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Pharm Exam 3 > Treatment of COPD and Asthma > Flashcards

Treatment of COPD and Asthma Flashcards

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1
Q

What is the pathophys of asthma?

A

Airway inflammation-airway hyperresponsiveness-respiratory symptoms-airflow obstruction, bronchial hyperresponsiveness, underlying inflammation.

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2
Q

Goals of asthma therapy:

A

prevent symptoms.
Require infrequent use of SABA
Prevent recurrence, loss of lung function

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3
Q

Intermittent Asthma classification: for Ages 0-11

Treatment step

A

Symptoms: < 2x/month (0 for 01-4)
SABA use: 4yo) FEV1 >80%, FEV1/FVC >85%
Exacerbations: 0-1/year

Treatment step 1

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4
Q

Mild Persistent asthma classification

Treatment step

A

Symptoms: >2days/week but not daily
Nighttime awakenings: 1-2x/month ( 0-4) 3-4x/month (5-11)
SABA use: >ddays/week but not daily
Normal activity interference: Minor limitation
Lung Function: (>4yo) Fev1: >80%, FEV2/FVC >80%

Treatment step 2

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5
Q

Moderate persistent asthma classification for children

Treatment step

A

Symptoms: Daily
Nighttime awakenings: 3-4x/mo (0-4), >1x/week but not nightly (5-11)
SABA use: Daily
Normal activity interference: Some limitation
Lung function: (>4yo) Fev1 60-80%, FEV1/FVC 75-80%

0-4: Step 3 consider short course of oral systemic corticosteroids
5-11: Step 3 Medium dose ICS,consider short course of oral systemic coricosteroids

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6
Q

Severe persistent asthma classification for children

Treatment step

A 
Symptoms: Throughout the day
Nighttime awakenings:(0-4) >1x/week, (5-11) Often 7x/week
SABA Use: Several times/day
Activity: extremely limited
Lung Function (>4yo): FEV1 <75%

0-4: Step 3 and consider short course of oral systemic corticosteroids
5-11: Step 3 Medium dose ICS option OR step 4 and consider short course of oral systemic corticosteroids

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7
Q

Tx for Step 1 asthma in Children 0-4 year

A

SABA PRN

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8
Q

Tx for Step 2 asthma in children 0-4 years

A

SABA + Low dose ICS, alternative Montelukast or cromolyn

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9
Q

Tx for Step 3 asthma in children 0-4 years

A

SABA + Medium dose ICS (if you have done Montelukast as step 2 alternative then try low dose ICS before up to medium dose)

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10
Q

Tx for Step 4 asthma in children 0-4 years

A

SABA + Medium dose ICS AND either Montelucast or LABA

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11
Q

Tx for Step 5 asthma in children 0-4 years

A

SABA + High-dose ICS AND either montelukast or LABA

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12
Q

Tx for Step 6 asthma in children 0-4 years

A

SABA + High-dose ICS AND either Montelukast or LABA AND oral corticosteroids

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13
Q

Tx for Step 1 asthma in children 5-11 years

A

SABA PRN

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14
Q

Tx for Step 2 asthma in children 5-11 years

A

SABA + Low Dose ICS alternative: LTRA cromolyn, nedocromil

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15
Q

Tx for Step 3 asthma in children 5-11 years

A

SABA + Medium-dose ICS OR low-dose ICS + either LABA, LTRA, or theophylline

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16
Q

Tx for step 4 asthma in children 5-11 years

A

SABA + Medium-dose ICS + LABA, alternative Medium-dose ICS + either LTRA or theophylline

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17
Q

Tx for Step 5 asthma in children 5-11 years

A

SABA + High-dose ICS + LABA alternative medium-dose ICS + either LTRA or theophylline

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18
Q

Tx for Step 6 asthma in children 5-11 years

A

SABA + High-dose ICS + LABA + oral corticosteroid Alternative High-dose ICS + either LTRA or theophylline + oral corticosteroid

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19
Q

Asthma classification adult: Intermittent

Tx step

A

Symptoms: < 2x/mo
SABA Use: < 2days/week
Activity interference: None
Lung function: Normal FEV1 between episodes; FEV1 >80%, FEV1/FVC normal

Tx step 1

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20
Q

Asthma classification adult: Persistent Mild

Tx step

A 
Symptoms: >2days/week
Nighttime awakenings: 3-4/mo
SABA use: >2days/week
Activity interference: Minor
Lung function: FEV1>80%, FEV1/FVC normal

Step: 2

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21
Q

Asthma classification adult: Persistent Moderate

Tx step

A 
Symptoms: daily
Nighttime awakenings: >1x/week
SABA use: Daily
Activity interference: some limitation
Lung function: FEV1>60-<80%, FEV1/FVC: reduced 5%

Step 3

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22
Q

Asthma classification adult Persistent Severe:

Tx step

A 
Symptoms: throughout the day
Nighttime awakenings: Often 7x/week
SABA use: Several times/day
Activity interference: extremely limited
Lung function: FEV1< 60, FEV1/FVC: reduced 5%

Step 4 or 5

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23
Q

Step 1 asthma tx adults

A

SABA PRN

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24
Q

Step 2 asthma tx adults

A

Low-dose ICS, alternative cromolyn, nedocromil, LTRA or theophylline

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25
Step 3 asthma tx adults
Medium dose ICS OR Low-dose ICS + LABA alternative Low-dose ICS + either LTRA, Theophylline or zileuton
26
Step 4 asthma tx adults
Medium-dose ICS + LABA alternative Medium-dose ICS + either LTRA, Theophylline, or zileuton
27
Step 5 asthma tx for adults
High-dose ICS + LABA AND consider omalizumab for patients who have allergies.
28
Step 6 asthma tx for adults
High-dose ICS + LABA + Oral corticosteroid AND omalizumab for pts with allergies
29
MOA for step 1 SABA
Binds to B receptors on several sites-smooth muscle relaxation Onset approx 5 minutes
30
ADE SABA
dose-dependent heart palpitations, anxiety, tachycardia, tremor (use of SABA >2days/ week need to change long-term control med)
31
ex of SABA
"OL" albuterol, Levalbuterol,
32
MOA anticholinergics
Inhibits cholinergic and muscarinic receptors on bronchial smooth muscle causing bronchodilation. Onset 5-15 minutes.
33
ADE anticholinergics
Dry mouth and respiratory secretions, Increased wheezing, Less cardiac tim than SABA
34
Low-dose ICS MOA
- decreased number and activity of inflammatory cells, - enhances effect of B-adrenergic drugs. - inhibits bronchoconstrictor mechanism - direct smooth muscle relaxation
35
ADE Low-dose ICS
- Cough, dysphonia, Oral thrush (rinse and spit) - In high doses: adrenal suppression, osteoporosis, skin -thinning, bruising, cataracts - Low-medium doses: growth suppression in children, velocity may be altered.
36
Inhaled Corticosteroids examples
"Ones and Ides" Beclomathasone, Budesonide
37
LTRA definition, ex, MOA
Leuoktriene receptor antagonist: Montelukast, Interfere with pathway of leukotriene mediators, which are released from mast cells, eosinophils and basophils. -Can be adjunct with ICS (not preferred to LABAs for >12yo)
38
Mast cell stabilizers ex and MOA
Cromolyn, Stabilizes mast cells, Blockade of chloride changes. may be preventative prior to exercise of unavoidable exposure to allergens
39
ADE LTRAs
No specific adverse event have been identified
40
Zileuton MOA
Similar to LTRA's only blocks the enzyme not the recptor
41
Zileuton ADE:
Elevation of liver enzymes, not preferred over LTRAs
42
Zafirlukast interactions
Food-decreases bioavailability, take at lest 1 hour before or 2 hours after meals, CYP 2C9 Substarte and inhibitor, Increase levels of warfarin!
43
Theophylline MOA
mild to moderate bronchodilator non-selective phosphodiesterase inhibitor must monitor serum theophylline conc. adjust dose to achieve 8-15mcg/mL at steady state
44
ADE theophylline
Usual dose: Insomnia, gastric upset, aggravation of ulcer, increased hyperactivity in children, dysuria.
45
Toxicities of theophylline
Tachycardia, N/V, Tachyarrhythmia, CNS stim, HA, Seizure, Hematemesis, Hyperglycema, Hypokalemia
46
DI theophylline
Metabolized by CYP 1A2 and CYP3A4 (also induces these!!) Many DI's exist!! This is not a first line medication. A lot of older pt's may be on it-because they don't like to switch.
47
LABA MOA
- Tail binds to B receoptor at exosite-prevents molecule from dissociating from receptor. - Head attaches to same spot as SABA's. - Causes bronchodilation - do not use as mono therapy!! - Every 12 hour dosing is crucial to maintaining proper control!
48
ADE LABA
Tachycardia tremor hypokalemia Unexpected bronchospasm & hyperresponsiveness
49
Black box warning LABA
-Increased risk of severe asthma exacerbation and asthma related death with regular use of LABA
50
Omalizumab MoA
Recombinant DNA antibody (IgE), Binds to portion of IgE antibody preventing binding to its high-affinity receptor on mast cells and basophils, -decrease in release of mediators in response to allergen exposure. Approved for >12yo
51
ADE Omalizumab
Urticaria, anaphylaxis (0.1%) , injection site pain and bruising
52
DI oral systemic corticosteroids
``` Herpes infection varicella TB HTN peptic ulcer dz DM Osteoporosis ```
53
What time frame tx requires a tapered dose when taking pt off of oral corticosteroids?
5days | Healthier younger pt's > 3-5 days
54
Non-pharm tx for asthma
``` Avoid triggers, Remove carpets Encase mattress pillows vacuum close windows air filters allergen-free zone ```
55
First line for exercise-induces bronchospasm (EIB)
SABA (albuterol)
56
Second line for EIB
LTRA's
57
Last line for EIB
Cromolyn
58
Non-Phare techniques for EIB
Warm-up | Mask or scarf over mouth in cold weather.
59
Inflammatory mediator of Asthma
Eosinophils
60
Inflammatory mediator of COPD
neutrophils
61
Pink puffers
Emphysema
62
Blue Bloaters
Chronic bronchitis
63
R/f for COPD
cigarette smoking, Genetics (a1 antitrypsin rare)
64
symptoms of COPD
Dyspnea, Chronic smokers cough, Sputum, spirometry
65
FEV1 FEV1/FVC Mild stage 1 COPD
FEV1: >80% FEV1/FVC: <70% Mild airflow limit, chronic cough and sputum not always present.
66
FEV1 FEV1/FVC Moderate stage 2 COPD
FEV1: <70% | SOB on exertion, and cough sputum sometimes present *typical stage where pt presents
67
FEV1 FEV1/FVC Severe stage 3 COPD
FEV1: >30% <50% | FEV1/FVC: Greater SOB reduced exercise capacity.
68
FEV1 FEV1/FVC Very severe stage 4 COPD
FEV1: <50% plus presence of chronic respiratory failure | FEV1/FVC: 70%
69
Mild COPD tx
SABA
70
Step 2 Moderate COPD tx
SABA + Long acting bronchodilators and ADD rehab
71
Step 3 Severe COPD tx
SABA + Long acting bronchodilators and rehab, ADD Inhaled glucocorticoids if repeated exacerbations
72
Step 4 Very Severe COPD Tx
SaBA + Long acting bronchodilators and rehab ADD inhaled glucocorticoids and ADD long term O2 consider surgical tx.
73
goal of tx for COPD
Relieve symptoms. Prevent dz progression
74
Ex; of SABA
"OL's" Albuterol, levalbuterol
75
Ex of anticholinergics
"IUM" Iptratropium, iptratropium albuterl
76
What has a longer duration of action SABA or Ipratropium
Ipratropium (anticholinergic) has longer duration of action.
77
Black box warning for LABAs Arcapta, Brovana, Presimat, Valanterol,
may not apply to patients with COPD
78
Oxygen initiation requirement
Stage IV COPD
79
Non-pharm tx for COPD
Stop smoking, Avoid triggers, filter air, Adjust ADL's
80
tx for Exacerbations of COPD
Oxygen first (>90%)!!! SABA. 2nd line is short acting anticholinergic, systemic glucocorticosteroids, FEV1<50%
81
ABX for exacerbations of COPD when 3 cardinal symptoms present
Increase dyspnea sputum volume sputum purulence OR if 2/3 if sputum and is one of the symptoms

Pharm Exam 3 (4 decks)

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