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What is asthma?
inflammatory airway disease
Drug induced asthma is caused by what drugs?
aspirin, NSAIDS, beta blockers
What drugs can be used if pt. has concurrent post miocardial infraction or congestive heart failure and does not have severe asthma?
low to moderate beta-1 selective agents such as atenolol or metoprolol XL
What class of drugs can be used in aspirin-sensitive asthma?
What class of drugs are the most efficacious for long term management of persistent asthma?
Adding long acting inhaled beta agonist for treatments of asthma occurs when?
in pt. with moderate to severe persistent asthma
What drug is used for asthma in pt. with severe asthma that requires frequent emergency departments visits and hospitalizations?
- omalizumab (Xolair)-is an inti IgE
- given SQ q2-4wks.
Monitoring of asthma at home is done by using what?
- Peak expiratory flow meter (PEF)
- green zone: 80-100%
- yellow: 50-79% (advised cosultation with MD)
- red: <50% (medical attention, implemented plan)
- spirometry is performed at MD office
What is the MOA of corticosteroids for asthma?
are antinflammatory; block late reaction to allergen and decrease airway hyperresponsiveness; inhibit cytokine production...;reverse beta2 receptor downregulation
What are examples of corticosteroids for asthma?
- beclomethasone HFA (QVAR)-MDI
- budesonide (Pulmicort)-DPI
- budesonide-formoterol (Symbicort)-MDI
- flunisolide (Aerobid)-MDI
- fluticasone (Flovent (MDI) Flovent Diskus (DPI))
- fluticasone-salmeterol (Advair HFA or Advair Diskus)
- mometasone (Asmanex)-DPI
- triamcinolone (Azmacort)-MDI
- MDI-metered dose inhaler
- DPI-dry powder inhaler
What are the SE of corticosteroids?
- cough, oral thrush (candidiasis), dysphonia(disturbance in vocal function)
- -high doses may cause growth suppression (not established yet)
What are drug interactions with corticosteroids?
- CYP450 inducers: carbamazepine, phenobarbital, phenytoin, rifamin
- inhibitors: erythromycin, clarythromycin, itraconazole, oral contraception, conjugated estrogens
What is the MOA of long acting beta2 agonist?
- relax bronchial smooth muscle by acting on beta2 receptors
- duration of action is about or more than 12hrs
What are examples of long acting beta2 agonist?
- formaterol (Foradil aerolizer)-DPI
- salmeterol (Serevent Diskus)-DPI
What are SE of long acting inhaled beta2 agonist?
tachycardia, tremor, hypokalemia, prolong QTc (used in combos with corticosteroids for asthma)
What is the MOA of methylxanthines?
bronchodilation, smooth muscle relaxation results from phosphodiaterase inhibition
What is an example of methylxanthine?
- theophylline (Uniphyl)-tabs.
- (not really used in asthma)
- theraputic conc. 5-15mcg/ml
What are SE of theophylline?
- dose related toxicities: tachycardia, CNS stimulation, hyperglycemia, hypokalemia
- SE at usual doses: insomnia,hyperactivity in kids...
What is the MOA of leukotriene modifiers?
- leukotriene receptor antagonist
- inhibiton of CysLT receptor
- 5-lipoxygenase inhibitors
What are examples of leukotriene modifiers?
- montelukast(Singular)-granuel,chew tab,tabs (taken HS)
- zafirlukast (Accolate)-bid
- zileuton(Zyflo, CR)-qid; CR:bid
What are SE of leukotriene modifiers?
- singular and accolate are usually well tolerated
- zyflo-may cause liver dysfunction
What drug interactions or other interactions occur with leukotriene modifiers?
- take accolate 1hr before food or 2hr after meals
- zyflo and accolate may increase warfarin and theophylline levels
What are examples of short acting inhaled beta2 agonist? (MDI or nebulizer)
- role is to relax bronchial smooth muscle by acting on beta2 receptors (little effect on heart rate)
- albuterol HFA(Ventolin,Proventil,ProAir)-2puffs q4hours as needed
- pirbuteol(Maxair Autohaler)
What are SE of short acting inhaled beta2 agonist?
tachycardia, tremor, hypokalemia, rarely hyperglycemia
Whats the MOA of anticholinergics (quick relief drugs for asthma)?
block action of acetylcholine; with bronchodilation there is competitive inhibition of muscarinic cholinergic receptors
What are examples of anticholinergics?
- ipratropium with albuterol(Combivent)-2puffs q6hrs
What are SE of anticholinergics?
dry mouth, increased wheezing, blurry vision if sprayed into eyes
What are examples of systemic corticosteroids(used <2wks) (quick relief asthma drugs) and SE?
- SE:altered glucose levels,fluid retention, gain weight, HTN,mood alteration
T/F: MDI should be stored at room temp. and should be primed only with 1st.use
What is COPD?
chronic obstructive pulmonary disease characterized by airflow limitation that is not fully reversible (4th leading cause of death)
What are the COPD classifications?
- FEV(forced expiratory volume)/FVC(forced vital capacity) is <0.7 for all classes
- 1.mild FEV> or equal to 80%
- 2.moderate FEV 50-80%
- 3.severe FEV 30-50%
- 4.very severe FEV <30% or FEV<50% with respiratory failure
COPD is primarly caused by what?
What class of drugs is used for initial tx. of COPD?
long acting inhailed bronchodilators (ex.Spiriva(tiotropium-anticholinergic) and long acting beta2 agonist)
What class of drugs is preferred for prn use in pt.already receiving long acting beta2 agonist and anticholinergic?
short acting inhaled beta2 agonist
Inhailed corticosteroids are reserved for COPD pt. with?
severe COPD or very severe disease and exacerbations
Theophylline for COPD is an option for who?
pt. that are not controlled with beta2 agonist and anticholinergics
What are treatment options for diff. stages of COPD?
- 1. short acting bronchodilator prn
- 2. add one or more long acting bronchodilator
- 3.scheaduled tx. with one or more long acting bronchodilators
- add corticosteroids if pt. has recurrent exacerbations
- 4. same as stage 3. consider surgery
- long term oxygen if pt. has chronic respiratory failure
What are the drug options for acute exacerbations of COPD?
- inhaled albuterol, ipratropium or both
- systemic corticosteroids
- oral antibiotic for sputum and increased dyspnea(shortness of breath)