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Pharmacology > Exam 4 - Drugs For Asthma > Flashcards

Exam 4 - Drugs For Asthma Flashcards

1
Q

What is asthma?

A

Chronic inflammatory disorder of the airway

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2
Q

Characteristic signs and symptoms of asthma flare ups

A

Sense of breathlessness
Tightening of the chest
Wheezing
Dyspnea
Cough

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3
Q

Cause of asthma

A

Immune-mediated airway inflammation

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4
Q

What two things contribute to asthma symptoms?

A

Inflammation
Bronchoconstriction

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5
Q

Symptoms of COPD flare up

A

Airflow restriction
Inflammation
Cough
Excessive sputum production
Wheezing
Dyspnea

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6
Q

What is COPD a combination of?

A

Chronic bronchitis
Emphysema

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7
Q

What is chronic bronchitis?

A

Chronic cough and excessive sputum
Hypertrophy of mucous secreting glands of the epithelium of airways

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8
Q

What is emphysema?

A

Enlarged air spaces in bronchioles and alveoli

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9
Q

Common cause of COPD

A

Smoking cigarettes

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10
Q

*Two main pharmacologic classes of asthma drugs

A

*Anti-inflammatory agents
*Bronchodilators

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11
Q

What are the three classes of anti-inflammatory agents?

A

Glucocorticoids (prednisone)
Leukotriene Modifiers (Zafirlukast)
Mast cell stabilizers (Cromolyn)

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12
Q

What are the three classes of Bronchodilators?

A

Beta2 agonists (albuterol)
Methylxanthines (Theophylline)
Anticholinergics (Atrovent)

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13
Q

Three advantages of inhalation drug therapy

A

Therapeutic effects are enhanced
Systemic effects are minimized
Relief of acute attacks is rapid

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14
Q

Three types of inhalation drug therapy

A

Metered-dose inhalers (MDIs)
Dry-powder inhalers (DPIs)
Nebulizers

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15
Q

Patient teaching for inhalers

A
  • Need to wait at least one minute between inhales of medication, especially when using more than one type of inhaler medication
  • May have bad taste in mouth
  • Need to rinse mouth or gargle after use to prevent infection in mouth
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16
Q

Which type of asthma drugs are taken daily for long-term control?

A

Anti-inflammatory drugs

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17
Q

Most effective anti-asthma drugs available

A

Glucocorticoids

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18
Q

Examples of glucocorticoid medication

A

Budesonide (Pulmicort)
Fluticasone (Flovent)
Prednisone

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19
Q

Functions of glucocorticoids

A
  • Reduce bronchial hyperreactivity
  • Decrease airway mucus production
  • Increase number of bronchial beta2 receptors as well as their responsiveness to beta2 agonists
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20
Q

How are glucocorticoids administered?

A

Usually by inhalation
IV for acute conditions
Oral for chronic long-term use

Dosing must be on a fixed schedule, not PRN

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21
Q

How do glucocorticoids suppress inflammation?

A
  • Decrease synthesis/production & release of inflammatory mediators
  • Decrease infiltration & activity of inflammatory cells
  • Decrease edema of the airway mucosa
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22
Q

Use for Glucocorticoids

A

Prophylaxis of chronic asthma & managing COPD

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23
Q

Which type of administration of glucocorticoids is safest?

A

Inhaled

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24
Q

When are inhaled glucocorticoids used?

A

As first line treatment for patients with persistent asthma
Should use them daily to manage

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25
Q

When should oral glucocorticoids be used?

A

In patients with moderate to severe asthma or management of acute exacerbations of asthma or COPD

Used only when symptoms cannot be controlled with safer inhaled medications

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26
Q

Why are oral glucocorticoids more dangerous?

A

Adverse effects are minor when taken acutely, but can be severe when used long term

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27
Q

Adverse effects of PO form of glucocorticoids from long-term use

A

Adrenal suppression
Osteoporosis
Hyperglycemia
PUD

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28
Q

Adverse effects of inhaled glucocorticoids

A

Oropharyngeal candidiasis
Dysphagia hoarseness
(Both can be avoided if gargle/rinse mouth after use)

In children/adolescents: can slow growth

Promotion of bone loss
Increased risk of cataracts
Increased risk of glaucoma

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29
Q

Function of leukotriene modifiers

A

Suppress effects of leukotrienes to prevent process of bronchoconstriction from happening
Also help with inflammation but are less effective than glucocorticoids

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30
Q

*Most commonly used leukotriene modifier

A

*Montelukast (Singulair)

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31
Q

Other available leukotriene modifiers

A

Zileuton (Zyflo) - PO
Zafirlukast (Accolate) - PO

32
Q

*Adverse effects of all Leukotriene Modifiers

A

Neuropsychiatric effects:
- Depression
- Suicidal thinking
- Suicidal behavior

33
Q

Prototype for Mast Cell Stabilizer drugs

A

Cromolyn

34
Q

Uses of Cromolyn

A

Chronic asthma
Exercise-induced bronchospasm (EIB)
Allergic rhinitis

35
Q

What does Cromolyn do?

A

*Suppresses bronchial inflammation
(Not a bronchodilator)

36
Q

Routes for Cromolyn

A

Inhalation
Nebulizer
MDI

37
Q

Adverse effects of Cromolyn

A

Cough
Bronchospasm

38
Q

Safest anti-inflammatory asthma medication

A

Cromolyn

39
Q

*Function of bronchodilators

A

Provide symptomatic relief, but do not alter the underlying disease process (inflammation)

40
Q

What should patient’s using bronchodilators also be taking?

A

A glucocorticoid for long-term suppression of inflammation

41
Q

Most effective type of bronchodilators

A

Beta2-adrenergic agonists

42
Q

Classes of bronchodilator medications

A

Beta2 adrenergic agonists
Monoclonal antibodies (new and expensive)
Methylxanthines
Anticholinergics

43
Q

Types of beta2-adrenergic agonists

A

Albuterol
Salmeterol
Terbutaline

44
Q

Use of beta2-Adrenergic agonists bronchodilators

A

Most effective drugs for relief of acute bronchospasm and prevention of exercise induced bronchospasm

Used for quick relief and long-term control of asthma

45
Q

Mechanism of action of beta2-adrenergic agonists

A

Through activation of beta2 receptors in the smooth muscle of the lung
Which promotes *bronchodilation, relieving bronchospasm

46
Q

There are short acting and long acting beta2 agonists. What are each of them used for?

A

SABAs (short term) = prn for attack
LABAs (long term) = long term control

47
Q

Examples of SABAs

A

Albuterol
Proventil

48
Q

What are SABAs used for?

A

Taken prn
Preventive
(Mainly asthma pts)

49
Q

Adverse effects of SABAs

A

Tachycardia
Angina
Tremor

50
Q

Examples of LABAs

A

Acilidinium bromide (Tudorza)
Salmeterol/Serevent diskus

51
Q

What are LABAs used for?

A

Long term control
Fixed dosages, not prn
(Mainly COPD pts, esp with more advanced COPD)

52
Q

Adverse effects of LABAs

A

Not a first line
May increase asthma
Contraindicated in asthma alone

53
Q

Adverse effects of inhaled beta2 adrenergic agonists

A

Tachycardia
Angina
Tremor

54
Q

Adverse effects of oral beta2 adrenergic agonists

A

(From excessive dosage)
Angina pectoris
Tachydysrhythmias
Tremor

55
Q

Prototype Methylxanthines

A

Theophylline

56
Q

How can theophylline be administered?

A

PO
IV (for COPD in ICU)

57
Q

Function of theophylline

A

Bronchodilation

58
Q

Adverse effects of theophylline

A

*Narrow therapeutic index
Plasma level 10-20 mcg/mL
Can cause toxicity easily

59
Q

Other types of Methylxanthines

A

Aminophylline
Dyphylline

60
Q

Examples of glucocorticoid/LABA combinations

A

Fluticasone/Salmeterol (Advair)
Budesonide/Formoterol (Symbicort)

61
Q

What are glucocorticoid/LABA combinations used for?

A

Long term maintenance in adults and children with worse respiratory issues
Not for initial therapy since they are a combo product

62
Q

Adverse effects of glucocorticoid/LABA combinations

A

May have black box warning because they can increase the risk for asthma (due to LABAs)

63
Q

How do anticholinergic drugs work?

A

Block muscarinic receptors in the bronchi
With decreases bronchoconstriction

64
Q

What are anticholinergic drugs used for?

A

COPD patients

65
Q

How are anticholinergic drugs administered?

A

Inhaled only

66
Q

Prototype anticholinergic drug

A

Ipratropium (Atrovent)

67
Q

Adverse effect of Atrovent

A

Dry mouth
Sore pharynx

68
Q

Example of how someone with chronic asthma should be managing it

A

Long term drug therapy:
- Long term control: inhaled glucocorticoids
- Quick relief of ongoing attack: inhaled SABAs

69
Q

Goal for someone experiencing an acute severe exacerbation

A

*Requires immediate attention
Goal = relieve airway obstruction and hypoxemia, and normalize lung function ASAP

70
Q

Initial therapy for someone experiencing an acute severe exacerbation

A

*Oxygen
*Systemic glucocorticoid to reduce airway inflammation
*Nebulized high-dose SABA to relive airflow obstruction

(And then nebulized ipatropium/Atrovent to further reduce airflow obstruction)

71
Q

Drugs for exercise-induced asthma

A

*SABA = preferred Or *Cromolyn administered prophylactically

72
Q

When should the drugs for exercise-induced asthma be taken?

A

Beta2 agonists inhaled immediately before exercise (Albuterol or Proventil)

Cromolyn should be inhaled 15 mins before exercise

73
Q

Drugs used to manage stable COPD

A

Bronchodilators
Glucocorticoids
Phosphodiesterase-4 inhibitors

74
Q

Drugs used to manage acute episode with COPD

A

SABAs (inhaled) either alone or in combo with inhaled Anticholinergics

Systemic glucocorticoids with antibiotics

Supplemental oxygen

75
Q

What should a pt with COPD’s expected O2 stats be?

A

88%-92%

Pharmacology (16 decks)

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