Drugs for Asthma and COPD

Question 1

terbutaline

Answer 1

short acting beta 2 agonist (relax airway smooth muscle)

only beta 2 drug available by subcutaneous injection

Question 2

Albuterol

Answer 2

short acting beta 2 agonist (relax airway smooth muscle)

first line of treatment

Question 3

pirbuterol

Answer 3

• short acting beta 2 agonist (relax airway smooth muscle)
• prevention and reversal of bronchospasm
• can produce clinically significant cardiovascular effects in some patients

Question 4

levalbuterol

Answer 4

short acting beta 2 agonist (relax airway smooth muscle)

treatment and prevention of bronchospasm

Question 5

formoterol

Answer 5

• long acting beta 2 agonist (relax airway smooth muscle)
• high lipid solubility due to long half life
• patients >5 y/o as ADD ON to corticosteroid in asthma
• maintenance bronchoconstriction in COPD

Question 6

salmeterol

Answer 6

• long acting beta 2 agonist (relax airway smooth muscle)
• high lipid solubility due to long half life
• prevention exercise-induced bronchospasm
• in patients >4 y/o

Question 7

indacaterol and vilanterol

Answer 7

• long acting beta 2 agonist (relax airway smooth muscle)
• high lipid solubility due to long half life
• Tx breathing problems caused by COPD

Question 8

olodaterol

Answer 8

• long acting beta 2 agonist (relax airway smooth muscle)
• high lipid solubility due to long half life
• long term, once daily maintenance bronchodilator
• COPD patients

Question 9

ipratropium

Answer 9

• anticholinergic drug, M3 antagonist
• free of systemic atropine-like effects
• COPD drug

Question 10

tiotropium

Answer 10

• anticholinergic drug, M3 antagonist
• slower dissociating, once daily maintenance Tx
• COPD drug

Question 11

aclidinium

Answer 11

• anticholinergic drug, M3 antagonist
• long term maintenance Tx of bronchospasm
• COPD drug

Question 12

What patients should be cautious using methylxanthine?

Answer 12

pts with peptic ulcer disease, seizure disorders, cardiac arrhythmias

Question 13

MOA methylxanthines

Answer 13

derived from purine base, Xanthine; inhibit PDE (increase cAMP) causing smooth muscle relaxation and suppress response of airways to stimuli

Question 14

theophylline

Answer 14

• methylxanthine (increase cAMP)
• treat asthma/COPD/chronic bronchitis
• take orally
• narrow therapeutic window
• CYP 450 metabolism

Question 15

methylxanthine drugs

Answer 15

• theophylline
• theobromine
• caffeine

Question 16

inhaled corticosteroids use/side effect

Answer 16

• added as daily maintenance

- side effect = oral pharyngeal candida

Question 17

beclomethasone

Answer 17

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• pts 5+ y/o
• RISK of adrenal insufficiency

Question 18

budesonide

Answer 18

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• pts 6+ y/o
• NOT GOOD WITH MILK ALLERGY

Question 19

ciclesonide

Answer 19

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• pts 12+ y/o

Question 20

flunisolide

Answer 20

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• may eliminate need for oral corticosteroids
• pts 6+ y/o

Question 21

Fluticasone

Answer 21

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• NOT for acute bronchospasm
• pts 4+ y/o
• ORAL CANDIDA RISK

Question 22

momentasone

Answer 22

• inhaled corticosteroid
• CONTRAINDICATED WITH MILK ALLERGY
• maintenance Tx asthma and prophylactic therapy
• pts 4+ y/o

Question 23

triamcinolone

Answer 23

• inhaled corticosteroid
• maintenance Tx asthma and prophylactic therapy
• indicated in patients requiring systemic corticosteroids
• DEATHS d/t adrenal insufficiency have occurred
• contraindicated status asthmaticus

Question 24

oral and parenteral corticosteroids

Answer 24

• combine with short acting-beta agonists for flareups

- oral steroids more likely to cause side effects than inhaled

Question 25

prednisone

Answer 25

- oral and parenteral corticosteroids - used as anti-inflam/immunosuppressive - may lead to HPA axis suppression

Question 26

leukotriene receptor antagonist MOA and use

Answer 26

- block cysteinyl leukotriene receptors (CystLT1) | - used for treatment and prevention of acute asthma attacks, taken ORALLY

Question 27

zafirlukast

Answer 27

- leukotriene receptor antagonist - CAN CAUSE LIVER INJURY - prophylaxis and chronic Tx of adults and children 5+ y/o

Question 28

montelukast

Answer 28

- leukotriene receptor antagonist - inhibits actions of LTD4 at CysLT1 receptor w/o agonist - treat allergies and prevent asthma attacks - not used for reversal of bronchospasms in acute attacks

Question 29

zileuton

Answer 29

- 5-lipoxygenase inhibitor - thus inhibits leukotriene formation - prophylaxis and chronic Tx of asthma - NOT RECOMMENDED in active liver dz (hepatic enzymes >3x normal limit)

Question 30

MOA monoclonal Ab drugs

Answer 30

- prevent activity of mast cells | - using anti- IgE Ab

Question 31

Uses Omalizumab (3)

Answer 31

- for moderate to severe persistent asthma - patients 6+ y/o with positive skin test or invitro reactivity to perennial aeroallergen - chronic idiopathic urticaria

Question 32

class omalizumab

Answer 32

monoclonal Ab

Question 33

Risk omalizumab

Answer 33

- ANAPHYLAXIS | - should only be administered in a health care setting due to life threatening activity