1
Q
Types of drugs for bronchodilation of airways
A
- bronchodilators (sympathomimetic drugs)
- Methylxanthine drugs
- Muscarinic antagonist (Anticholinergics)
2
Q
Two types of sympathomimetic drugs
A
non-selective & selective
3
Q
Types of drugs for inflammation/thickening of airways
A
- Corticosteroids
- Cromolyn & Nedocromil
- Leukotriene Pathway Inhibitors
- Monoclonal antibodies
4
Q
Beta-adrenergic agonists
A
-SABAs & LABAs
5
Q
Anticholinergics (antimuscarinic) agents
A
SAMAs & LAMAs
6
Q
What do alpha & beta agonist drugs mimic?
A
epinephrine or norepinephrine
7
Q
What tissue do B2 drugs attack?
A
resp, uterine, & vascular smooth muscle
8
Q
What is the actions of B2 drugs?
A
promotes smooth muscle relaxation
9
Q
Name the short-acting selective beta-2 agonist
A
- albuterol & terbutaline
10
Q
Name the long-acting selective beta-2 agonist
A
salmeterol
11
Q
SE of selective B2 agonist
A
- tachycardia
- hypokalemia
- hypoxemia
- dysrhythmias
- tremor
- restlessness
12
Q
When it says nonindicated in asthma this means…
A
contraindicated in monotherapy can be used in combo therapy
13
Q
What is the name of the OTC direct agonist used for asthma?
A
Primatene MIST (straight epi)
14
Q
NOTES
A
anticholinergics + SABA is more beneficial in tx of severe asthmatic attacks
15
Q
MOA for selective B2 agonist?
A
selective stimulates B2-adrenergic receptors, relaxing airway smooth muscle
16
Q
Uses for Albuterol (Proventil)
A
- asthma
- exercise-induced asthma
17
Q
Interaction characteristics for Albuterol (Proventil) & Levalbuterol (Xopenex)
A
- HTN
- hypokalemia
18
Q
Age to use Neb form for Albuterol (Proventil)
A
< 2yo
19
Q
Age to uses MDI form of Albuterol (Proventil)
A
4 yo or older
20
Q
Serious reactions of Albuterol (Proventil) & Levalbuterol (Xopenex)
A
- heart stuff
- hyper/hypotension
- K+ & Glucose problems
21
Q
Uses for Levalbuterol (Xopenex)
A
- asthma
- exercise-induced asthma
22
Q
Uses for Salmeterol (Serevent) & Formoterol (Foradil)
A
- asthma maintenance
- exercise-induced asthma
- COPD maintenance
23
Q
MOA for Salmeterol (Serevent) & Formoterol (Foradil)
A
selectively stimulated beta 2 adrenergic receptors, relaxing airways smooth muscle
24
Q
BB warning for Salmeterol (Serevent) & Formoterol (Foradil)
A
- asthma: if monotherapy–> incr risk of asthma-related death
- peds/kids: if monotherapy–> may incr risk of hospitalization
25
What is the anti-cholinergic (muscarinic) antagonist that is short acting?
Ipratropium (Atrovent)
26
What is the anti-cholinergic (muscarinic) antagonist that is long acting?
Tiotropium (Spiriva)
27
MOA for anti-cholinergic (muscarinic) antagonist
reverse vagally (blocks Ach) mediated bronchospasm. May decr mucous gland hypersecretion
28
Are anti-cholinergic (muscarinic) antagonist typically not used in___?
allergen or exercise-induced bronchospasm
29
Uses for Ipratropium (Atrovent)
- COPD maintenance
- Asthma exacerbation mod-severe
30
Uses for Tiotropium (Spiriva)
COPD maintenance
31
SEs for Anti-cholinergic (muscarinic) antagonist
Caution w/
- glaucoma angle-closure
- prostatic hypertrophy
- bladder neck obstruction
32
Important methylxanthines
- Theophylline (tea)
- Theobromine (cocoa)
- Caffeine (coffee)
33
Sustained-release theophylline can improve what SE of this medication?
nocturnal symptoms
34
SEs for Theophylline
- N/V
- HA
- GI discomfort
- Diuresis
- Cardiac arrhythmias
- Seizures
35
Uses for Theophylline (Elixophyllin)
- asthma/COPD maintenance
36
Is Theophylline (Elixophyllin) used in asthma exacerbations
NO
37
MOA for Theophylline (Elixophyllin)
phosphodiesterase inhibitor & bronchodilator; increased cAMP
38
What are the 1st line agents for all patients w/ persistent asthma?
Inhaled corticosteroids
39
Local SEs of inhaled cortitcosteroids
- dysphonia
- Oropharyngeal candidiasis
- Cough
40
System SEs of inhaled corticosteroids
- adrenal suppression
- growth suppression
- bruising
- osteoporosis
- cataracts/glaucoma
- psychiatric disturbances
41
Why do we see systemic effects when using inhaled corticosteroids?
with inhaled corticosteroids, most of it is swallowed. Only 10-20 percent are inhaled
42
Patient Education for inhaled corticosteroids
rinse mouth w/ water or brush teeth after taking meds
43
Inhaled corticosteroids (2)
- Fluticasone [Flovent]
- Budesonide inhalation [Pulmicort]
44
Uses for Fluticasone inhalation [Flovent]
- prevent asthma attacks
- COPD?
45
Age range for Fluticasone inhalation [Flovent]
>/= 4yo
46
Can fluticasone be used as a rescue med for asthma attacks?
NO
47
Can condition can long term steroid use cause?
osteoporosis
48
Warning for Fluticasone inhalation [
Flovent]
Do not use in powder form if allergic to milk
49
MOA for Fluticasone [Flovent]
uses fluorocarbothioate ester linkage to cause potent vasoconstrictive and anti-inflammatory activity. (direct local effect)
50
Uses for Budesonide inhalation [Pulmicort]
- asthma maintenance & prophylaxis
- COPD exacerbation
51
What are the age limitation of Budesonide inhalation [Pulmicort] asthma maintenance?
- >/= 6yo for dry powder
- 12mo - 8yo for nebulizer
52
Is Budesonide [Pulmicort] a rescue med for asthma attacks?
NO
53
MOA for Budesonide inhalation [Pulmicort]
thought to inhibit multiple inflammatory cytokines
54
Warning of Budesonide inhalation [Pulmicort]
severe hypersensitivity to milk proteins should avoid
55
Which medication is preferred (1st line) for pregnant women w/ persistent asthma?
Budesonide inhalation [Pulmicort]
56
Can you use Budesonide inhalation during lactation?
Yes
57
Name a systemic corticosteroid used in pulm issues?
Prednisone
58
Uses for Prednisone
- Anaphylaxis
- Angioedema
- Urticaria
- Asthma acute ex.
- COPD acute ex.
59
MOA for Prednisone
- decr inflammation by suppressing the immune system via lymphatic system
- it also suppresses adrenal function at high doses
60
Concerns related adverse effects of prednisone
- adrenal suppression
- immunosuppression
- Kaposi sarcoma
- Myopathy
- Psychiatric issues
61
Prednisone Pearls for the elderly.
use the smallest possible effective dose for the shortest time
62
Prednisone pearls for peds
- may mess w/ speed of growth & development
63
How must one stop prednisone?
gradual tapering of dose
64
Prednisone pearls for stress
higher dosing when subject to stress (trauma, surgery, severe infx)
65
Uses for Cromolyn sodium (intal) [cromolyn inhaled]
- asthma chronic (decr gradually to bid after stabilized)
- asthma, exercise-induced
66
MOA for Cromolyn sodium (Intal) [Cromolyn inhaled]
inhibits mast cell degranulation (mast cell stabilizer)
67
Off label uses for Cromolyn sodium (Intal) [Cromolyn inhaled]
- food allergies
- IBD
68
Cromolyn sodium (Intal) Serious Rxns
- bronchospasm
- anaphylaxis
69
Cromolyn sodium (Intal) common rxns
- throat issues
- bitter taste
- wheezing/cough
70
Main Leukotriene receptor antagonists (LRA) (2)
- Montelukast & Zafirlukast
71
Uses for Montelukast (Singulair)
- asthma, maintenance
- exercise-induced asthma
- allergic rhinitis
72
BB warning for Montelukast [Singulair]
serous neuropsychiatric events
73
MOA for Montelukast [Singulair]
cysteinyl leukotriene receptor antagonist--> block leukotriene inflammatory mediators
74
Uses for Zileuton (Zyflo)
asthma maintenance
75
MOA for Zileuton (Zyflo)
inhibits 5-lipoxygenase interfering w/ leukotriene formation
76
Zileuton (Zyflo): BB Warnings
avoid in alcoholics & patient w/ mood disorders
77
Zileuton (Zyflo) Pearls
- monitor for liver toxicity & behavior disturbances
78
NOTE
- LRAs + ICSs = mod persistent asthma
79
List the Monoclonal Antibodies in asthma
- Omalizumab (IgE)
- Mepolizumab, Bernalizumab, Resilzumab (IL-5)
- Dupilumab (IL-4) [self-administered]
80
Asthma: Approach to Management
- Assessing asthma control & severity
- Severe vs uncontrolled asthma
- Pharmacotherapy for asthma (meds)
- Treat modifiable risk factors & control environmental factors
- Guided asthma self-management edu & skills training
81
Non pharmacologic Tx for Asthma
- Encourage exercise
- Stop smoking
- Pt. edu
- control triggers
82
Acute bronchospasms must be treated promptly & effectively with... (and list them)
bronchodilators
- B2 agonist
- muscarinic antagonist
- theophylline
- Nasal O2
83
Long-term preventive tx requires control of inflammatory process which include what names?
- corticosteroids
- LABA w/steroid (never monotherapy)
- Anti-IgE antibodies
- Leukotriene antagonist
84
Inhaled SABAs are not recommended for long-term daily tx.
- albuterol CFC/HFA
- Pirbuterol CFC
- Levalbuterol
85
Inhaled SABAs via Nebulizer that can be mixed w/ budesonide
- Albuterol
- Levalbuterol (R-albuterol)
86
List the anticholinergic meds for asthma.
- Ipratropium HFA (MDI/Neb)
- Ipratropium w/ albuterol (MDI/Neb)
87
Duo-neb includes what medications
albuterol & ipratropium
88
List systemic corticosteroids
- Methylprednisolone
- Prednisolone
- Prednisone
- Methylprednisolone acetate
89
Which systemic corticosteroids can be used for short course "bursts" therapy?
- Methylprednisolone
- Prednisolone
- Prednisone
90
When do you use methylprednisolone acetate?
use in place of oral corticosteroids in pts who are vomiting or if adherence is a problem
91
Describe the drug: Ipratropium bromide/albuterol inhaled [Combivent]
inhaled & combo SAMA & SABA
92
Uses for Ipratropium bromide/albuterol inhaled [Combivent]
- COPD
- asthma exacerbation, mod-sever
93
MOA for ipratropium bromide/albuterol inhaled [Combivent]
combo SABA & SAMA
94
Safety warnings for ipratropium bromide/ albuterol inhaled [Combivent].
caution during labor & delivery
risk of interference w/ uterine contractility
95
Uses of budesonide/formoterol inhaled [Symbicort]
-asthma maintenance
- COPD maintenance
96
MOA for budesonide/formoterol inhaled [Symbicort]
combo ICS & LABA
97
Is budesonide/formoterol inhaled a rescue medication?
NO
98
Uses of Fluticasone/Salmeterol [Advair]
- asthma maintenance
- COPD maintenance
99
MOA of Fluticasone/Salmeterol [Advair]
combo inhaled ICS & LABA
100
In people w/ COPD fluticasone/salmeterol [Advair], is what type of tx?
long-term tx
101
In people w/ asthma fluticasone/salmeterol [Advair], is what type of tx?
short-term tx until symptoms are well controlled w/ ds other meds
102
Uses for Mometasone/Formoterol [Dulera]
asthma, maintenance tx
103
MOA for Mometasone/Formoterol [Dulera]
combo ICS + LABA
104
Pearls: Mometasone/Formoterol [Dulera]
- long tern uses --> adrenal suppression
- paradoxical bronchospasm
105
Uses for Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]
- asthma, maintenance tx
- COPD, maintenance tx
106
MOA for Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]
inhaled combo ICS/LAMA/LABA
107
Pearls: Fluticasone furoate/Umeclidinium/Vilanterol [Trelegy Ellipta]
- angioedema
- cardiac arrhythmia
- adrenal suppression
- paradoxical bronchospasm
- eosinophilia
- Churg-Strauss syndrome
108
In all combo medications, you should monitor for
- osteoporosis
- chronic use of bone mass-reducing drugs
- height in children
- vision disturbances (IOP, glaucoma)
109
Study Slide 87 for 10 mins
DONE
110
Study Slide 89 for 10 mins
DONE
111
In immediate tx w/ a SABA, if w/n 20 mins, a pts has an incomplete response, then what is next?
3 more SABA treatments w/m 1 hours
112
In immediate tx w/ a SABA, if there is a poor response, then what is next?
addition of oral or intravenous corticosteroids
113
In immediate tx w/ a SABA, if pt continues to have inadequate or poor response, then what is next?
in-patient management w/ continuous oximetry & close monitoring
114
Study slide 91 for 10 minutes
DONE
115
Differentiate b/t COPD & asthma
COPD (cigarette smoke) - asthma (allergens)
COPD (damage/injury) - asthma (inflammation)
COPD (older) - asthma (younger)
COPD (irreversible) - asthma (reversible)
116
Study Slide 116 for 10 minutes
DONE
116
Uses for Aform
116
117
Block 2
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