Drugs for Asthma and COPD

Question 1

Anti-inflammatory drug classes (3)

Answer 1

Corticosteroids
Antibodies
Leukotriene receptor modifiers

Question 2

Bronchodilators (3)

Answer 2

Beta-2 agonists
Anti-cholinergic drugs
Methylxanthines

Question 3

Absorption/deposition of beta-2 agonists

Answer 3

10-20% is inhaled and enters the lungs —> systemic circulation

80-90% is swallowed and enters the GI tract —> liver —> first-pass metabolism and systemic circulation

Question 4

What is unique about Terbutaline (SABA)?

Answer 4

It is the only b-2 drug available by subQ injection

Question 5

Avoid Terbutaline in patients with…

Answer 5

A sulfa allergy

Question 6

Metaproterenol (SABA) is used for…

Answer 6

Bronchial asthma and reversible bronchospasm.

Question 7

Major warning associated with Metaproterenol (SABA)

Answer 7

Paradoxical bronchospasm

Question 8

Use of Pirbuterol (SABA) is…

Answer 8

Prevention and reversal of bronchospasm.

Question 9

Major warning associated with Pirbuterol (SABA) is…

Answer 9

Cardiovascular effects

Question 10

Levalbuterol (SABA) is used for…

Answer 10

Treatment and prevention of bronchospasm

Question 11

What warning is associated with Levalbuterol (SABA)?

Answer 11

Paradoxical bronchospasm

Question 12

Fomoterol (LABA) is given for the…

Answer 12

Maintenance treatment of patients with asthma/COPD, along with an additional control agent.

Question 13

Salmeterol (LABA) is given for…

Answer 13

Prevention of exercise-induced bronchospasm.

Question 14

Indacaterol and Vilanterol (LABA) are given to which patients?

Answer 14

Patients with COPD.

Question 15

Oldaterol (LABA) is given as a…

Answer 15

One-daily maintenance bronchodilator for airway obstruction in COPD patients.

Question 16

All LABAs share the following 2 characteristics:

Answer 16

1. Must be given as concomitant treatment with another med, like an ICS.
2. Increase the risk of asthma-related deaths and hospitalizations.

Question 17

What class of drug is Atropine?

Answer 17

Anti-cholinergic drugs

Question 18

Aside from Atropine, what suffix is associated with anti-cholinergic drugs?

Answer 18

-ium

Ipratropium, Tiotropium, Aclidinium

Question 19

Ipratropium is an anti-choinergic and is an analog of…

Answer 19

Atropine, but does not produce the same atropine-like effects because it is poorly absorbed.

Question 20

Tiotropium is indicated for…

Answer 20

Long-term, once-daily treatment of bronchospasm in COPD.

Question 21

Aclidinium is indicated for…

Answer 21

Long-term maintenance of bronchospasm in COPD

Question 22

Examples of Methylxanthines include…

Answer 22

Theophylline
Theobromide
Caffeine

Question 23

MOA of Theophylline…

Answer 23

1. Inhibit PDE and slow cAMP degradation.
2. Inhibit adenosine’s action of bronchoconstriction.

—> both lead to bronchodilation and suppression of response to airway stimuli.

Question 24

What are the contraindications for Methylxanthines?

Answer 24

Acid-peptic Dz
Seizures
Arrhythmias

Question 25

What is the most effective controllers and anti-inflammatory agents of Asthma?

Answer 25

Inhaled corticosteroids

Question 26

What is the MOA of ICS?

Answer 26

- Switch off transcription of multiple genes encoding inflammatory proteins. - Reduce levels of eosinophils, T-cells and mast cells in airway mucosa.

Question 27

How often are ICS taken?

Answer 27

2x daily

Question 28

What should be given as first-line therapy in patients with persistent asthma?

Answer 28

ICS

Question 29

If symptoms are not controlled well with an ICS, what else could be added?

Answer 29

A LABA in addition to an ICS

Question 30

What are the suffixes of ICSs?

Answer 30

- sone | - ide

Question 31

The major caution of giving Beclomethasone is...

Answer 31

In patients who have been on systemically active corticosteroids prior, it can cause adrenal insufficiency and death.

Question 32

Budesonide should not given during...

Answer 32

Should not be given in treatment of status asthmaticus or acute attacks.

Question 33

Ciclesonide should not be given in....

Answer 33

The treatment of acute bronchospasm AND in patients with a Thrush infection.

Question 34

Flunisolide might be able to....

Answer 34

Reduce or eliminate the need for OCS

Question 35

Major side effect of Fluticasone is...

Answer 35

Thrush

Question 36

Mometasone is contraindicated in patients with...

Answer 36

A known milk hypersensitivity

Question 37

Triamcinolone is given to patients who need...

Answer 37

Systemic corticosteroid therapy

Question 38

Triamcinolone does not relieve... Deaths from.... have happened

Answer 38

Does not relieve acute bronchospasm. Deaths from adrenal insufficiency has happened.

Question 39

Major OCS used is...

Answer 39

Prednisone

Question 40

Leukotriene antagonists are given for...

Answer 40

Treatment and prevention of acute asthma attacks

Question 41

The MOA of Leukotriene antagonists is...

Answer 41

Block activation nd cascade from CysLT receptors

Question 42

Montelukast inhibits... It is given to...

Answer 42

Inhibits actions of LTD4 at the CysLT1 without agonist activity. Given to prevents allergies and asthma attacks.

Question 43

Zariflukast inhibits... It’s major toxicity is...

Answer 43

Inhibits LTD4 and LTE4. Hepatotoxicity.

Question 44

Zileuton inhibits... It should not be given to...

Answer 44

Inhibits LOX, therefore LTB4, LTC4, LTD4 and LTE4. Not recommended in cases with active liver disease or elevated liver enzymes > 3x normal.

Question 45

Omalizumab is of what drug class?

Answer 45

Monoclonal antibody drugs

Question 46

Omalizumab MOA

Answer 46

1. Binds to free IgE, thus decreasing cell-bound IgE. 2. decrease expression of IgE receptors. 3. Decreased mediator release. 4. Decrease allergic inflammation AND prevents exacerbation.

Question 47

Omalizumab is given for... What must the patient have in addition?

Answer 47

Moderate to severe persistent asthma. Patients must have a positive skin test or in vitro reactivity to perennial aeroallergen and SX are not adequately controlled otherwise.

Question 48

Omalizumab, aside form asthma, can be used in the treatment of... What is the major warning of its use?

Answer 48

Chronic idiopathic urticaria. Anaphylaxis.