma, emphysema, bronchitis

ONLY beta agonist subQ injection

don’t use with sulfa allergy

not rec for tocolysis

Question 9

Metaproterenol

Answer 9

SABA

bronchial asthma, reversible bronchospasm associated with bronchitis and COPD

warnings–>can produce paradoxical bronchospasm (life threatening)

Question 10

Pirbuterol

Answer 10

SABA

prevention and reversal of bronchospasm

warning–>clinically significant CV effect in some patients

Question 11

Levalbuterol

Answer 11

SABA

treatment or prevention of bronchospasm 4+

warning–>paradoxical bronchospasm

Question 12

Beclomethasone

Answer 12

ICS

maintenance treatment for asthma and prophylactic therapy 5+

warnings–> adrenal insufficiency and death d/t transfer from systemic cortico to less systemic inhaled cortico

***takes months for recovery of HPA fxn

Question 13

ICS general features

Answer 13

most effective asthma controllers and anti-inflammatory agents

reduce eosinophils in sputum, T lymp and mast cells in airway mucosa

switch off transcription of genes that encode inflammatory proteins

BID, rapidly improve sx

reduce AHR

prevent irreversible changes in airway fxn

slow deterioration on withrdrawal

first-line therapy for asthma
—>add LABA next step

Question 14

Budesonide

Answer 14

ICS

maintenance treatment of asthma (prophylactic) 6+

don’t use as primary tmt in status asthmaticus or acute episode of asthma where intensive measures required

Question 15

Ciclesonide

Answer 15

ICS

maintenance asthma

don’t use in acute bronchospasm or in presence of Candida infection

Question 16

Flunisolide

Answer 16

ICS

maintenance, reduce or eliminate need for oral corticosteroids

Question 17

Fluticasone

Answer 17

ICS

maintenance asthma 4+

can cause Candida in mouth or pharynx

Question 18

Mometasone

Answer 18

ICS

maintenance asthma 4+

don’t give known hypersensitivity to milk proteins

Question 19

Triamcinolone

Answer 19

ICS

maintenance asthma, reduce need for systemic corticosteroids

don’t use for relief of acute bronchospasm

don’t give as primary tmt for status asthmaticus or acute asthma that needs intensive tmt

deaths d/t adrenal insufficiency

Question 20

Prednisone

Answer 20

oral corticosteroid

• ->combine with SABA to treat severe asthma and flare-ups
• ->more likely to cause side effects c/t ICS

anti-inflamm/immunosuppressive

also treats endocrine conditions

can lead to HPA suppression–>cushing syndrome, hyperglycemia

Question 21

Fomoterol

Answer 21

LABA

5+ as add on to long-term asthma control (ICS)

maintenance of bronchoconstriction in COPD

increase asthma-related deaths and hospitalizations
–> use only as concomitant therapy with ICS

Question 22

Salmeterol

Answer 22

LABA

maintenance, prevent exercise-induced bronchospasm 4+

Question 23

Indacaterol and Vilanterol

Answer 23

LABA

breathing problems caused by COPD

Question 24

Olodaterol

Answer 24

LABA

long term qd maintenance of airflow obstruction

Question 25

Atropine

Answer 25

anticholinergic temporary blockage of severe or life-threatening asthma/COPD restrict dose 2-3mg in CAD patients

Question 26

Ipratropium

Answer 26

anticholinergic maintenance tmt of bronchospasm relatively fee of systemic atropine-like effects

Question 27

Tiptropium

Answer 27

anticholinergic long-term qd maintenance tmt of bronchospasm

Question 28

Aclidinium

Answer 28

anticholinergic long-term maintenance tmt of bronchospasm in COPD

Question 29

Methylxanthines overview

Answer 29

derived from purine base xanthine treat asthma, chronic bronchitis, emphysema theophylline, theobromine, caffeine

Question 30

Theophylline

Answer 30

bronchodilation (SM relax) suppress response of airway to stimuli treats asthma and COPD extreme caution in PUD, seizure disorders and arrhythmias

Question 31

Montelukast

Answer 31

leukotriene receptor antagonist less effective than ICS, potentiate corticosteroid action bind CysLT-->block their activation of inflammatory cascade inhibits LTD4 at receptor without any agonist activity treats allergies and prevents asthma attacks dont use as reversal of bronchospasm in acute asthma attacks

Question 32

Zafirlukast

Answer 32

leukotriene antagonist prophylaxis and chronic treatment of asthma hepatotoxicity

Question 33

Zileuton

Answer 33

leukotriene antagonist prophylaxis and chronic treatment of asthma don't use to treat acute asthma attack don't use with active liver disease or ALT/AST 3 times ULN

Question 34

Omalizumab

Answer 34

anti-IgE antibody treats moderate to severe persistent asthma 6+ with positive skin test or reactivity to perennial aeroallergen also treats chronic idiopathic urticaria ANAPHYLAXIS, only give in healthcare setting