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Pharmacology > Exam 4 - Drugs For Asthma > Flashcards

Exam 4 - Drugs For Asthma Flashcards

(75 cards)

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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
When should oral glucocorticoids be used?
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
26
Why are oral glucocorticoids more dangerous?
Adverse effects are minor when taken acutely, but can be severe when used long term
27
Adverse effects of PO form of glucocorticoids from long-term use
Adrenal suppression Osteoporosis Hyperglycemia PUD
28
Adverse effects of inhaled glucocorticoids
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
29
Function of leukotriene modifiers
Suppress effects of leukotrienes to prevent process of bronchoconstriction from happening Also help with inflammation but are less effective than glucocorticoids
30
*Most commonly used leukotriene modifier
*Montelukast (Singulair)
31
Other available leukotriene modifiers
Zileuton (Zyflo) - PO Zafirlukast (Accolate) - PO
32
*Adverse effects of all Leukotriene Modifiers
Neuropsychiatric effects: - Depression - Suicidal thinking - Suicidal behavior
33
Prototype for Mast Cell Stabilizer drugs
Cromolyn
34
Uses of Cromolyn
Chronic asthma Exercise-induced bronchospasm (EIB) Allergic rhinitis
35
What does Cromolyn do?
*Suppresses bronchial inflammation (Not a bronchodilator)
36
Routes for Cromolyn
Inhalation Nebulizer MDI
37
Adverse effects of Cromolyn
Cough Bronchospasm
38
Safest anti-inflammatory asthma medication
Cromolyn
39
*Function of bronchodilators
Provide symptomatic relief, but do not alter the underlying disease process (inflammation)
40
What should patient’s using bronchodilators also be taking?
A glucocorticoid for long-term suppression of inflammation
41
Most effective type of bronchodilators
Beta2-adrenergic agonists
42
Classes of bronchodilator medications
Beta2 adrenergic agonists Monoclonal antibodies (new and expensive) Methylxanthines Anticholinergics
43
Types of beta2-adrenergic agonists
Albuterol Salmeterol Terbutaline
44
Use of beta2-Adrenergic agonists bronchodilators
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
Mechanism of action of beta2-adrenergic agonists
Through activation of beta2 receptors in the smooth muscle of the lung Which promotes *bronchodilation, relieving bronchospasm
46
There are short acting and long acting beta2 agonists. What are each of them used for?
SABAs (short term) = prn for attack LABAs (long term) = long term control
47
Examples of SABAs
Albuterol Proventil
48
What are SABAs used for?
Taken prn Preventive (Mainly asthma pts)
49
Adverse effects of SABAs
Tachycardia Angina Tremor
50
Examples of LABAs
Acilidinium bromide (Tudorza) Salmeterol/Serevent diskus
51
What are LABAs used for?
Long term control Fixed dosages, not prn (Mainly COPD pts, esp with more advanced COPD)
52
Adverse effects of LABAs
Not a first line May increase asthma Contraindicated in asthma alone
53
Adverse effects of inhaled beta2 adrenergic agonists
Tachycardia Angina Tremor
54
Adverse effects of oral beta2 adrenergic agonists
(From excessive dosage) Angina pectoris Tachydysrhythmias Tremor
55
Prototype Methylxanthines
Theophylline
56
How can theophylline be administered?
PO IV (for COPD in ICU)
57
Function of theophylline
Bronchodilation
58
Adverse effects of theophylline
*Narrow therapeutic index Plasma level 10-20 mcg/mL Can cause toxicity easily
59
Other types of Methylxanthines
Aminophylline Dyphylline
60
Examples of glucocorticoid/LABA combinations
Fluticasone/Salmeterol (Advair) Budesonide/Formoterol (Symbicort)
61
What are glucocorticoid/LABA combinations used for?
Long term maintenance in adults and children with worse respiratory issues Not for initial therapy since they are a combo product
62
Adverse effects of glucocorticoid/LABA combinations
May have black box warning because they can increase the risk for asthma (due to LABAs)
63
How do anticholinergic drugs work?
Block muscarinic receptors in the bronchi With decreases bronchoconstriction
64
What are anticholinergic drugs used for?
COPD patients
65
How are anticholinergic drugs administered?
Inhaled only
66
Prototype anticholinergic drug
Ipratropium (Atrovent)
67
Adverse effect of Atrovent
Dry mouth Sore pharynx
68
Example of how someone with chronic asthma should be managing it
Long term drug therapy: - Long term control: inhaled glucocorticoids - Quick relief of ongoing attack: inhaled SABAs
69
Goal for someone experiencing an acute severe exacerbation
*Requires immediate attention Goal = relieve airway obstruction and hypoxemia, and normalize lung function ASAP
70
Initial therapy for someone experiencing an acute severe exacerbation
*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
Drugs for exercise-induced asthma
*SABA = preferred Or *Cromolyn administered prophylactically
72
When should the drugs for exercise-induced asthma be taken?
Beta2 agonists inhaled immediately before exercise (Albuterol or Proventil) Cromolyn should be inhaled 15 mins before exercise
73
Drugs used to manage stable COPD
Bronchodilators Glucocorticoids Phosphodiesterase-4 inhibitors
74
Drugs used to manage acute episode with COPD
SABAs (inhaled) either alone or in combo with inhaled Anticholinergics Systemic glucocorticoids with antibiotics Supplemental oxygen
75
What should a pt with COPD’s expected O2 stats be?
88%-92%

Pharmacology (16 decks)

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