Pharm: Asthma & COPD

Question 1

What is the goal of asthma management?

Answer 1

Control symptoms

Prevent remodeling

Question 2

What two broad drug catergories are used for asthma treatment?

Answer 2

Anti-inflammatory drugs

Bronchodilators

Question 3

What drug classes are included under the umbrella of anti-inflammatory drugs used to treat asthma?

Answer 3

Homone containing (corticosteroids) –> inhaled or oral

Antibodies

Non-hormone containing leukotriene receptor modifiers –>lipoxygenase inhibitors or receptor blockers

Question 4

What drug classes are included under the umbrella of bronchodilators drugs used to treat asthma?

Answer 4

Beta-2 agonists (short or long acting)

Anticholinergic

Methylxanthines

Question 5

What class of drugs excites bronchial B2 receptors?

Answer 5

Beta agonsits

Question 6

What class of drug improves bronchial inflammation?

Answer 6

Inhaled corticosteroids

Question 7

What class of drugs inhibits receptors in the bronchi?

Answer 7

Muscarinic antagonists

Question 8

Which route of administration is the most effective when administering corticosteroids or B2 agonists?

Answer 8

Inhaled

More effective but minor route of administration

Question 9

What is the major route of administration of corticosteroids/B2 agonists?

Answer 9

Orally

Less effective, have first pass metabolism (liver)

Question 10

What is the drug treatment plan for asthma?

Answer 10

ICS –> LABA –> LAMA

Question 11

What is the drug treatment plan for COPD?

Answer 11

LAMA –> LABA –> ICS

Question 12

What are the short acting B2 agonist medications (SABA)?

Answer 12

Albuterol

Terbutaline

Metaproterenol

Pirbuterol

Levalbuterol

Question 13

What is the MOA of B2 agonists?

Answer 13

Relax airway smooth muscle cells

Reverse bronchoconstriction asthma causes

Question 14

What is important to know about B2 agonists compared to other asthma meds?

Answer 14

They are the most commonly used

Question 15

What are indications for SABAs?

What are some additional indications for albuterol?

Answer 15

Treat or prevent acute bronchospasm

Albuterol used in:

asthma

acute bronchitis

COPD

bronchiolitis

Question 16

What are some adverse effects of albuterol?

Answer 16

HA, dizziness, insomnia, dry mouth, cough

Question 17

What are some warnings of SABAs?

Answer 17

paradoxical bronchospasm (esp metaproterenol)

deterioration of asthma

CV effects (esp. pirbuterol)

Immediate hypersensitivey reactions

Question 18

What is unique about terbutaline?

Answer 18

It’s the only B2 drug available subQ

Question 19

What is a contraindication to terbutaline injection?

Answer 19

sulfa allergy

Question 20

What are the inhaled corticosteroids?

Answer 20

“-one” & “ide”

Beclomethasone

Fluticasone

Mometasone

Triamcinolone

Budesonide

Ciclesonide

Flunisolide

Question 21

What is a warning unique to beclomethasone?

Answer 21

death due to adrenal insufficiency after transfer from oral corticosteroids

Months are required for recovery of hypothalamic-pituitary adrenal function

Question 22

What is the most effective controller of asthma?

Answer 22

ICS

Also the most effective anti-inflammatory used in asthma therapy

Question 23

What is the MOA of ICSs?

Answer 23

Switch off transcription of multiple activated genes that incode inflammatory proteins

Have several effects on the inflammatory process

Reduce eosinophils, number of activated T cells, and surface mast cells in airway mucosa

Question 24

What are some effects of ICS use?

Answer 24

rapidly improves sx of asthma

prevents sx of exercise induced asthma

reduce airway hyperresponsiveness

Prevent airway remodeling

Question 25

What is important to know when stopping ICS?

Answer 25

Withdrawl results in slow deterioration of asthma control Do not tx underlying condition!

Question 26

What are some cautions/warnings of ICS?

Answer 26

Don't use as primary tx of status asthmaticus or other acute asthma episodes (budesonide & mometasone) Severe hypersensitivity rxn in those with milk protein allergies (mometasone & budesonide) Candida infections Severe adrenal insufficiency (beclomethasone & triamcinolone)

Question 27

What is a benefit specific to flunisolide?

Answer 27

Adding this med may reduce or eliminate need for oral corticosteroids

Question 28

What is your oral corticosteroid?

Answer 28

Prednisone

Question 29

When do you use an oral corticosteroid?

Answer 29

in combo with SABAs to tx moderate to severe asthma flairs

Question 30

What are your LABAs?

Answer 30

Fomoterol Salmeterol Indacaterol Vilanterol Olodaterol

Question 31

When is it appropriate to use LABAs?

Answer 31

Only in addition to a long-term asthma control medication such as a corticosteroid For bronchospasm associated with COPD

Question 32

What is a warning for LABAs?

Answer 32

Increases risk of asthma related death and hospitalizations

Question 33

What are the anticholenergic drugs used for COPD?

Answer 33

Atropine Ipratropium Tiotropium Aclidinium

Question 34

What anticholinergic drugs are used temporarily, for maintenance, and for long term maintenance?

Answer 34

Atropine - temporary Ipratropium - maintenance Tiotropium & aclidinium - long term maintenance

Question 35

What is the MOA of anticholinergic drugs?

Answer 35

block Ach from binding muscarinic receptors therefore preventing PSN impulses responsible for bronchoconstriction

Question 36

What is important to remember about atropine?

Answer 36

total dose should be restricted to 2-3 mg when used recurrently to avoid effects of atropine-induced tachycardia Lots of side effects

Question 37

What is unique about ipratropium?

Answer 37

Relatively free of systemic anticholinergic effects

Question 38

What drugs are in the methylxanthine class?

Answer 38

Theophylline Theobromine Caffeine

Question 39

What is the MOA of methylxanthines?

Answer 39

Smooth muscle relaxation (bronchodilation) Supression of airway response to stimuli

Question 40

What group of patients should you use extreme caution in when giving methylxanthines?

Answer 40

active peptic ulcer dz seizure disorders cardiac arrhythmias

Question 41

What are the leukotriene receptor antagonists/ lipoxygenase inhibitors?

Answer 41

Zafirlukast Montelukast

Question 42

What is the MOA of LT antagonists?

Answer 42

Block cysteinyl leukotriene rectptors (CysLT1 receptors) reversibly Decrease subsequent inflammatory cascade therefore decreasing airway edema & relaxing SM

Question 43

What is an indication for LT antagonists?

Answer 43

Tx and prevention for acute asthma attacks Most prescribed drugs for management of asthma

Question 44

What specific LT does montelukast inhibit?

Answer 44

LTD4

Question 45

What specific LTs does Zafirlukast block?

Answer 45

LT D4 and E4

Question 46

What is a warning specific to zafirlukast?

Answer 46

Hepatotoxicity - life threatening hepatic failure

Question 47

What is the MOA of Zileuton?

Answer 47

Inhibits 5-lipoxygenase and thus inhibits LTB4, C4, D4 and E4

Question 48

When do you use Zileuton?

Answer 48

Prevent asthma attack, not to tx acute attack

Question 49

What is a warning of Zileuton?

Answer 49

Not recommended in cases of active liver dz or persistant hepatic enzympe elevations \>3 times the upper limit of nl

Question 50

What monoclonal Ab is used in asthma?

Answer 50

Omalizumab

Question 51

What is the MOA of Omalizumab?

Answer 51

Binds to free IgE, decreasing cell bound IgE Decreases expression of high affinity receptors on mast cells, basophils & eosinophils that cross react with IgE Decreases mediatior release Decreases allergic inflammation/prevents asthma/reduces sx

Question 52

What is a caution to take when administering omalizumab?

Answer 52

only administer in healthcare setting due to life threatening anaphylactic reaction, make sure you observe pts after administration