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Pharmacology 2 > Asthma + COPD > Flashcards

Asthma + COPD Flashcards

1
Q

Pathophysiology
Asthma

A

Asthma is a chronic inflammatory disorder of the airways. The pathophysiology of asthma involves the following components: airway inflammation, intermittent airflow obstruction and bronchial hyperresponsiveness.

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2
Q

Signs and symptoms
Asthma

A

SOB
Chest tightness or pain
Wheezing when exhaling

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3
Q

Rationale for drug use
Asthma

A

Symptom control and relief.

Prevention of exacerbations, acute asthma and death.

Improve and maintain lung function and quality of life

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4
Q

Step 1 asthma treatment criteria and drugs

A

Symptoms <2 times / month
SABA reliever puffer (salbutamol)

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5
Q

Step 2 asthma management criteria and drugs

A

Suitable for most new pts
ICS (low maintenance dose) + SABA (reliever as needed)

Budesonide + Salbutamol

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6
Q

Step 3 asthma criteria and treatment

A

Low dose ICS (budenoside) + fomoterol (LABA) + SABA (salbutamol)
Used for frequent use of inhaler (more than 2 times a week

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7
Q

Suffix
Beta2 agonist

A

LABA
terol

SABA
Salbutamol
terbutaline

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8
Q

Two kinds of Beta2 agonists

A

Short acting SABA
Long acting LABA

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9
Q

Generic names
Beta2 agonists

A

SABA
Salbutamol
Terbutaline
LABA
Formoterol
Indacaterol
Salmeterol

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10
Q

MOA
Beta 2 agonists

A

Relax bronchial smooth muscle by stimulating beta2 adrenoreceptors.

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11
Q

Indication
SABA

A

Symptom relief of asthma and COPD
Prevention of exercise-induced bronchoconstriction

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12
Q

Indication
LABA

A
  • Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids (except olodaterol)
  • COPD
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13
Q

Precautions
Beta 2 agonists

A

Cardiovascular disorders (including hypertension, ischaemic heart disease, heart failure, arrhythmias)—risk of cardiovascular adverse effects.

Diabetes—risk of hyperglycaemia with high doses.

Treatment with other sympathomimetic amines—may increase adverse effects (tremor, tachycardia, headache); avoid combination or adjust dose as necessary.

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14
Q

Adverse effects
Beta2 agonists

A

tremor, palpitations, headache
Hyperglycemia in high doses

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15
Q

Practice points
Beta2 agonists

A
  • high or increasing** usage of SABAs** indicates poorly controlled asthma and requires review of management
  • check inhaler technique and compliance regularly, especially when asthma control is poor
  • withhold LABA (24–36 hours) and SABA (4 hours if possible) before diagnostic spirometry; see details in the Spirometry Quick Reference Guide at the National Asthma Council Australia website
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16
Q

Drug class and indication

Formoterol

A

Beta2 agonist - LABA
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* Symptom relief of asthma in patients receiving inhaled corticosteroids and regular formoterol
* COPD

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17
Q

Drug class and indication

Indacaterol

A

Beta2 agonist - LABA
COPD

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18
Q

Drug class and indication

Indacaterol with glycopyrronium

A

Beta2 agonist (LABA) + Anticholinergics
COPD

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19
Q

Drug class and indication

Indacaterol with glycopyrronium and mometasone

A

Beta2 agonist (LABA) + Anticholinergic + corticosteroids

Maintenance treatment of severe asthma inadequately controlled with a combination inhaled corticosteroid and long-acting beta2 agonist

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20
Q

Drug class and indication

Indacaterol with mometasone

A

Beta2 agonist (LABA) + corticosteroids
Maintenance treatment of asthma when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate

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21
Q

Drug class and indication

Salbutamol

A

Beta2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

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22
Q

Drug class and indication

Salmeterol

A

Beta2 agonist (LABA)
* Maintenance treatment of asthma in patients receiving inhaled or oral corticosteroids
* COPD

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23
Q

Drug class and indication

Terbutaline

A

Beta 2 agonist (SABA)
* Symptom relief of asthma and COPD
* Prevention of exercise-induced bronchoconstriction

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24
Q

Drug interactions
Beta2 agonists

A

beta-blockers + beta2 agonists
Beta-blockers antagonise the therapeutic effects of beta2 agonists and may precipitate asthma; seek specialist advice if the combination is felt necessary as a selective beta-blocker may be suitable.

theophylline + beta2 agonists
Theophylline can potentiate hypokalaemia induced by high doses of beta2 agonists; monitor patients with severe asthma closely for hypokalaemia.

Combination with other sympathomimetic amines may overload sympathetic nervous system = tremors, tachycardia

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25
**Suffix** Corticosteroids
"asone" or "sonide"
26
**Generic drug names** Corticosteroids
Beclometasone (inhaled) Budesonide (inhaled) Ciclesonide (inhaled) Fluticasone furoate (inhaled)
27
**Indication** Corticosteroids
Maintenance treatment of **asthma** and **COPD**
28
**MOA** Corticosteroids
Reduce airway inflammation and bronchial hyper-reactivity.
29
**Precautions** Corticosteroids
**COPD**—inhaled corticosteroids may increase the risk of pneumonia. **Smoking**—asthma patients who smoke may respond less well to inhaled corticosteroids than non-smokers and may require higher doses.
30
**Adverse effects** Corticosteroids
dysphonia, oropharyngeal candidiasis, bruising, facial skin irritation following nebulisation **Systemic adverse effects** Bone density loss Pneumonia: risk may be increased in COPD patients.
31
**Counselling** Corticosteroids
Use spacer rinse mouth with water after use
32
**Practice points** Corticosteroids
* **check inhaler technique** and compliance regularly * inhaled corticosteroids may be a **useful add-on treatment for COPD** inadequately controlled with long-acting beta2 agonists
33
# Drug class and indication Beclometasone (inhaled)
**Corticosteroid** Maintenance treatment of asthma
34
# Drug class and indication Beclometasone with formoterol
**Corticosteroid + Beta2 agonist (LABA)** * **Maintenance treatment of asthma** (including additional symptom relief) when use of an inhaled corticosteroid and long-acting beta2 agonist is appropriate * COPD with FEV1 <50% and recurrent exacerbations despite treatment with long-acting bronchodilators
35
# Drug class and indication Beclometasone with formoterol and glycopyrronium
**Corticosteroid + beta2 agonist (LABA) + anticholinergic (LAMA)** COPD with FEV1 <50% and recurrent exacerbations requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS)
36
ICS aka...
Inhaled coricosteroid
37
# Drug class and indication Budesonide (inhaled)
**Corticosteroid** Maintenance treatment of asthma Croup
38
# Drug class and indication Budesonide with formoterol
**ICS + LABA** * **Maintenance treatment of asthma** inadequately controlled with inhaled corticosteroids or when stabilised on regular budesonide and formoterol * **Maintenance and symptom relief of asthma** * **Symptom relief (mild asthma)** * COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist | Inhaled corticosteroid + LABA beta2 agonist
39
# Drug class and indication Budesonide with glycopyrronium and formoterol
**ICS + LAMA + LABA** **Moderate-to-severe COPD with frequent or severe exacerbations** requiring treatment with a long-acting beta2 agonist (LABA), long-acting anticholinergic and inhaled corticosteroid (ICS) | Inhaled corticosteroid + LAMA Anticholinergic + LABA Beta2 agonist
40
# Drug class and indication Ciclesonide (inhaled)
**ICS** Maintenance treatment of asthma | Inhaled corticosteroid
41
# Drug class and indication Fluticasone furoate (inhaled)
**ICS** Maintenance treatment of asthma | Inhaled corticosteroid
42
# Drug class and indication Fluticasone furoate with umeclidinium and vilanterol
**ICS + LAMA + LABA** * **Maintenance treatment of severe asthma** inadequately controlled with a combination inhaled corticosteroid (ICS) and long-acting beta2 agonist (LABA) * **Moderate-to-severe COPD with frequent or severe exacerbations** requiring treatment with a long-acting anticholinergic, a LABA and an ICS | Inhaled corticosteroid + inhaled anticholinergic + beta2 agonist
43
# Drug class and indication Fluticasone furoate with vilanterol
**ICS + LABA** * **Maintenance treatment of asthma** in patients who require a medium-to-high dose of inhaled corticosteroid (ICS) with a long-acting beta2 agonist (LABA) * COPD with FEV1 <50% and recurrent exacerbations despite treatment with a LABA | Inhaled corticosteroid + Beta2 agonist
44
# Drug class and indication Fluticasone propionate (inhaled)
**ICS** Maintenance treatment of asthma | Inhaled corticosteroid
45
# Drug class and indication Fluticasone propionate with formoterol
**ICS + LABA** **Maintenance treatment of asthma inadequately controlled** with inhaled corticosteroids or when stabilised on regular fluticasone propionate and formoterol | Inhaled corticosteroid + beta2 agonist
46
# Drug class and indication Fluticasone propionate with salmeterol
**ICS + LABA** * **Maintenance treatment of asthma inadequately controlled** with inhaled corticosteroids or when stabilised on regular fluticasone propionate and salmeterol * COPD with FEV1 <50% and recurrent exacerbations despite treatment with a long-acting beta2 agonist | Inhaled corticosteroid + beta 2 agonist
47
**Drug interactions** Corticosteroids
* **metabolised by CYP3A4**, consequently combinations with CYP3A4 inhibitors may increase their concentrations and the risk of adverse effects, while combinations with CYP3A4 inducers may decrease their efficacy. * **corticosteroids + NSAIDs** Oral corticosteroids increase risk of gastric ulceration with NSAIDs; consider need for an NSAID carefully; if an NSAID cannot be avoided use lowest effective dose for shortest period of time
48
Generic names of Anticholinergics (inhaled)
**Short acting** Ipratropium **Long acting** Aclidinium Glycopyrronium (inhaled) Tiotropium Umeclidinium
49
**Suffix** Anticholinergics (inhaled)
ium
50
**MOA** Anticholinergics (Inhaled)
**Promote bronchodilation** by inhibiting cholinergic bronchomotor tone. They **block muscarinic actions of acetylcholine.**
51
**Precautions** Anticolinergics (inhaled)
Cardiovascular disorders—**anticholinergics may increase risk of cardiovascular adverse effects**; patients with pre-existing cardiac conditions were often excluded from randomised, controlled trials.
52
**Adverse effects** Anticholinergics (inhaled)
dry mouth, throat irritation
53
Anticholinergics (inhaled) aka ...
antimuscarinics or muscarinic antagonists
54
**SAMAs VS LAMAs** | Anticholinergics (inhaled) aka antimuscarinics
**Short acting (SAMA)** Ipratropium is short acting; it is also known as a short-acting muscarinic antagonist (SAMA). It is an alternative to short-acting beta2 agonists (SABAs) in the initial **management of symptoms such as breathlessness in mild COPD**. In asthma, its use is mainly limited to treatment of severe acute attacks when SABA therapy is inadequate. **Long acting (LAMA)** Aclidinium, glycopyrronium, tiotropium and umeclidinium are long acting; they are also known as long-acting muscarinic antagonists (LAMAs). All LAMAs are marketed for use in **COPD** **In asthma, tiotropium** (Spiriva Respimat®) is marketed **as an add-on inhaler to regular inhaled corticosteroid (ICS)** with or without a long-acting beta2 agonist (LABA) for patients >6 years.
55
**Counselling** Anticholinergics (inhaled)
Ensure correct use of inhaler / use of spacer.
56
**Practice points** Anticholinergics (inhaled)
* **stop ipratropium** if treatment with a long-acting anticholinergic is required for COPD * before diagnostic spirometry, withhold ipratropium for 12 hours and LAMAs for 36 hours
57
# Drug class and indication Aclidinium
**LAMA** COPD | Anticholinergic (inhaled)
58
# Drug class and indication Aclidinium with formoterol
**LAMA + LABA** COPD | long acting anticholinergic (inhaled) + long acting beta2 agonist
59
# Drug class and indication Glycopyrronium (inhaled)
**Anticholinergic (LAMA)** COPD
60
# Drug class and indication Ipratropium
**Anticholinergic (LAMA)** Symptom relief of asthma and COPD
61
# Drug class and indication Tiotropium
**Anticholinergic - inhaled (LAMA)** * COPD * Maintenance treatment of moderate-to-severe asthma as adjunct to standard treatment including an inhaled corticosteroid (ICS)
62
# Drug class and indication Tiotropium with olodaterol
**Anticholinergic (inhaled) LAMA + Beta2 agonist (LABA)** COPD
63
# Drug class and indication Umeclidinium
**Anticholinergic (inhaled) LAMA** COPD
64
# Drug class and indication Umeclidinium with vilanterol
**Anticholinergic (inhaled) LAMA + beta2 agonist (LABA)** COPD
65
**Pathophysiology** COPD
Chronic obstructive pulmonary disease is characterised by poorly reversible airflow obstruction and an abnormal inflammatory response in the lungs. The latter represents the innate and adaptive immune responses to long term exposure to noxious particles and gases, particularly cigarette smoke.
66
**Signs and symptoms** COPD
* Increasing breathlessness * Persistent chesty cough * Frequent chest infections * Persistent wheezing
67
**Drug rationale** COPD
Symptom relief. Improvement of exercise tolerance and quality of life. Prevention or treatment of exacerbations and complications of COPD.
68
Step 1 COPD treatment
start with a **SABA (albuterol)** or **ipratropium** when required for symptom relief
69
Step 2 COPD treatment
add or switch to a LABA or long-acting anticholinergic1 for persistent symptoms
70
Practice points for inhaled medications
Use a spacer to maximise medication effectiveness and correct use of medication
71
Similarities between COPD and Asthma management
1st line treatment SABA Use of inhaled medications both experience cough and SOB
72
Differences between Asthma and COPD management
Asthma: * not progressive disease * Broad inflamatory response * treated with beta 2 agonists and ICS * Treatable / curable esp. in children * often diagnosed <20yrs COPD: * Progressively worsens * Common in >40yrs develop * Commonly a Smoker * irreversible * Emphysema * Sputum

Pharmacology 2 (41 decks)

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