asthma/COPD

Question 1

short-acting beta2 agonists

Answer 1

• albuterol and terbutaline
• bronchodilators
• inhaled
• use as needed basis and acute exacerbation
• b for “bute” and beta

Question 2

levalbuterol

Answer 2

• R isomer of albuterol
• most beta agonists are racemix mixture and only the R isomer is effective
• S isomer may promote inflammation

Question 3

adverse SE of SABA

Answer 3

• musculoskeletal tremor
• tachycardia
• hyperglycemia
• hypokalemia
• hypomagnesemia
• prolonged QT
• lactic acidosis
• paradoxical bronchospasm
• tolerance with chronic use
• selectivity is lost with higher doses

Question 4

LABA

Answer 4

• Salmeterol and Formoterol
• bronchodilators
• **always use in combo with inhaled corticosteroids!
• use: long-term control of symptoms

Question 5

antimuscarinics

Answer 5

• M3>M2 (M3 = bronchoconstriction and M2 = negative feedback)
• bronchodilation
• Tiotropium and Ipratropium bromide
• tiotropium preferred (more selective and longer half-life)

Question 6

Tiotropium

Answer 6

• antimuscarinic (M3>M2) –> bronchodilation
• also has anti-inflammatory props and decreases mucous production
• 1st line agent for chronic stable COPD

Question 7

Ipratropium bromide

Answer 7

• antimuscarinic –> bronchodilator
• tx: chronic COPD but less preferred than tiotropium
• shorter t1/2, less M3 selectivity

Question 8

SE of antimuscarinics

Answer 8

• dry mouth
• bladder outlet obstruction
• glaucoma
• paradoxical bronchospasm
• cardiovascular mortality and CVA??
• need higher doses to prevent vagal induced bronchospasm

** opp of SLUDGE

Question 9

Aclidinium bromide

Answer 9

• newer antimuscarinic
• M3>M2 affinity
• metabolized in plasma –> short circulation t1/2 –> less SE
• higher doses can be given more safely (bettter at preventing vagal induced bronchoconstriction)

Question 10

methylxanthines

Answer 10

• theophylline, theobromine, caffein
• PDE inhibitors –> weak bronchodilators
• anti-inflammatory role
• improve contractility and reverse fatigue of diaphragm in PTs with COPD
• restore corticosteroid sensitivity
• narrow tx toxic window

Question 11

problems with methylxanthines

Answer 11

• narrow tx window
• SE at tx doses: anorexia, nausea, HA, insomnia, GERD
• SE at slightly higher doses: cardiac arrthymia and seizures
• drug interactions: cyp450 metabolism

Question 12

inhaled corticosteroids

Answer 12

• anti-inflammatory agents
• budenoside, fluticasone propionate, beclmethasone diproprionate and mometasone
• 1st line tx for persistent asthma
• additive effect with B2 agonist
• steroid sensitivity can be restored with theophylline
• but many SE

Question 13

leukotriene inhibitors

Answer 13

• montelukast, pranlukast, zafirlukast, zileuton
• use as add-on tx for mild asthma
• no role in COPD
• DOC for asprin-induced asthma
• prophylaxis for exercise-induced bronchospasm
• SE: liver toxicity for zileuton, association with Churg-Strauss syndrome

Question 14

sodium cromoglycate and nedocromil sodium

Answer 14

• prevent mast cell degranulation and mediator release from macrophages and eosinophils
• alternative tx for mild persistent asthma
• no role in COPD

Question 15

omalizumab

Answer 15

• anti-IgE antibody
• administered subQ every 2-4 weeks
• only used in PTs with very severe asthma who are poorly controlled on oral corticosteroids

Question 16

management of persistent asthma

Answer 16

1. low dose ICS
2. low dose ICS + LABA or medium dose ICS
3. med dose ICS + LABA
4. high dose ICS + LABA and consider omalizumab for PTs who have allx
5. add oral corticosteroids

**use of SABA > 2day/week for sx relief indicated inadequate control and the need to step up

Question 17

tx of exacerbation of asthma and COPD

Answer 17

• treat the same way
• systemic corticosteroid for 5-7 days
• SABA and short-acting anticholinergic
• Antibiotics for COPD