Asthma & COPD - Chapter 23 Flashcards
1
Q
Asthma
A
-A “twitchy” or hyper-reactive airway overreacts to stimuli such as aeroallergens, cold air, etc. Overtime these airways (bronchial tubes) become chronically inflamed and sensitive.
2
Q
Asthma Attacks
A
-Muscles around the bronchial tubes tighten (i.e. bronchospasm or bronchoconstriction) and mucus is produced in the bronchial tubes further restricting airflow.
3
Q
Asthma Classifications
A
- Mild Intermittent
- Mild persistent
- Moderate persistent
- Severe persistent
4
Q
Risk Factors of Asthma
A
- Family history
- Exposure to tobacco or smoke
- Secondhand smoke
- Chronic exposure to air pollution
- Exposure to some allergens and infections early on in life
5
Q
Airway Changes During an Asthma Attack
A
- Airway irritation triggers airway constriction
- Inflammation produces swelling and further restricts airflow
- Mucus production is increased further obstructing breathing passages
6
Q
Symptoms of Asthma
A
- Cough
- Wheezing
- Shortness of breath
- Chest tightness
- Nocturnal awakening
- Sleep deprivation
7
Q
Managing Asthma Symptoms
A
- Lifestyle modifications
- Medication
- Home monitoring of breathing using a peak flowmeter
8
Q
Metered Dose Inhalers (MDI’s)
A
- A device that delivers a specific amount of medication to the lungs in the form of a short burst of aerosolized medicine
- Most need priming; some are shake well, others are not
- 30 seconds-1 minute between puffs
9
Q
Spacers
A
-A device that is attached to the end of an MDI. The drug is sprayed into the chamber and then slowly inhaled into the lungs
10
Q
Nebulizer
A
-A device that converts a liquid dose of medicine into an aerosolized mist that can be inhaled by normal breathing when used with a mask
11
Q
Dry Powder Inhalers (DPI’s)
A
-A device that delivers medication to the lungs in the form of a dry powder
12
Q
Classifications of Asthma Drugs
A
- Rescue medicines: treat acute symptoms (fast acting)
- Controllers: Prevent asthma episodes (used daily)
13
Q
Rescue Medicines used for Asthma
A
-Short-acting B2-adrenergic agonist (SABA) bronchodilators
14
Q
B2 adrenergic agonist’s MOA
A
-Bind to B2 receptors, bronchial smooth muscle relaxes and bronchospasm reverses
15
Q
Short Acting B2 adrenergic agonists (SABA) Examples
A
- salbutamol
- terbutaline
- orciprenaline
16
Q
Generic: salbutamol
A
Airomir
Ventolin
- Bronchodilator
- Short acting B2 adrenergic agonist
17
Q
Generic: terbutaline
A
Bricanyl Turbuhaler
- Bronchodilator
- Short acting B2 adrenergic agonist
18
Q
Generic: orciprenaline
A
orciprenaline
- Bronchodilator
- Short acting B2 adrenergic agonist
19
Q
Short Acting B2 Adrenergic Agonists ADR’s
A
- Nervousness, jitters
- Tremors
- Increased heart rate
- Difficulty sleeping
- Dry mouth
- Mild headache
- Hypertension
20
Q
Classifications of Controllers/Maintenance Drugs
A
- Inhaled corticosteroids
- Long-acting B2 agonists
- Leukotriene antagonists
- Mast cell stabilizers
- Xanthine derivatives
21
Q
Inhaled Corticosteroids MOA
A
- Are anti-inflammatory
- Decrease the synthesis of pro-inflammatory substances
- Reduce infiltration of mediators of the inflammatory response into airway cells
22
Q
Inhaled Corticosteroids Examples
A
- beclomethasone
- budesonide
- ciclesonide
- fluticasone
- mometasone
23
Q
Generic: beclomethasone
A
Qvar
- Inhaled corticosteroid
- DO NOT SHAKE
24
Q
Generic: budesonide
A
Pulmicort
-Inhaled corticosteroid
25
Generic: ciclesonide
Alvesco
- Inhaled corticosteroid
- DO NOT SHAKE
26
Generic: fluticasone
Flovent
-Inhaled corticosteroid
27
Generic: mometasone
Asmanex Twisthaler
-Inhaled corticosteroid
28
Inhaled Corticosteroids ADR's
- Thrush
- Coughing
- Hoarseness
- Throat irritation
- Dry mouth
- Flushing
- Loss of taste
- Unpleasant taste
29
General Inhaler Warning Labels
- SHAKE WELL (most MDI's except Alvesco and Qvar)
- KEEP DRY
- RINSE MOUTH AFTER USE (corticosteroid inhalers)
30
Glucocorticosteroids
The primary route of administration for corticosteroids used for the treatment of asthma is inhalation; however, they may be administered orally (or iv) for more severe symptoms.
31
Glucocorticosteroids Examples
- prednisone
- prednisolone
- dexamethasone
- hydrocortisone
- methylprednisolone
32
Generic: prednisone
Deltasone
Winpred
-glucocorticosteroid
33
Generic: prednisolone
Pediapred
-glucocorticosteroid
34
Generic: dexamethasone
Decadron
dexamethasone
-glucocorticosteroid
35
Generic: hydrocortisone
Solu-Cortef
-glucocorticosteroid
36
Generic: methylprednisolone
Medrol
Solu-Medrol
-glucocorticosteroid
37
Long-Acting B2 Adrenergic Agonists (LABA)
- Have been associated with increased risk of severe asthma exacerbations and death
- Use is restricted to patients whose asthma cannot be adequately controlled with other medications
38
Long Acting B2 adrenergic Agonists Examples
- formoterol
| - salmeterol
39
Generic: formoterol
Foradil
Oxeze
-Long-acting B2 adrenergic agonist
40
Generic: salmeterol
Serevent
-Long-acting B2 adrenergic agonist
41
Glucocorticosteroids/LABA Combination Examples
- salmeterol/fluticasone
- formoterol/budesonide
- formoterol/mometasone
42
Generic: salmeterol/fluticasone
Advair
-Glucocorticosteroids/LABA Combination
43
Generic: formoterol/budesonide
Symbicort Turbohaler
-Glucocorticosteroids/LABA Combination
44
Generic: formoterol/mometasone
Zenhale
-Glucocorticosteroids/LABA Combination
45
Leukotriene Receptor Antagonists
- Common ending: "lukast"
| - Reduce inflammation by interfering with the binding of leukotrienes to smooth muscle receptors on airways
46
Leukotriene Receptor Antagonists Examples
- montelukast
| - zafirlukast
47
Generic: montelukast
Singulair
-Leukotriene receptor antagonist
48
Generic: zafirlukast
Accolate
-Leukotriene receptor antagonist
Warning Labels:
-TAKE ON EMPTY STOMACH
49
Leukotriene Receptor Antagonist ADR's
- Cough
- Hoarseness
- Headache
- Heartburn
- Runny nose
- Indegestion
- Dizziness or drowsiness
- Muscle aches or cramps
50
Leukotriene Antagonists Warning Labels
-ONCE OPENED, THE PACKET CONTENTS MUST BE ADMINISTERED WITHIN 15 MINUTES (montelukast granules)
51
Mast Cell Stabilizers
- Released as a part of the immune response to antigens
| - Make mast cells less reactive to antigens, thus reducing the release of inflammatory substances
52
Mast Cell Stabilizers Examples
- cromolyn sodium
| - ketotifen
53
Generic: cromolyn sodium
Nalcrom
-Mast cell stabilizer
54
Generic: ketotifen
Zaditen
-Mast cell stabilizer
55
Xanthine Derivatives
-Common ending: "phylline"
- Oldest class of drugs used for asthma
- have both bronchodilator and anti-inflammatory properties
- Very narrow TI
56
Xanthine Examples
- aminophylline
| - theophylline
57
Generic: aminophylline
aminophylline
-Xanthine derivative
58
Generic: theophylline
Theo-Dur
Theolair
Uniphyll
-Xanthine Derivative
59
Xanthine Derivatives ADR's
- Insomnia
- Dizziness
- Headache
- Irritability
- Decreased appetite
- Stomach cramps
60
Drugs and Foods That Increase Theophylline Levels
- Oral contraceptives
- Erythromycin
- CCB's
- Cimetidine
- Caffeine
- Chocolate
61
Drugs and Foods That Decrease Theophylline Levels
- Phenobarbitol
- Phenytoin
- Carbamazepine
- Cigarette smoking
62
Monoclonal Antibodies Examples
-omalizumab
63
Generic: omalizumab
Xolair
-Monoclonal Antibody
64
Monoclonal Antibodies ADR's
- Mild redness, itching, swelling, or bruising at injection site
- Headache
- Nausea
- Difficulty breathing
- Hives or rash
65
Monoclonal Antibodies Warning Labels
- REFRIGERATE
| - DISCARD RECONSTITUTED SOLUTION AFTER 24 HOURS
66
Chronic Obstructive Pulmonary Disease (COPD)
- A chronic, progressive, inflammatory airway disease with damage to alveolar sacs that produces gradual loss of pulmonary function
- Causes obstructed airflow from the lungs
67
Symptoms of COPD
-Airflow obstruction
-Shortness of Breath
-Chronic persistent cough
Wheezing
68
Risk Factors of COPD
- Cigarette smoking or secondhand smoke
- Exposure to occupational irritants
- Air pollution
- Viral infections
69
Treatment of COPD
1) Relieve symptoms and airway obstruction
2) Correct hypoxia
3) Treat any precipitating factors
4) Pharmacological Treatment
- Bronchodilators
- Glucocorticosteroids
- Antibiotics
5) Nonpharmicological treatments
70
Short Acting Bronchodilators For COPD (SABA) (SAMA)
- bind to B2 receptors, bronchial smooth muscle relaxes and bronchospasm reverses
- Muscarinic antagonists bind to muscarinic receptors, block the effects of acetylcholine and cause relaxation of bronchial smooth muscle and bronchodilation
71
Short Acting Bronchodilators for COPD
- salbutamol
| - terbutaline
72
Muscarinic Receptor antagonists
-ipatropium
73
Generic: ipatropium
Atrovent
-Muscarinic Receptor Antagonist
74
Long-Acting Bronchodilators for COPD Examples
- salmeterol
- formoterol
- indacaterol
- olodaterol
75
Generic: indacaterol
Onbreez Breezhaler
- Long acting bronchodilator
- For COPD only
76
Generic: olodaterol
Striverdi Respimat
77
Long Acting Muscarinic Antagonists for COPD Examples
- tiotropium
- umeclidinium
- aclidinium
- glycopyronium
78
Generic: tiotropium
Spiriva
-Long acting muscarinic antagonist
79
Generic: umeclidinium
Incruse Ellipta
-Long acting muscarinic antagonist
80
Generic: aclidinium
Tudorza Genuair
-Long acting muscarinic antagonist
81
Generic: glycopyronium
Seebri Breezhaler
-Long acting muscarinic antagonist
82
Combination Inhalers Examples (LAMA and LABA)
- indacaterol/glycopyronium
- vilanterol/umeclidinium
- olodaterol/triotropium
- formoterol/aclindinium
83
Generic: indacaterol/glycopyronium
Ultibro Breezhaler
-Combination inhaler
84
Generic: vilanterol/umeclidinium
Anoro Ellipta
-Combination inhaler
85
Generic: olodaterol/triotropium
Inspioloto Respimat
-Combination inhaler
86
Generic: formoterol/aclindinium
Duaklir Genuair
-Combination inhaler
87
Combination SAMA and SABA
-ipratropium/salbutamol
88
Generic: ipratropium/salbutamol
Combivent Respimat
-Combination SAMA and SABA
89
Generic: ipratropium/fenoterol
Duovent
-Combination SAMA and SABA
90
Other COPD Therapies
- Inhaled and/or oral corticosteroids
- Xanthines
- Antibiotics for lung infections
- Oxygen therapy
- Phosphodiesterase 4 inhibitor
91
Generic: roflumilast
Daxas
-Phosphodiesterase 4 inhibitor
92
Combination Inhalers (Corticosteroid and LABA)
- salmterol/fluticasone
- formoterol/mometasone
- formoterol/budesonide
- vilanterol/fluticasone
93
Generic: vilanterol/fluticasone
Breo Ellipta
- Combination inhalers (corticosteroid/LABA)
- For COPD only
