Asthma/COPD

Question 1

Steroids (inhaled, systemic)
Leukotrine modifying agents
Roflumilast

Answer 1

Anti inflammatory agents

Question 2

Beta 2 agonists

MOA

Answer 2

Act like NE and E at B2 receptors- bind and cause smooth muscle relaxation and mast cell stabalization
-useful in asthma and copd

Question 3

Beta 2 agonists

AEs

Answer 3

Skeletal muscle tremor 
Tachycardia 
Nervousness 
Hypokalemia 
MDI: dry mouth, cough

Question 4

Beta 2 agonists

Available agents

Answer 4

Short acting: fast onset/short duration
-used for acute attack

Long acting: slow onset/long duration

• not used as rescue therapy
• longer half life
• preventative

Question 5

B2 agonists
Anticholinergic agents
Theophylline

Answer 5

Bronchodilators

Question 6

Long acting beta agonists
LABAs
Warnings/recommendations

Answer 6

• increase/worsening of increased risk of asthma related deaths for PTs using labas for asthma treatment
• use only when paired with a glucocorticoid
• use for a shortest duration possible
• use in combo product to increase compliance
• desensitize beta 2 receptors; steroids help lessen the desensitizing of the receptors

Question 7

Albuterol (vetolin, Proventil): PO, MDI, neb
Lavalbuterol (xopenex): MDI, neb
Metaproterenol (alupent, metaprel):PO, neb
Pirbuterol (max air): autohaler
Terbutaline (brethine): PO, IV
Fenoterol (duovent): only available in combo with ipatropium

Answer 7

Short acting beta 2 agonists

SABAs

Question 8

Salmeterol (servent): diskus
Formoterol (foradil): aerolizer
Arfomoterol (brovana): Neb
Indacaterol( arcapta): powder for inhalant
Olodaterol (striverdi respimat): MDI
Vilanterol (breo ellipta, anoro ellipta): powder for inh- only available in combo with fluticasone or umeclidium

Answer 8

Long acting beta 2 agonists

LABAs

Question 9

Inhaled have beta 2 agonists

Answer 9

Have a low risk of AEs

Question 10

Systemic beta 2 agonists

Answer 10

Have a a higher risk of AEs

Question 11

Anticholinergic agents

MOA

Answer 11

Inhibit the Ach effects on bronchial smooth muscle

• use in asthma limited to acute attacks
• technique is very important for use

Question 12

Aclidinium (Tudorza press air): powder for inh
Ipratopium (atrovent HFA): MDI, neb, nasal spray
Umeclidium + vilantrerol (anoro ellipta)
Ipratopium + albuterol (combivent):MDI
Ipratopium + fenoterol (duovent)
Tiotoprium (spriva handihaler): oral inhalation
Glycopyrrolate + indacaterol(utibron): powder for inh

Answer 12

Anticholinergic agents (inhaled)

Question 13

Anticholinergic agent

AEs

Answer 13

Dry mouth 
Constipation 
Urinary hesitancy 
Tachycardia 
(Anti slud)

Question 14

Theophylline

MOA

Answer 14

Bronchodilation
Stimulates respiratory center
Augments diaphragm contractility

Question 15

Theophylline
AE/risks
Not commonly used/last resort

Answer 15

*Narrow therapeutic index: effectiveness and toxicity is very close together (high variability)
Dosing varies by population: smokers(metabolized faster), elderly, children
*monitor closely
Tachycardia, GI upset, nervousness, sleep disturbances
Toxicity: N/V, PVC, seizures, arrhythmia

Question 16

Corticosteroids
Anti inflammatory agent
MOA

Answer 16

Anti inflammatory
Inhibit. Migration of inflammatory cells
Inhibit mucus production
Improve response to b2 stimulation
Formulations: systemic, inhaled (topical)

Question 17

Corticosteroids

AEs

Answer 17

Systemic effects
Acute: fluid retention, mood changes, sleep disturbances, increased appetite, hypokalemia, hypoglycemia
Chronic: *growth suppression, cataracts, osteoporosis, HTN, HPA axis suppression
Inhaled: oral candidiasis, dysphonia, brush teeth, rinse mouth

Question 18

Fluticasone (Flovent): MDI 
Budensonide (pulmicort): turbohaler, neb 
Triamcinolone (azmacort): MDI
Beclomethasone (beclovent, Qvar): MDI
Flunisolide (aero-bid): MDI 
Ciclesonide (alvesco): MDI

Answer 18

Inhaled corticosteroids

Question 19

Leukotriene modifying agents
Anti inflammatory
MOA

Answer 19

Reduce inflammation and bronchoconstriction caused by leukotrienes 
Receptor antagonism (zafirlukast, montelukast)
Inhibition of 5-lipoxygenase pathway (Zileuton)

Question 20

Zafirlukast (accolate)
Montelukast (singulair)
Zileuton (zyflo)

Answer 20

Leukotriene modifiers

Question 21

Zafirlukast (accolate)

Answer 21

LTD4 antagonist: block LTD4 from binding to its receptor
-important drug inx concerns
AE: GI upset, increased LFTs, suicide risk, anxiety, nightmares, aggression, depression

Question 22

Montelukast (singulair)

Answer 22

LTD4 antagonist: blocks LYD4 from binding to its receptor
No significant drug inx
AE: GI upset, suicide risk, nightmare, aggression, anxiety, depression

Question 23

Zileuton (zyflo)

Answer 23

Leukotriene modifier
5-lip oxygenase inhibitor
AE: GI upset, increased LFTs, low WBC, weakness, conjunctivitis, suicide risk, anxiety, nightmares, depression, aggression
liver damage**

Question 24

Omalizumab (Xolair)
Other anti inflammatory
Biologic agent: monoclonal antibody
-injectable

Answer 24

*Used to treat severe allergic rxn asthma
-binds to free igE to mast cells and basophils and promotes release of inflammatory mediators
Only approved for PTs under 12 with positive skin prick test

Question 25

Omalizumab (Xolair) Other anti inflammatory AE

Answer 25

``` Anaphylaxis-with in 2 hrs of dose Injection sure rxn (pain, red, itching) Rash Headache -500$ a vial(expensive) ```

Question 26

Roflimilast (dailyresp) Other Tx for COPD only MOA

Answer 26

PDE4 inhibitor (lungs)- increase cAMP Decreases inflammatory response Not for treating acute bronchospasms PO-1x daily

Question 27

Roflumilast (daliresp) | AE

Answer 27

Weight loss (5-10% loss in 1 year) Psychiatric AE: insomnia, anxiety, depression Diarrhea Drug inx risks