Pulmonary Pharm Flashcards
(15 cards)
What is Zileuton?
-5-LOX inhibitor
-Non-specific & inhibit the formation of all leukotrienes in the AA path
-Reduction of inflammation & bronchoconstriction
-Can cause hepatotoxicity (monitor LFTs)
What are Montelukast & Zafirlukast?
-Leukotriene receptor antagonists, specifically LTD4 inhibitors
-Blocking receptors more specifically (from AA path)
-Used for mild asthma, not as good as steroids
What is the mainstay for treating obstructive lung disease?
-Glucocorticoids
-They inhibit both LOX & COX pathways
-Can be used to treat inflammation in both asthma & COPD
-Chronic use should be avoided = HTN, DM, psychosis, avascular necrosis of the hip
What are examples of inhaled glucocorticoids?
-Fluticasone, Budesonide
-Beclomethasone
-Best 1st line for asthma
-Useful in early COPD
-Risk of oral thrush/ candida with improper use
-Prevent with mouth rinse or mouth spacer
What are examples of systemic glucocorticoids that can be used for obstructive disease exacerbation?
-Use depends on severity
- Oral = Prednisone, Hydrocortisone, Dexamethasone
-IV = Methylprednisolone
What is Ipratropium?
-Short-acting muscarinic antagonist
(SAMA)
-Blocking bronchoconstriction & mucus secretion
-Used for acute exacerbations
-Chronic COPD
-Asthma & COPD exacerbations, can use Ipratropium-albuterol inhaler
What is Tiotropium?
-Long-acting muscarinic antagonist (LAMA)
-Blocking bronchoconstriction & mucus secretion
-Used for maintenance therapy & prevention of exacerbations
-Chronic COPD
What are Albuterol & Levalbuterol?
-Short-acting Beta agonist (SABA)
-Activating Beta2 receptors of the SNS to promote bronchodilation
-Minimal interaction with plasma memb.
-SEs = tremors, sinus tachycardia, & tachyarrhythmia
-Temporary hypokalemia
-Used for acute exacerbations
-PRN for intermittent asthma
What are Formoterol & Salmeterol?
-Long-acting Beta agonists (LABA)
-Activating Beta2 receptors for bronchodilation
-Have a lipophilic side chain = attachment to plasma memb.
-Used for maintenance & preventing exacerbations
-Salmeterol has slightly longer duration due to secondary exosite
-SEs = tremors, sinus tachycardia, & tachyarrhythmia
-Do not use alone in asthma = increased risk of asthma-related death
What is Roflumilast?
-Phosphodiesterase-4 (PDE-4) Inhibitor
-Preventing degradation of cAMP to promote vasodilation
-Used in COPD only
What is Omalizumab & what is it used for?
-Monoclonal ab against IgE
-For asthma only, maxed on other meds + elevated IgE level
-SEs = anaphylaxis
What are Nedocromil & Cromolyn?
-Mast cell degranulation inhibitors
-Asthma only, not used because there are better options for management
What are Methylxanthines?
-Theophylline, caffeine
-Not really used
-If pt is taking, theophylline & adenosine is given, it will not work
What does the escalation with COPD & pharm therapy look like?
-Baseline start or mild COPD = SABA
-More severe = LAMA
-LABA
-Inhaled Steroid
-PDE-4 inhibitor
-Oral steroids
What does the escalation with asthma & pharm therapy look like?
-Increased based on number & severity of attacks
-Baseline = SABA
-Inhaled steroids
-then add LABA
-Can try to continue increasing dose of inhaled steroids
-Targeted therapies/ Mabs
-Oral steroids
