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HLST220: Pharmacology > Chapter 79: Drugs for COPD and Asthma > Flashcards

Chapter 79: Drugs for COPD and Asthma Flashcards

(61 cards)

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1
Q

very mild asthma is controlled

A

PRN SABA

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2
Q

mild asthma is controlled

A

on low dose ICS or LTRA or PRN budesonide/formoterol

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3
Q

risk of exacerbation

A
  • previous history of severe exacerbation
  • poorly controlled asthma
  • overuse of SABA
  • current smoker
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4
Q

treatment of asthma must address components of

A

inflammation and bronchoconstriction

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5
Q

what are the two pharmacologic agents used to treat asthma

A
  • anti-inflammatory agents
  • bronchodilators
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6
Q

inhalation drug therapy advantages

A
  • therapeutic effects enhanced
  • systemic effects minimized
  • relief of acute attacks is rapid
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7
Q

anti-inflammatory drugs are takes for ________ control

A

long term

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8
Q

what are the principle anti-inflammatory drugs

A

glucocorticoids (budesonide, fluticasone)

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9
Q

what is considered the most effective anti-asthma drugs available

A

glucocorticoids

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10
Q

glucocorticoids use

A

prophylaxis of chronic asthma

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11
Q

glucocorticoids dosing

A

fixed schedule
- should be taken daily

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12
Q

inhaled use of glucocorticoids

A

safer

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13
Q

oral use of glucocorticoids should be used

A

as brief as possible
- potential for toxicity; should only be used when symptoms cannot be controlled with other medications

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14
Q

adverse effects of inhaled forms of glucocorticoids

A
  • adrenal suppression
  • oropharyngeal candidiasis
  • dysphonia
  • can slow growth in children and adolescents
  • promotion of bone loss
  • increased risk of cataracts
  • increased risk of glaucoma
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15
Q

adverse effects of oral glucocorticoids

A
  • adrenal suppression (can be fatal in times of stress)
  • osteoporosis
  • hyperglycemia
  • peptic ulcer disease
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16
Q

discontinuing treatment of glucocorticoids must be done

A

slowly
- recovery of adrenocortical function

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17
Q

leukotriene modifiers MOA

A

suppress/block effects of leukotrienes
- promote smooth muscle constriction, blood vessel permeability, and inflammatory responses through the direct action and recruitment of eosinophils and other inflammatory cells

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18
Q

leukotriene modifiers (Zafirlukast) use

A

prevention and treatment of chronic asthma symptoms (alone or in combination)

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19
Q

leukotriene modifiers (Zafirlukast) adverse effects

A

GI upset, headache, liver damage, neuropsychiatric effects (depression, sucidal thinking, sucidal behaviour)

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20
Q

Zafirlukast [Accolate] should not be used in

A

kids under 12

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21
Q

Cromolyn MOA

A

works on mast cells to suppress inflammation by preventing the release of histamine and other inflammatory mediators

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22
Q

cromolyn is used for

A

prophylaxis in mild to moderate asthma

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23
Q

Montelukast [Singulair] (leukotriene modifier)

A

used in kids 2+

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24
Q

cromolyn adverse effects

A

cough

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25
cromolyn administration
inhaler and eye drops (not absorbed well)
26
cromolyn excretion
urinary
27
zafirlukast dosing
10mg once daily in the evening
28
monoclonal antibody drug
omalizumab [Xolair]
29
omalizumab [Xolair] MOA
forms complexes with free IgE therefore reducing the amount of IgE available to bind with mast cells
30
omalizumab [Xolair] therapeutic uses
patients age 6+ with moderate to severe asthma that (1) is allergy related (2) cannot be controlled with an inhaled glucocorticoid
31
omalizumab [Xolair] dosage
subcut q2-4wks
32
omalizumab [Xolair] adverse effects
- injection site reactions - viral infection - upper resp infections - sinusitis - headache - pharyngitis - cardiovascular events - malignancy - life threatening anaphylaxis
33
phosphodiesterase-4 inhibitor example
Roflumilast [Daxas]
34
Roflumilast [Daxas] use
add on to bronchodialator for severe COPD with chronic bronchitis
35
Roflumilast [Daxas] MOA
inhibits PDE-4 - enzyme that breaks down cAMP; resulting in reduced inflammation
36
Roflumilast [Daxas] should not be taken with
food - delayed bioavailability
37
Roflumilast [Daxas] side effects
diarrhea, weight loss, reduced appetite, nausea
38
beta2 adrenergic agonists MOA
through activation of beta2 receptors in the smooth muscle of the lung, these drug promote bronchodilation, relieving bronchospasm
39
Inhaled short-acting beta2 agonists (SABAs)
- taken PRN to abort an ongoing attack -EIB: taken before exercise to prevent an attack
40
Inhaled long-acting beta2 agonists (LABAs)
- long term control in patients who experience frequent attacks - fixed schedule dosing
41
SABA dosing
taken PRN to abort an ongoing attack
42
LABA dosing
fixed schedule
43
Beta2 adrenergic agonists inhaled preparations adverse effects
tachycardia, angina, tremor
44
Beta2 adrenergic agonists oral preperations adverse effects
angina pectoris, tachydysrhythmias, tremor
45
SABA prototype:
salbutamol [ventolin]
46
LABA prototype
salmeterol [serevent]
47
how to use a metered dose inhaler
- wait 1 min before puffs - shake well before use - can use with spacer - all ages - prime before first use
48
Methylxanthines example
Theophylline [theodur]
49
Theophylline [theodur] MOA
produces bronchodialation by relaxing smooth muscle of the bronchi
50
what is required with the use of Theophylline [theodur]
regular blood work - plasma levels between 10-20mcg
51
Theophylline [theodur] has a
narrow therapeutic index
52
Theophylline [theodur] is excreted
heptic metabolism
53
Theophylline [theodur] is influenced by
smoking, second hand smoke, heart and liver disease, other drugs
54
Theophylline [theodur] drug interactions
- caffeine - tabacco and marijuana - cimetidine - fluoroquinolone antibiotics
55
Methylxanthines plasma levels between 20-25 effects
nausea, vomiting, diarrhea, insomnia, restlessness
56
Methylxanthines plasma levels below 20
adverse effects uncoomon
57
Methylxanthines plasma levels above 30
severe dysrhythmias
58
Theophylline toxicity treatment
- stop drug - activated charcoal - dysrhythmias respond to lidocaine - IV diazepam to control sezuires
59
tiotropium [Spiriva] MOA
- relieves bronchospasm by blocking muscarinic receptors in the lungs - maintenance of COPD
60
tiotropium [Spiriva] adverse effects
dry mouth
61
Ipratropium [Atrovent] adverse effects
- dry mouth and irritation of the pharynx - glaucoma

HLST220: Pharmacology (46 decks)

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