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Pharmacology - Exam 3 > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

(56 cards)

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1
Q

What is the pathophysiology of asthma?

A
  • reversible, chronic hyper-responsiveness leading to inflam
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2
Q

What is the etiology of asthma?

A
  • triggers

i. e. airborne allergens, virus, cold

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3
Q

What is the goal of asthma therapy?

A
  • reduce impairment & lung remodeling

- reduce risk

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4
Q

What are the steps of treatment in a 0-4 y/o with asthma?

A
  • step 1: SABA
  • step 2: low dose ICS (alt: montelukast or cromolyn)
  • step 3: med dose ICS
  • step 4: med dose ICS + montelukast or LABA
  • step 5: high dose ICS + montelukast or LABA
  • step 6: high dose ICS + montelukast or LABA + daily oral steroids
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5
Q

What are the steps of treatment in a 5-11 y/o with asthma?

A
  • step 1: SABA
  • step 2: low dose ICS (alt: cromolyn or theophilline as last line)
  • step 3: med dose ICS OR low dose ICS + either LABA, LTRA, or theophylline
  • step 4: med dose ICS + LABA (alt: med dose ICS + either LTRA or Theophylline)
  • step 5: high dose ICS + LABA (alt: high dose ICS + either LTRA or Theophylline)
  • step 6: high dose ICS + LABA + oral steroid (alt: high dose ICS + either LTRA or Theophylline + oral steroid)
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6
Q

When can you rx a LABA?

A
  • once the patient is on ICS
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7
Q

What are the steps of treatment in a patient over 12 y/o with asthma?

A
  • step 1: SABA
  • step 2: low dose ICS (alt: cromolyn, nedocromil, LTRA, or theophylline)
  • step 3: med dose ICS OR low dose ICS + LABA (alt: low dose ICS + either LTRA, theophylilne or Zileuton)
  • step 4: med dose ICS + LABA (alt: med dose ICS + either LTRA, theophylline, or Zileuton)
  • step 5: high dose ICS + LABA AND consider omalizumab in pts w/ allergies
  • step 6: high dose ICS + LABA + oral corticosteroids AND consider omalizumab in pts w/ allergies
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8
Q

What is the MOA of SABAs?

A
  • bind b-receptors in lungs –> smooth m. relaxation
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9
Q

What is the onset of SABAs?

A
  • ~5 mins
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10
Q

What are adverse effects of SABAs?

A
  • heart palpitations
  • anxiety
  • tachycardia
  • tremor
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11
Q

What should be done when patient admits to using SABA >2d/w?

A
  • step up tx
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12
Q

What are examples of SABAs?

A
  • albuterol

- levalbuterol

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13
Q

What is not a prefered step 1 asthma rx?

A
  • short acting bronchodilator anticholinergis
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14
Q

What is an example of short acting bronchodilator anticholinergics?

A
  • ipatropium (Atrovent HFA)
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15
Q

What is the MOA of anticholinergics?

A
  • inhibits cholinergic & muscarinic receptors

- causes bronchodilation

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16
Q

What are the ADEs of anticholinergics?

A
  • dry mouth

- increased wheezing

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17
Q

What is the MOA of inhaled corticosteroids (ICS)?

A
  • decrease number & activity of inflam cells
  • enhance effect of b-adrenergic rxs
  • inhibit bronchoconstriction
  • direct smooth m. relaxation
  • decrease mucous production
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18
Q

What are the ADEs of ICS?

A
  • cough, dysphonia MC

- oral thrush if no rinse & spit

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19
Q

What are the ADEs of high dose ICS?

A
  • adrenal suppression
  • osteoporosis
  • skin thinning
  • easy bruising
  • cataracts
  • growth suppression/retardation
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20
Q

What are the ADEs of low to med dose ICS?

A
  • growth suppression

- altered growth velocity

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21
Q

What are examples of ICSs?

A
  • suffix: -methasone
  • suffix: -esonide
  • suffix: -isolide
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22
Q

What are examples of mast cell stabilizers?

A
  • cromolyn (Intal)

- nedocromil (Tilade)

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23
Q

What are examples of leukotriene receptor antagonist (LTRA)?

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A
  • montelukast (Singulair)
  • zafirlukast (Accolate)
  • zileuton (Zyflo)
24
Q

What is the MOA of mast cell stabilizers?

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A
  • stabilize mast cells

- blockade of chloride channels

25
What are ADEs of mast cell stabilizers?
- cough | - irritation
26
What is the MOA of LTRAs?
- interference w/ pathway of leukotriene mediators
27
What are the ADEs of LTRA?
- depression & suicidal ideation in children
28
What is the MOA of Zileuton (Zyflo)
- similar to LTRA | - only blocks enzyme not the receptor
29
What are the drug interactions of zileuton (Zyflo)?
- inhibits metabolism of warfarin & theophylline
30
What interactions occur with zafirlukast?
- food: take on empty stomach | - substrate and inhibitor of CYP2C9
31
What is the MOA of theophylline?
- mild to mod bronchodilator | - non-selective phosphodiesterase inhibitor
32
What are the ADEs of theophylline
- similar to caffeine | way to many to list
33
What are drug interactions of theophylline?
- metabolized and induced by CYP1A2 & 3A4 | - increased clearance when smoking
34
What is the MOA of LABAs?
- tail binds to b-receptor at exosite - head binds to same spot as SABA - bronchodilation
35
What are examples of LABA?
- salmeterol (Serevent) - formoterol (Foradil) - suffix: -terol
36
What are the ADEs of LABAs?
- tachycardia - tremor - hypokalemia - bronchospasms & hyperresponsiveness - heart issues
37
What must be done prior to rxing omalizumab?
- IgE tested
38
When is omalizumab recommended?
- in steps 5 or 6 for pts with allergies & severe persistent asthma inadequadly controlled on high ICS + LABA
39
What is the MOA of omalizumab?
- binds IgE antibody preventing it to bind on mast cell or basophil receptor - leads to decrease release of mediators
40
What are the ADEs of omalizumab?
- urticaria - anaphylaxis - injection site pain/burning
41
When are oral steroids recommended?
- only for most severe difficult to control asthma d/t well documented risk for side effects
42
What are the ADEs of short term use of oral steroids?
- hyperglycemia - increased appetite - fluid retention - wt gain - mood alteration - HTN
43
What are the ADEs of long term use of oral steroids?
- growth suppresion
44
When do you taper oral steroids?
- over 10d used
45
What is the 1st line tx for exercise induced bronchospasm?
- SABA
46
What is the 2nd line tx for exercise induced bronchospasm?
- LTRA
47
What is teh 3rd line tx for exercise induced bronchospasm?
- cromolyn
48
What might be a trigger of asthma?
- GERD
49
What are the steps of COPD tx?
- step 1: flu vaccine, decrease risk factors, SABA - step 2: ADD LABA - step 3: ADD ICS - step 4: ADD O2
50
What are other medications for COPD?
- mucolytics - antioxidants - immunoregulators - antitussives
51
What is the MC cause of COPD exacerbations?
- infection | - air pollution
52
What are the cardinal sx of COPD exacerbations from abx?
- increased dyspnea - sputum volum - sputum purulence
53
What is the tx of COPDers with mild infx exacerbations?
- 1 cardinal sx = no tx | - PCN, amoxicillin, doxycline, bactrim
54
What is the tx of COPDers with moderate infx exacertabitons?
- augmentin (amox/clavulanic acid)
55
What is the tx of COPDers with severe infx exacerbations?
- high dose levofloxacin
56
How long is tx for COPD exacerbated by infx?
- 7-10 d abx

Pharmacology - Exam 3 (4 decks)

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