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Pulmonology 2 > Pharm - Asthma and COPD > Flashcards

Pharm - Asthma and COPD Flashcards

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1
Q

Which asthma meds are quick relievers?

A

-SABAs

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2
Q

Which asthma meds are long term controllers ?

A

-inhaled corticosteroids

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3
Q

SABA MoA

A

-binds beta2-adrenergic receptors on bronchioles resulting in relaxation of the smooth muscles that surround the airway = bronchodilation

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4
Q

Indication for SABAs

A
  • drug of choice for acute bronchospasm
  • preferred tx for intermittent asthma and as quick-relief meds for asthma and COPD
  • should be prescribed to all pts w/ asthma for acute symptoms
  • they are rescue meds
  • the DONT tx underlying dz, ONLY symptoms
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5
Q

ADRs for SABAs

A
  • sinus tachycardia
  • arrhythmias
  • higher doses: somatic tremor
  • HA
  • dizziness
  • cough
  • decrease of serum K (esp. w/ other drug that are not K-sparing)
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6
Q

Monitoring parameters for SABAs

A
  • symptom relief

- adverse effects

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7
Q

albuterol

A
  • SABA
  • Brand: Proventil
  • MDI
  • 2 puffs q 4-6 hrs PRN
  • duration of action: 4-6 hrs
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8
Q

LABAs MoA

A
  • same as SABA but altered to sit on receptors longer

- controller, NOT rescue

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9
Q

Indications for LABAs

A
  • when pts have persistent symptoms and require daily use of SABA
  • used differently in asthma and COPD
  • asthma: only used w/ inhaled glucocorticoid NEVER solo
  • children >5: step 3 and above
  • children 0-4: step 4
  • COPD: LABA w/ SABA appropriate for all stages except mildest sx
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10
Q

Contraindications of LABAs

A
  • avoid use w/ CYP3A4 strong inhibitors
  • clarithromycin, ketoconazole, ritonavir
  • if used together can increase serum concentrations of LABA
  • avoid use w/ non-selective beta-blockers
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11
Q

salmeterol xinafoate

A
  • LABA
  • DPI
  • 1 inhalation BID
  • duration: 12 hrs
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12
Q

Anticholinergics MoA

A
  • block effect of Ach on the M2 and M3 muscarinic receptors
  • decreases parasympathetic tone on airways causing bronchodilation
  • slower onset that beta2-agonists but longer lasting
  • SAMAs: 8 hr relief
  • LAMAs: >24 hrs relief
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13
Q

indication for anticholinergics

A
  • SAMAs acute bronchospasm; PRN or regular basis for prevention/reduction of sx
  • LAMAs: when pts have persistent sx and require daily use of SABA or SAMAs
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14
Q

contraindications for anticholinergics

A

-hypersensitivity to the drug

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15
Q

ADRs in anticholinergics

A
  • poorly absorbed so systemic side effects are limited
  • most common: dry mouth
  • less common: worsening prostatic sx
  • inadvertent spray into eyes has precipitated acute glaucoma
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16
Q

monitoring parameters for anticholinergics

A
  • sx relief for efficacy

- appearance of side effects for safety

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17
Q

ipratroprium

A
  • SAMA
  • Atrovent
  • MDI
  • 2-3 puffs QID
  • duration: 6-8 hrs
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18
Q

tiotroprium

A
  • LAMA
  • spiriva
  • DPI w capsule
  • 2 inhalations/ 1 capsule
  • duration: 24 hrs
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19
Q

albuterol/ipratropium

A
  • combivent; respimate; duoneb
  • very common in COPD
  • MDI
  • 1 puff QID or 1 vial QID
  • duration: 6-8 hrs
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20
Q

phosphodiesterase-4 inhibitor is a treatment only for what?

A

COPD

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21
Q

phosphodiesterase-4 inhibitor MoA

A
  • reduces inflammation by inhibiting the breakdown of cAMP by phosphodiesterase-4
  • not a direct bronchodilator
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22
Q

indication for phosphodiesterase-4 inhibitor

A
  • reduce the risk of exacerbations in pts w/ severe COPD associated w/ chronic bronchitis and a hx of exacerbations
  • important b/c pts are most likely to die during exacerbation
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23
Q

contraindications of phosphodiesterase-4 inhibitor

A

moderate to severe liver impairment

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24
Q

ADRs of phosphodiesterase-4 inhibitor

A
  • decreases appetite
  • nausea
  • abdominal pain
  • diarrhea
  • sleep disturbances
  • HA
  • weight loss can occur
  • caution in people w/ depression
  • do not use w/ theophylline
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25
monitoring parameters of phosphodiesterase-4 inhibitor
- reduction of exacerbations | - adverse effects
26
phosphodiesterase-4 inhibitor product
roflumilast (Daliresp) 500 mcg PO daily
27
MDI
- metered dose inhalers - small devices that have a replaceable cartridge and act as a mouthpiece for delivery of meds into mouth for inhalation - cartridge contains medication dissolved in a propellant
28
what different techniques can be used when using an MDI
- mouthpiece inside mouth | - can be placed 1-2 fingers width away from mouth
29
what is the role of spacer devices?
- when pts have trouble w/ proper technique a spacer can be used - inhaler fits at the end of it , pt actuates the meter, med is released into chamber and the pt takes slow deep breaths to devliver drug to lungs
30
What medication should a spacer be used with?
inhaled corticosteroid
31
DPI
- similar to MDI - instead of releasing medication suspended in a propellant mist it releases the medication as a dry powder - easier - no priming required - DO NOT use w/ spacer
32
soft mist inhaler
- release the medication in a soft mist - mist lasts in the are about 6x longer than from MDI - propellant free - about 75% of the aerosolized particles are the size that are inhaled - decreased oropharyngeal deposition
33
theophylline (a methylzanthine) MoA
-causes modest bronchodilation d/t nonselective phosphodiesterase inhibition
34
indication for theophylline
- symptomatic tx - 3rd tier option for COPD - alternative bronchodilator
35
contraindications for theophylline
-hypersensitivity
36
drug interactions of theophylline
- many | - always review a pts meds
37
ADRs with theophylline
- think caffeine (it's also xanthine) - n/v - HA - jitters - insomnia - higher serum concentrations: persistent vom., cardiac arrhythmias, intractable seizures
38
monitoring parameters for theophylline
* **serum concentrations are very important - symptomatic improvement - side effects for toxicity
39
What is the mainstay of asthma tx?
inhaled corticosteroids (ICS)
40
ICS MoA
- anti-inflammatory action reduces airway inflammation - glucocorticoids diffuse across cell membrane and bind to receptors in cytoplasm then go to nucleus and bind DNA - inhibits synthesis of many inflammatory proteins through suppression of genes that encode them
41
ICS indication
- agent of choice for all pts w/ persistent asthma regardless of severity - should be added to bronchodilators and not used as monotherapy - inhaled is preferred route - long term controller med
42
ICS contraindications
-hypersensitivity to milk proteins for those prescribed advair diskus
43
ADRs in ICS
- dysphonia: hoarse voice d/t myopathy of laryngeal muscles, mucosal irritation and laryngeal candidiasis; reversible when tx is stopped - topical candidiasis: thrush - use spacer and rinse and spit to prevent - systemic effects: skin thinning, bruising, increased intraocular pressure, cataracts, growth deceleration, osteoporosis, increased risk of pneumonia, myopathy
44
monitoring parameters for ICS
- symptom relief | - adverse effects
45
fluticasone
- ICS - flovent - MDI - 440 mcg BID
46
fluticasone and salmeterol
- combo LABA plus ICS - advair diskus - DPI - 1 inhalation BID middle (250/50) inhaler strength
47
cromolyn sodium inhalation solution MoA
- prevent bronchospasm through mast cell stabilizing - prevent early and late asthmatic response to inhaled allergens - inhibits release of mediators of inflammation
48
indication for cromolyn sodium
- prevention only (controller) - prevention of exercise induced asthma - prevention of asthma sx caused by predictable allergic triggers
49
contraindications for cromolyn sodium
-hypersensitivity
50
ADRs of cromolyn sodium
-cough
51
dosing of cromolyn sodium
-must be dosed 3-4 x day
52
montelukast (Singulair) MoA
- leukotriene receptor antagonists - blocks action of leukotriene D4 on CysLT1 receptor in lungs and bronchi - reduces bronchoconstriction caused by leukotrienes resulting in less inflammation
53
indication for montelukast
- prophylaxis and chronic tx of asthma | - prevention of exercise-induced bronchoconstrction
54
contraindications for montelukast
-hypersensitivity
55
ADRs of montelukast
- HA - abdominal pain - cough - flu-like sx - **do not prescribe to those w/ active, preexisting anxiety, depression or sx of psychiatric disorder
56
Omalizumab (Xolair) MoA
- monoclonal ab against IgE | - forms complex w/ free IgE and prevents its interaction w/ receptors on mast cells, basophils, and others
57
indication for Omalizumab
- > 6 yo - moderate - severe persistant asthma - asthma sx that are inadequately controlled w/ ICS - total serum IgE level b/w 30-700 - positive skin test for IgE to an allergen year round
58
side effects of omalizumab
-injection site rxns
59
What are the 3 anti IL-5 drugs
- mepolizumab - reslizumab - benralizumab
60
Mepolizumab (Nucala) MoA
- humanized monoclonal ab specific for IL-5 | - blocks IL-5 binding to receptor complex on eosinophil cell surface (binds the free IL-5)
61
indication for mepolizumab
-maintenance tx of sever asthma in pts who are 12 or older and have eosinophilic phenotype
62
ADRs of mepolizumab
- hypersensitivity | - herpes zoster infections
63
expected clinical outcome of mepolizumab
- reduced exacerbations | - improved quality of life
64
Reslizumab
- IL-5 receptor antagonist (also binds free IL-5) - add-on maintenance therapy of severe asthma in pts over 18 w/ eosinophilic phenotype - need observation after dosing - best in pts w/ nasal polyps and high levels of blood and sputum eosinophils
65
benralizumab
- IL-5 receptor antagonist (actually bind receptor) | - add on therapy for pts >12 w/ sever asthma and an eosinophilic phenotype
66
ADRs of benralizumab
- HA - pharyngitis - hypersentivity rxns more so than other 2
67
expected clinical outcomes of benralizumab
- reduction in exacerbation rates | - glucocorticoid-sparing effect

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