Flashcards
Asthma and COPD Pharmacology
Cards in this deck (79)
- 1Name one type of Asthma Medication ClassificationRelievers (for intermittent symptoms):
e.g short acting beta2-agonists - 2Name one type of Asthma Medication ClassificationControllers (Maintenance therapy) :
Two types:
1. Anti-inflammatory medications:
steroidal - inhaled or oral corticosteroids
Non steroidal LTRAs, anti allergic agents.
2. Bronhcodilators: Long acting beta2 agonists, ethophyline, antcholinergics - 3Name the three major characteristics of Asthma - pathophysiology1. airway hyper responsiveness
2. chronic airway inflammation
3. reversible airway obstruction (either spontaneously or with treatment)
other features: nocturnal worsening, recurrent attacks, multiple triggers. - 4Asthma symptomologywheezing, cough, dyspnea, chest tightness, sputum production
- 5name three main types of inhalation devicesmetered dose inhaler
dry powder inhalers
nebulizer - 6List some advantages for administering drugs via inhalation1. drug delivered directly to site of action
2. minimal systemic effects
3. rapid relief of acute attacks
4. most devices are portable
Disadvantages:
1. technique may be difficult for some pts.
2. decreased efficacy with poor technique. - 7How much drugs reaches the lungs with a Metered Dose Inhaler?10-20%
shake prior to use - 8Is there more or less efficacy if the a MDI is cold?Less.
It is difficult to estimate how much is left in the canister - 9List the important steps of MDI technique:1. Stand or sit up straight
2. shake the inhaler
3. TAKE A SLOW DEEP BREATH IN.
4. as you start to inhale slowly, press on the inhaler. keep breathing until your lungs are full.
5. hold your breath for as long as you can. BETWEEN 5-10 SECS. - 10What should you remember to do after using an inhaler and why?rinse your mouth to prevent thrush and sore throat (for ICS only)
- 11List the difference in the amount of drug that reaches the lungs using a spacer vs. not using a space:spacer:21%
no spacer: 9% - 12What is a DPI (Dry powder inhaler)?breath activated,easier to use than an MDI
deliver more to the lungs (20%)
Biggest problem: bad inspiratory flow rate
additive may cause cough and irritation.
Have dose coutners. - 13List the steps involved in use an DPI Turbuhaler:1. turn the coloured wheel one way and back the other way until it clikcs.
2. breathe out normally
3. tilt head back slightly
4. breathe in deeply and forcefully
5. hold breath for 10 seconds or as long as you can.
rinse and gargle after. - 14What is a nebulizer?a nebulizer converts drug solution into a mist which is inhaled via face mask or mouthpiece.
- 15what are some of the disadvantages of a Nebulizer?1. less dose delivered to lower airways ( 10%)
2. takes longer to deliver drug.
3. there is an increased dose compared to MDI or DPI therefore increased side effects
4. care/maintenance required
5. not portable - 16What are some of the advantages of a Nebulizer?1. good for an acute attack
2. good for pts who are unable to use another device
3. good for anxious pts. - 17What is a steroid?general name for compounds that have 4 rings of carbon atoms
many different types with very different effects :
cholesterol
sex hormones
anabolic steroids
corticosteroids - 18What do Corticosteroids do?They have anti inflam effects:
1. Dec. synthesis and release of mediators (histamine, leukotrines, interleukins, prostoglandins)
2.Dec. infiltration and activity of inflammatory cells
3. Dec. edema of airway mucose
4. Dec. broncial hyperreactivity, lo - 19What do Corticosteroids increase?Increase number of bronchial beta 2 receptors and responsiveness to beta agonists.
- 20Will Corticosteroids relieve an acute attack?Use for prophylaxis on a fixed schedule to reduce severity of acute attacks
Will NOT relieve an acute attack. - 21What systems do corticosteroids affect?E.g cortisol, put the body in stress mode so the body is burning more glucose. Catabolic hormone.
1. increase salt and water retnetion by kidney
2. dysreg. of mood
3. incres. gastric acid prod.
4. dec. calcium absorption and increase excretion.
5. - 22Inhaled Corticosteroids (ICS)first line therapy fro all patients except pts with mild asthma
benefits seen in days, max effect in 3 months - 23short term Side effects of ICSS/F due to local deposition:
orophanyngeal candidiasis (thrush)
dysphonia
gargle after each puff. - 24long term side fx of ICS in high doses1. bone loss in women
2. adrenal insufficiency with long term high doses
3. exacerbation of glaucoma - 25ICS in childrenshown to slow growth in short term studies; long term show no effect.
still recommended as first line therapy for children - 26Side effects of Oral corticosteroids: short term:1. GI intolerance - n/v, diarrhea, cramps
2. glucose intolerance - can lead to diabetes
3. HTN
4. edema
5. psych. disturbances
6. insomnia (dose in the AM) - 27Long term SFX of OCS:1. Adrenal insufficiency (most supplement with steroids in times of stress)
2. osteoporosis, avascular necrosis
3. glaucoma, catracts
4. body fat redistribution - moon face, buffalo hump, truncal obesity
5. derma: skin atrophy, purpura, telangectiasis - 28What is Adrenal insufficiency?It is when the adrenal glands stop the production of endogenous glucocorticosteroids.
Adrenal glands atrophy and cannot make steroids
they do not recover immediately after stoping steroids, can take days or a year. - 29Control of Cortisolhypothalamus: release CRH: Pituitary gland- ACTH - adrenal cortex - glucocorticoids (Cortisol)
- 30Stress and adrenal insufficiency: stress = infection, exercise, surgeryBP and blood glucose content maintained vis increase in cortisol secretion from adrenal cortex.
with adrenal insuff. must receive suppl steroid when stressed.
anyone on long term glucocorticoids
after d/cd need supp. stress doses until adrenals recov - 31A. Insuff.patients should wear a Medic alter bracelet and carry emergency supply of corticosteroid.
- 32Corticosteroid withdrawal:withdraw slowly, schedule determined by degree of adrenal suppression
taper doses
withdrawal symptoms: HYPOtension, HYPOglycemia, myalgia, arthralgia, fatigue.
Tapering not required for acute dosing : less than 14 days. - 33Other common uses of corticosteroidsRheumatic diseases( arthritis)
Derma disorders
inflammatory bowel disease
cerebral edema
cancer
organ transplantation
allergic diseases and reactions - 34Beta 2 agonists: Inhaled Long acting or short acting ORALMost effect drugs for :
relieving actue bronchospasm
preventing exercise induced bronchospasm
Activate beta 2 adrengeric recepetors in lung smooth muscle causing BRONCHODILATION - 35Inhaled short acting Beta 2 agonists: SABAE.g Salbutamol:
blue coloured MDI
Drug of choice for RELIEF of ACUTE attacks (onset = mins, duration = 3-5 hours)
Drug of choice for preventing of exercise induced symptoms (use immed. prior)
Use on PRN basis not regularly - 36Inhaled long acting Beta 2 agonists: LABASalmeterol: long term control for sever asthma, use REGULARLY not PRN
must use with ICS
NOT for acute attacks
delayed onset, lasts up to 12 hours
sustained relaxation of airway smooth muscle
good for nocturnal symptoms - 37Combo ICS and LABAAdvair: fluicasone and salmeterol
maintenance therapy for patients with moderate to sever disease who need both drugs
use regularly q 12 h
MDI or DPI - 38Oral beta 2 agonistsSalbutamol
slow and erratic absorption
long acting
more side effects than inhaled agents
REGULAR use not PRN
NOT FOR ACUTE attacks - 39Parental Beta 2 AgonistsFor asthmatic emergencies
unable to use inhaled therapy, coughing excessively, poor response to nebulization, life threatening cases
Salbutamol or epinephrine (NON SELECTIVE BETA AGONIST)
-i - 40Side effects of Parental Beta 2 Agonistsincreased sfx (HA, angina, dysrhythmias, incre. BP, Inc. blood glucose
decreased potassium
may be given SC, IM, or IV - 41Salbutamol dosingDosing depends on route of administration
MDI inhalation: 100-200 mcg
Nebulization: 2.5 mg
Oral tablet : 2 mg
injection: 4-8 mcg/kg - 42Beta 2 agonists : SFXstimulation of beta 1 receptors in heart:
inc. HR, inc. Contractility, angina
Tremor, anxiety, restlessness (stimulation of b2 recepetors in skeletal muscle)
Hypokalemia
IV: Oral: Nebulized: MDI/DPI
Reports of mortality with overuse - 43Beta 2 agonists overusefreq. of use is a marker for disease control
pt needing SABA more than 3 times per week must receive anti-inflammatory meds.
pts receiving SABA several times daily require urgent reassessment (need increase in anti inflamm. therapy) - 44Leukotriene Receptor Antagonists (LTRAs)Montelukast (singular)
Leukotriens lead to bronchoconstriction, eosinophil infiltration, mucous production, airway edema.
work by blocking leukotriene receptors.
CONTROLLER: no reliever meds.
Add on therapy for asthma not controlled with ICS/LABA or - 45LTRASdecrease exercise induced asthma
have minimal side effects
dosed orally OD - BID on an empty stomach - 46Cromolyn (Sodium Cromoglycate) - LTRAsuppresses inflammation:
prevents release of histamine from mast cells
Controller: NOT reliever med
Exercise induced bronchospasm (inhale 15 mins prior)
alternative to ICS in mild asthma where pt is unable or unwilling to take
Safe - 47Cromolyn (Sodium Cromoglycate) route LTRAInhalation via nebulization only usually QID
- 48Theophylline LTRABronchodilator for maintenance therapy of chronic asthma esp. pts with nighttime attacks
Oral admin
relaxes bronchial smooth muscle via inhibition of phosphodiesterase and increase in cAMP.
third line agent due to safety and toxicity issues - 49Theophylline LTRARed flag drug
narrow therapeutic range, many drug interactions
dose by body weight; titrate according to drug levels (Therapeutic drug monitoring) - 50Theophylline LTRA side effectsside effects increase if levels are above therapeutic range.
nausea, vomitting, diarrhea, insomnia, increase heart rate, restlessness, arrhythmia, convulsions. - 51Theophylline LTRA drug interactionscaffeine (avoid)
increase effects on CNS/heart, increases theophylline levels
-CYP450 inducers: esp smoking decrease theophyline
-CYP450 inhibitors increase theophyline
Dose OD-BID with food to increase absorption - 52Muscarinic Antagonists:Anticholinergics - inhaled atropine derivatives causing bronchodilation
slower onset than beta agonists
approved only for COPD but off label asthma use
few side effects: dry mouth, oropharyngeal irritation, metallic taste, avoid getting spray in eyes) - 53Short acting Muscarinic Antagonists (SAMA) - MDI, NebulizersIpratropium bromide (Atrovent)
used for allergen or exercise induced asthma, ACUTE attack (Emerg. management), pts intolerant of SABA
less effective than SABA
slower onset than SABA
inhaled q6h usually PRN - 54Long acting Muscarinic Antagonisits (LAMA) - DPITiotropium bromide
for COPD
No clear role in Asthma
onset - 30 MINS
NOT for acute tx
DPI only
Inhaled OD - 55Measuring lung function FEV1Forced expiratory volume in one second.
gold standard test for determining reversibility of airway disease and bronchodilator efficacy
20% improvement in FEV1 produces noticable subjective relief in most pts. - 56Limitations to FEV1Limitations: test depends on pt effort and co-operation
spirometer required - expensive and cumbersome - 57Measuring Lung Function PEFRPeak Expiratory Flow Rate:
maximal rate of airflow during expiration
exhalation as forcefully as possible into a peak flowmeter
pts should measure PEFR every morning. - 58Zone System for self monitoring PEFRGreen Zone:
PEFR greater than 80% of pb
no symptoms, good control
Yellow zone
PEFR = 50-80% of pb
some symp. suboptimal control
may need inhalation of SABA, a short course of OCS
Red Zone:
PEFR=less then 50% of PB - medical alert
requires im - 59Key principles of Asthma CareAchieve an acceptable level of disease control
control environment
asthma education/self management
ICS is first line therapy for ALL ages
additional therapy (e.g LABAs or LTRAs) are added to ICS if control not achieved. - 60Symbicort as single inhaler therapybudesonide (ICS) and formoterol
Formoterol - both a rapid acting and long lasting beta 2 agonist
can be used a reliever and controller at the same ICS dose in pts greater or equal to 12 yrs. with asthma uncontrolled on fixed dose ICS/LABA
can be used as a controller alone (with SABA as a reliver when needed) - 61Emergency management of AsthmaGoals: relieve airway obstruction, hypoxemia, normalize lung function
primary therapy: repetitive inhalation of SABA (MDI or Neb)
ER: short course corticoster. (IV or PO)
and or hihg dose ICS if no response to first dose of SABA
Oxygen=95 + - 62Non Pharmacologic optionsAvoid precipitating factors (allergens)
smoking cessation
vaccination: pneumococcal vaccine, and annual flu vaccine
avoid meds that may trigger attacks e.g ASA, non steroidal anti inflam, NSAIDs - 63COPD - Major features1. chronic airflow limitation
2. chronic cough, increase sputum, dyspnea, impaired gas exchange - 64Clinical manifestations Asthmaage of onset less than 40
not causal with smoking
no sputum
often allergies
stable with exacerbations
spirometry often normalizes
clinical symptoms are intermittent and variable - 65Acute exacerbations of COPD (AECOPD)1. increase respiratory sym (dyspnes, sputum volume, purulence)
2. non-specific symp - malaise, sleep disturbance, fatigue, depression, confusion.
Triggers - inhaled irritants (smoke, allergens, GERD, CHF, drug reactions - 66How many AE per year50% due to infection (Viral, bacterial)
Most pts 2-3 AE per year. - 67Goal of COPD therapyslow disease progression, control symptoms, improve exercise tolerance, reduce mortality.
- 68Goal of AE-COPD therapyRelief of acute symptoms (dyspnea, sputum production, and purulence)
cure infection
prevent mortality - 69Management of COPDSMOKING CESSATION
avoid occupational and air pollutants
Pulmonary rehabilitation/exercise
Immunization to prevent respiratory infection or related complication (flu, pneumo) - 70Pharma of COPDif asymotomatic, normal spirometry - no meds
symptomatic :
less symtoms - SAMAor SABA PRN
More symps: LAMA or LABA standing
If greater or equal to 2 AE per year add ICS - 71if you have greater or equal to two AE a year what is your pharma?LAMA OR LABA and ICS
- 72Role of ICS in COPDFewer pts benefit from maintenance corticosteroid
only add in selected cases - 73Theophylline in COPD:"weak bronchodilator and modest improvement in pulmonary function, dyspnea, and exercise performance
may add if continued symptoms despite the use of LAMA/LABA or uncontroled nocturnal symptoms.
Monitoring of blood levels, sfx and DIs - 74Roflumilast in COPDphosphodiesterase 4 PDE4 inhibitor
increases level of cAMP in lung cells - reduced inflammation, cough, mucus
used in pts with freq. AE who are already on LAMA/LABA and maybe ICS - 75SFX of RoflumilastGI: nausea, disrrhea, weight loss
CNS: insomnia, dizziness, hA, anxiety, depression
Orally, OD - 76Management of AECOPDChest xray to rule out pneumonia or CHF
O2 sat. 88-92%
bronchodilators
systemic corticosteroid
antibiotics
supportive care - 77Pharmacotherapy of AECOPD: Bronchodilatorsinhaled bronchodilators for increasing dyspnea
SABA with or without SAMA (combo usually used)
Nebulizer or MDI wiht space same efficacy. - 78Pharm AECOPD : corticosteroidssystemic steroids show benefit for AE
improve FEV1 and shorten recovery time, reduce treatment failure and length of hospital stay.
Rec: prednisone 40 mg daily * 5 days in most moderate to sever cases. NO ICS - 79Pharma AECOPD: Antibioticsused if increased dyspnea, sputum volume and purulence or mechanical ventilation.
there is Increased infection risk in pts on chronic OCS
most common pathogens H. Influenca, Haemophilus specif, M. Catarrhalis, Strep. pneumoniae
Information
- Description
- Flashcards on Asthma and COPD Pharmacology, created by asissons on 19/03/2015.
- Created by
- asissons
- Views
- 41
- Rating