Respiratory Flashcards

Question

leukotriene inhibitors

Answer 1

-Leukotriene is an arachidonic acid metabolite, inflammatory mediator -Leukotriene receptors mediate: -Airway inflammation -Edema -Bronchoconstriction -Secretion of thick, viscous mucous -Leukotriene inhibitors can reduce airway inflammation and edema, produce bronchodilation and reduce the secretion of thick viscous mucous -Leukotriene inhibitors subdivided into two categories: -1. Leukotriene receptor blockers -2. Lipoxygenase inhibitors

Answer 2

-Block leukotriene receptor which will reduce leukotriene activity resulting in decreased airway inflammation -Uses: Can be used to treat mild-moderate persistent asthma. Also used to treat seasonal and allergic rhinitis *Not for COPD* -May take weeks to see benefit – improved pulm fxn, control of Sx, reduction in attacks, reduction in airway inflammation -NOT for acute Treatment; often used in conjunction w/ beta2 adrenergic agonists -Examples: -Zafirlukast (Accolate) (B) (PO) - BID dosing -Montelukast (Singulair) (B) (PO) - QPM dosing -very protein bound -> only need once or twice a day

Answer 3

-ADRs – minimal as a class: -Zafirlukast – fever, malaise, peripheral neuropathy (28%), rash, GI disturbances -Montelukast – Headache (18%) -Drug Interactions: -Zafirlukast – CYP450 enzyme inhibitor - increased levels of ASA, warfarin and theophylline -Montelukast – no dose adjustments needed

Answer 4

-inhibits 5-lipoxygnease enzyme which results in decreased production of leukotrienes -Uses: Can be used to treat mild-moderate persistent asthma; *Not for COPD* -Contraindication: Do not use in pts with active liver disease (LFTs > 3X ULN) -Precaution: Use w/ caution in pts. with -history of liver disease or alcoholic cirrhosis -PK considerations – short T1/2; administered ACHS (4 x’s a day, with meals and at bedtime) -ADRs – CNS effects (headache in up to 25% of pts); flu like Sx, dyspepsia and increase LFTs -DDI - CYP450 enzyme inhibitor - increased levels Beta Blockers, theophylline and warfarin levels

Answer 5

-Zafirlukast (Accolate)- can use in kids over 5 y.o -Montelukast (Singulair)- can use in kids over 12 months old -Zileuton (Zyflo)- can use in kids over 12 y.o. -As a Class – not effective in everyone, but generally better ADRs than steroids

Answer 6

-Interleulkin-5 antagonist, alpha-directed cytolytic monoclonal antibody (IgG1 kappa) -Severe eosinophilic asthma,c ≥12 yrs of age (Canada: ≥18 yrs of age). -NOT for COPD -precautions: Anaphylactic reactions can occur. Be prepared to treat such reactions -Dosing: SQ administrations. Dose is 30mg SQ q4weeks x 3 weeks then every 8 weeks. Keep refrigerated -ADRs: Headache, pharyngitis, local injection site reactions

Answer 7

-Interleulkin-5 antagonist, alpha-directed cytolytic monoclonal antibody (IgG1 kappa) -Severe eosinophilic asthma ≥12 yrs of age. Also, also indicated for eosinophilic granulomatosis with polyangitis -NOT FOR COPD -Precautions: Anaphylactic reactions can occur. Be prepared to treat such reactions -Dosing: SQ administrations. 100mg SQ every 4 weeks -ADRs: Headache, local injection site reactions, back pain, fatigue

Answer 8

-interleukin-5 antagonist, monoclonal antibody (IgG4 kappa) -Severe eosinophilic asthma ≥18 yrs of age -Not for COPD. -Precautions: Anaphylactic reactions can occur. Be prepared to treat such reactions -Dosing: SQ administrations. Dose is based on body weight. 3 mg/kg IV infusion over 20-50min every 4 weeks. Keep refrigerated. -ADRs: Anaphylaxis (0.2%), oropharyngeal pain

Answer 9

-IgG monoclonal antibody. Inhibits IgE binding to the IgE receptor on mast cells and basophils, this leads to decreased activation and release of inflammatory mediators. -Moderate to severe asthma in patients ≥6 yrs of age with a positive skin test or in vitro reactivity to a perennial aeroallergen. Also, chronic idiopathic urticaria in patients ≥12 yrs of age who fail antihistamines. -NOT for COPD. -Precautions: Anaphylactic reactions can occur. Be prepared to treat such reactions -Dosing: SQ administrations- Dose is based on age, weight and serum total IgE level -75 – 375 mg SQ every 2 to 4 weeks -Keep refrigerated -ADRs: Anaphylaxis (0.2%), CNS effects (headache, dizziness), arthralgias, pain, local injection site reactions

Answer 10

-selectively blocks PDE4, a major cAMP -metabolizing enzyme found in inflammatory cells, which is involved in promoting the pathogenesis of COPD. Indications: Add-on therapy to bronchodilators to decrease the risk of exacerbations in pts with severe COPD -NOT for asthma -CI: Moderate-severe liver dysfunction -Precautions: neuropsychiatric ADRs, weight loss** -Dosing: PO daily -ADRs: GI** (nausea, diarrhea, ab. pain, decreased appetite, wt. loss), dizziness, headache, insomnia, back pain -DDIs: CYP3A4 and 1A2 substrate

Answer 11

-Goals of Therapy -Reduce Impairment: -Minimal or no chronic SX day or night -Minimal use (< 2x per week) of inhaled short acting beta2 agonist (SABA) -Maintain (near) normal pulmonary function -No limitations on activity; no school/work missed -Meet patients’ and families expectations of and satisfaction with asthma care -Reduce Risk: -Prevent exacerbations and minimize ED visits and hospitalizations -Prevent loss of lung function -Minimal or no ADRs from drugs

Answer 12

-Based on symptoms, nighttime awakening, use of SABA PRN for symptom control, interference with normal activity and lung function -Classification is either Intermittent or Persistent: -Intermittent asthma: -Use inhaled SABA PRN -intensity of SABA PRN tx depends on the severity of the exacerbation symptoms -Increased use of short acting beta2-agonists may indicate the need to initiate or increase long-term or maintenance tx -Persistent asthma (mild, moderate or severe): -require use of SABA PRN in addition to long-term or maintenance treatment. Use stepwise approach to determine the maintenance treatment

Answer 13

-Step 1 – intermittent - SABA prn -Step 2 – mild persistent -Step 3 - 4 – moderate persistent -Step 4 - 6 – severe persistent -Provides general guidelines – not specific RX -A rescue course of systemic corticosteroids may be needed at any time and at any step

Answer 14

-teach self management -Teach about controlling environmental factors -Review administration techniques and compliance -Use of written plans

Answer 15

-Prevent and decrease symptoms (esp dyspnea) -Reduce the frequency and severity of exacerbations -improve health status and exercise capacity

Answer 16

-all stages- avoidance of risk factors, influenza and pneumococcal vaccine -stage 1- very mild COPD with FEV1 about 80%- short acting bronchodilators PRN -stage2- moderate COPD with FEV1 50-80%- regular tx with 1 or more long acting bronchodilators, short acting bronchodilators PRN, rehabilitation -stage 3- severe emphysema with FEV1 30-50% of normal- same as stage 2, inhaled glucocorticosteroids -stage 4- very severe COPD with lower FEV1 than stage 3 or those with stage 3 FEV1 and low blood oxygen levels- same as stage 3, tx of complications, long term O2 therapy, surgery

Answer 17

-GOLD 1- mild - FEV1 >= 80% -GOLD 2 moderate- FEV1 50-79% -GOLD 3- severe- 30% <= FEV1 < 50% -GOLD 4- very severe- FEV1 < 30%

Answer 18

-group A- bronchodilator -group b- long acting bronchodilator (LABA or LAMA) -> if it doesnt work use both -etc.

Answer 19

-Slight variations between MDI and DPI -MDIs – Must shake before use. Must “prime” before initial use or if not used in several days. Drug delivered to drug via propellant. Can use spacer to administer. -DPIs – No shaking or priming necessary. Dry powder inside. No propellants. Drug delivered to lungs by force of breathing. NO spacer used -Proper storage essential – avoid extreme heat or cold -Store at room temperature -Pts should keep track of # of puffs or # of days using each inhaler -Some DPIs have counters on them -Float test doesn’t work.

Answer 20

-Take cap off inhaler (shake if MDI) -Breathe out all the way -For MDI - Start breathing in slowly through mouth, THEN press down on the inhaler. For DPI – put mouthpiece to lips and breathe in QUICKLY. -Hold your breath and count to 10 slowly (if you can) -If using 2 puffs – wait one minute between puffs -If using a different inhaled drug, wait 5 minutes between drugs -Use bronchodilators first and steroids last -Rinse and spit after steroid use

Answer 21

-Decrease inflammation and promote smooth muscle relaxation -cilomilast under investigation for the management of both asthma and COPD -Roflumilast recently approved for COPD

Answer 22

Under investigation for alpha-1 antitrypsin deficiency in emphysema

Answer 23

-Characterized by elevated pulmonary arterial pressure and secondary right ventricular failure -Causes: -Idiopathic -Congenital heart disease -Genetic -Drugs: -fenfluramine, dexfenfluramine & PPA (withdrawn from market -SSRIs, amphetamines, chemo drugs, cocaine -Connective Tissue Diseases -HIV -Portal HTN

Answer 24

-VC- vasconstriction -GF- glomerular filtration -VD- vasodilation

Answer 25

-he wants us to understand there is alpot going on this chart

Answer 26

-Group 1: PAH – Pulmonary Arterial HTN -Group 2: PH w/ left heart disease (PVH) -Group 3: PH associated w/ lung disease and/or hypoxemia -Group 4: PH due to chronic thrombotic and/or embolic disease -Group 5: Miscellaneous

Answer 27

-All Classification Groups should receive: -Diuretics (to decrease congestion and edema)- decrease fluid volume -Oxygen (in patients w/ hypoxemia) -Warfarin (INR of around 2) -Digoxin (to improve LVEF and control HR) -Exercise (to improve functional class and O2 consumption -More targeted treatment varies by group and depends on response to a basal vasoreactivity test Examples of targeted treatment on following slides

Answer 28

-Only for pts who respond to the basal reactivity test. -Usually use nifedipine, amlodipine or diltiazem at high doses

Answer 29

-MOA: prolong the VD effect of nitric oxide -CI: don’t use w/ nitrates and alpha-1 blockers -ADRs: headache, flushing, etc. -Sildenafil (Revatio) – main agent used, less data for other agents in PAH -> only low dose needed to treat -> higher dose is viagra

Answer 30

-MOA: will reduce VC and proliferation -Initial preferred therapy for Group 1 PAH -ADRs: hepatotoxicity, teratogenicity, headache, flushing, edema, etc. -DDIs: several -Bosentan can only be prescribed/dispensed through direct access programs -Examples: -bosentan (Tracleer) -ambrisentan (Letaris) – more selective

Answer 31

-Epoprostenol IV (Flolan): -First line in severe PAH -MOA: Vasodilates and inhibits platelet aggregation -> helps PH but also prevents clots! -Administration: Start in hospital. This is a continuous IV infusion given indefinitely -ADRs: chest pain, anxiety, h/a, dizziness, flushing, bradycardia -Treprostinil (Remodulin) – IV, SQ, Inh -Some administration advantages over epoprostenol -Iloprost (Ventavis) - Inh

Respiratory Flashcards

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