Asthma/ COPD Flashcards by Puja Patel

Q

Ashtma vs COPD

A

Asthma- allergen disease, reduced airway via smooth muscle thickining and bronchocontriction, eosinophils, CD4, symptoms- episodic SOB, cough, chest tightness, often reversible lung function

COPD-inflammation with irritation (cigerrette smoke), reduced airway via cellular damage by external irritants, CD8, symptoms- chronic cough, sputum porduction (excessive mucus production), DOE, often irreversible lung function,

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Q

Main featues of asthma

A

Airway inflammation, airway obstruction, bronchial hyperresponsiveness (easily triggered by stimuli)

Early resonse and late response

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Q

Main features of COPD

Bronchitis predominant COPD?

Emphysema predominant COPD?

A

Airway inflammation, structural changes/ “remodeling” (fibrosis), mucolilary dysfunction

Gasping for breath

Bronchitis predominant COPD- excessive muscus production

Emphysema predominant COPD- trouble breathing

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Q

Best way to treat COPD?

A

Smoking Ceasation- varenicline and bupropion

Only treatment that improves lung function

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Q

Inhaled therapy

A

Preferred route of delivery- Reduce systemic exposure

High concentration lower doses

Need good technique

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Q

Metered dose inhaler (MDI)

A

Advantages- small, compact, portable, easy to use, Can be used with a spacer (improved delivery), no drug preparation

Disadvantages- need proper technique/ coordination with breath (requires a breath hold), Expensive

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Q

Dry powder inhaler (DPI)

A

Advantages- small compact, portable, easy to use, usually cheaper vs MDI, less coordination needed

Disadvantages- patients must prepare the dose, requires fast inhalation (requires a beath hold) moisture sensitive (can’t put in bathroom)

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Q

Soft mist inhaler

A

Advantages- compact, portable, multi dose device , high lung deposition, does not contain propellant

Disadvantages- complicated process for first dose, slow moving mist, cannot use spacer, expensive

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Q

Nebulizer

A

Advantages- minimal technique requied, patient is not required to hold breath

Disadvantages- expensive, requires dose preparation, bulky (not portable), administration times 5-15 min, needd a power source, cleaning needed

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Q

Consideration for device selection

A

Patient related factors- age, physical and cognitive ability, prefernce

Availability of the drug

Convenience- portable, maintenance, cleaning

Cos

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Q

Short acting B2 agonist (SABA) MOA and use

A

MOA- stimulate adenylyl cyclase at beta blockers→ increase cAMP in bronchial smooth muscle→ bronchodilation

DOC for acute asthma attack and exercise induced asthma

onset of action-5 min

duration-3-4 hours

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Q

Albuterol

A

SABA
use PRN- ADR- mouth irratation, cough
ADR at high doses- skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1
No difference in efficacy as other drugs in class
Less expnesive then levalbuteral- so albuterol preferred

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Q

Levalbuterol

A

SABA
use PRN- ADR- mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1
No difference in efficacy as other drugs in class
More expnesive then albuteral- so albuterol preferred

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Q

Long acting B2 agonist (LABA)

A

MOA- stimulate adenylyl cyclase at beta blockers→ increase cAMP in bronchial smooth muscle→ bronchodilation (Same MOA as SABA)

DOC for asthma when combined with inhaled glucocorticoid

CANNOT BE USED AS MONOTHERAPY FOR ASTHMA

CAN BE USED AS MONOTHERPAY FOR COPD

Good for COPD- drys up mucus secretion

onset of action-30 min

duration-12-24 hours

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Q

Salmeterol

A

LABA- Long acting dosed twice a day
use PRN- ADR- mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1

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Q

Formoterol

A

LABA- long acting dose twice a day
use PRN-ADR- mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1

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Q

Indacaterol

A

LABA- ultra long acting dose once a day
use PRN-ADR- mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1

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Q

Olodaterol

A

LABA- ultra long acting dose once a day
use PRN-ADR-mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1

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Q

Vilanterol

A

LABA- ultra long acting dose once a day
use PRN-ADR-mouth irratation, cough
ADR at high doses-skeletal muscle tremor, tachycardia/ palpitation, tolerance
- lose selectivity and hit beta 1

Q

Ipratropium

A

Muscarinic antagonist- short acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated, (HOT, DRY, FAST, CRAZY)

dry mouth, eyes
bitter, metallic taste
constipation
urinary retention
NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)

Q

Tiotropium

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

dry mouth, eyes
bitter, metallic taste
constipation
urinary retention
NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)

Q

Aclidinium

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

dry mouth, eyes
bitter, metallic taste
constipation
urinary retention
NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)

Q

Umeclidinum

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated,(HOT, DRY, FAST, CRAZY)

dry mouth, eyes
bitter, metallic taste
constipation
urinary retention
NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)

Q

Glycopyrolate

A

Muscarinic antagonist- long acting

MOA- competitively block effecrs o Ach in airway→ prevent vasocontriction medicated by vagal discharge

Bronchodilation effects longer then B2 agonist

ADR- minimally absorbed, well tolerated, (HOT, DRY, FAST, CRAZY)

dry mouth, eyes
bitter, metallic taste
constipation
urinary retention
NO TREMER OR ARRHYTHMIAS ( good for older COPD patients)

Theophylline

Methylxanthine derivatives MOA- **non-selectively inhibits phosphodiesterase (PDE**)→ increasaes cAMP→ bronchodilation **blocks adenosine recpotors→ bronchodilation** **Considered high concentration to be effective** **narrow theraputic index** **Younger people- will clear drug quicker (higher dose)** **Older people- will clear it slower (lower dose)** **_CYP 1A2 metabolism- tabacco smoke inducer of CYP 1A2_** * **_Smokers need higer dose_** * **_when they quit smoking need lower dose otherwise toxic effects_** **_ADR- theophyline over 40_** * **GI distress (enhanced grastic acid secretion)** * Tremor * Insomnia * in overdose- **severe nausea**, vomitting, hypotension, agitation, **arrthymias, cardiac arrest, seizures**

Roflumilast

* **MOA-** selectively inhibits PDE-4 (found in the lung)→ increase cAMP→ Bronchodilation * **USED FOR SEVERE ASTHMA/ COPD** * **Should be given with at least one other long acting broncodilator for COPD (LABA)** * Partially metabolized by CYP 3A4 * DDI- with rifampin, phenobarbital, phenytoin, carbamazepine * **ADR** * N/V/D, abdominal pain, HA, dyspepsia * **Psychiatric events- scren for psych events prior to use, d/c therapy if mood changes** * **weight loss**

Corticosteroids

MOA- Bind to glucocorticoid receptor to * inhibit inflammatory cell migration and activation * inhibit cytokines and mediator release * upregulates b2 recepotris * inhibits IgE synthesis **DOC FOR ASTHMA IN COMBINATION WITH LABA** **TAPER OFF** **_4-6 weeks for effect_** **_used if on SABA but still chronic SOB_**

Beclomethasone

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Budesonide

Inhaled corticosteroid **Safe in pregnancy** **ADR- Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Fluticasone propionate

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Fluticasone furoate

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Mometasone

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Flunisolide

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Ciclesonide

Inhaled corticosteroid ADR- **Thrush (oral candidiasis)- consel patient to rinse mouth after each use,** dystonia, sore throat, cough

Prednisone

Oral/ IV corticosteroid ADR- adrenal supression , **cushings syndrome,** growth retardation, **osteroporosis (dose limiting),**glucose intolerance, infection risk, mood changes, weight gain, edema

Prednisolone

Oral/ IV corticosteroid ADR- adrenal supression , **cushings syndrome,** growth retardation, **osteroporosis (dose limiting),**glucose intolerance, infection risk, mood changes, weight gain, edema

Methyleprednisolone

Oral/ IV corticosteroid ADR- adrenal supression , **cushings syndrome,** growth retardation, **osteroporosis (dose limiting)**,glucose intolerance, infection risk, mood changes, weight gain, edema

Hydrocortisone

Oral/ IV corticosteroid ADR- adrenal supression , **cushings syndrome**, growth retardation, **osteroporosis (dose limiting),** glucose intolerance, infection risk, mood changes, weight gain, edema

Corticosteriod in kids

Potential growth stunting but only in the first year not progressive ## Footnote **Still preferred DOC in children for asthma**

Zileuton

Lipoxygenase inhibitors MOA- inhibits action of 5-lipoxygenas to inhibit the synthesis of leukotrienes ADR- Insomnia, Headache, somnolence GI upset, **_Heptoxicity ( if LFT is greater then 3x the ULN, females greater then 65 at greater risk (monitor))_** **_Neuropsychiatric events- abnormal dreams, hostility, agression, suicidality, agitation, hallucination_** **_DO not use in alcoholics, hepititis_**

Montelukast

**MOA**- competitively block action of leukotrienes at LTD4 receptor Can be used for asthma, allergic symptoms, exercise-induced asthma, urticaria **(if anti-hisamine failed)** ADR- **Neuropsychiatric events-** abnormal dreams, hostility, agression, suicidality, agitation, hallucination

Zafirlukast

**MOA-** competitively block action of leukotrienes at LTD4 receptor Can be used for asthma, allergic symptoms, exercise-induced asthma, urticaria **(if anti-hisamine failed)** ADR- **Neuropsychiatric events**- abnormal dreams, hostility, agression, suicidality, agitation, hallucination, **Hepatoxicity** **DDI- with warfarin→ may increase risk of bleeding**

Cromolym sodium

* Mast cell stabilizers- multiple daily doses * MOA- Block influx of Ca→ prevention of mast cell degreanulation→ stabilize mast cells→ prevent release of inflammatory mediator * Do not excert any firect bronchodilating, antihistaminic oranti-inflammatory effect **(only used for mild cases of asthma)** * Not for rescue symptoms * **Clinical improvment in 2-6 weeks** * Well tolerated * mild throat irratation, cough abnormal taste in mouth

Nedrocromil sodium

Mast cell stabilizers- multiple daily doses MOA- Block influx of Ca→ prevention of mast cell degreanulation→ stabilize mast cells→ prevent release of inflammatory mediator Do not excert any firect bronchodilating, antihistaminic oranti-inflammatory effect **(only used for mild cases of asthma)** Not for rescue symptoms **Clinical improvment in 2-6 weeks** Well tolerated mild throat irratation, cough abnormal taste in mouth

Omalizumab

Anti- IgE MOA- moncolonal IgE antibody→ inhibits bindng of IgE to surface of mast cells & basophils→inhibit inflammatory mediators **_Indicated for allergic asthma not relieved with corticosteroid therapy_** Dose based on IgE levels and body weight- SQ injection **Must be older the 12** **Takes up to 12 weeks to work** ADR- * Injection site reactions * **anaphylaxsis→ usually 1.5-2 hours post dose (monitor in office)** * Arthralgia, headache * Pharyngitis and sinitus * malignancies?

Mepolizumab

IL-5 Antagonist MOA- humanized interleukin-5, monoclonal antibody antagonist to reduce the amount of circulating eosinophils **Used for severe asthma for patients who continue to have exacerbations despite adequte therapy** SQ injection or IV every 4 weeks by HCP **Must be older then 18 with eosinophilic phenotype** ADR- * injection site reactions * headache * **hypersensitivity reactions- monitor after first dose** * malignancies * muscle and face bpain