Medications Used For Treating Patient's With Asthma And Copd

Front 1

Inhaled Corticosteroids -

1) Medications

2) MOA

3) Indication

Back 1

1) Medications:

-mometasone (Asmanex)

-fluticasone (Flovent)

-budesonide (Pulmicort)

-beclomethasone (Qvar)

2) MOA

-Block late-phase activation to allergen, inhibit inflammatory cell migration and activation

3) Indication

-Controller drug, prevention of inflammation

Comment:

-Need consistent use to be helpful

-Cornerstone medication of most asthma levels

Front 2

Mast Cell Stabilizer -

1) Medications

2) MOA

3) Indication

Back 2

1) Medications:

-cromolyn sodium (Intal)

-nedocromil (Tilade)

2) MOA:

-Halts degradation of mast cells and release of histamine and other inflammatory mediators

3) Indication:

-Controller drug, prevention of inflammation

Comment:

-Need consistent use to be helpful

-Less clinical effect compared with ICS

Front 3

Leukotriene Receptor Antagonist (aka Leukotriene Modifier) -

1) Medications

2) MOA

3) Indication

Back 3

1) Medications:

-montelukast (Singulair)

-zafirlukast (Accolate)

-Leukotriene inhibitor - zileuton (Zyflo)

2) MOA:

-Inhibit action of inflammatory mediator (leukotriene) by blocking select receptor sites

3) Indication:

-Controller drug, prevention of inflammation

Comment:

-Likely less effective than ICS

-Particularly effective add-on medication when disease control is inadequate w/ ICS, when asthma is complicated by allergic rhinitis

-In mild, persistent asthma, an alternative, although not preferred, therapeutic option for controller therapy

Front 4

Systemic Corticosteroids (oral or parenteral) -

1) MOA

2) Indication

Back 4

1) MOA:

Inhibit eosinophilic action and other inflammatory mediators

2) Indication:

-Treatment of acute inflammation such as in asthma flare or COPD exacerbation

Comments:

-Oral route preferred whenever possible

-Indicated in treatment of acute asthma flare to reduce inflammation

-In higher doses and with longer therapy (> 2 weeks), adrenal suppression may occur

-No taper needed if use is short-term (< 10 days) and at lower dose (prednisone, 40-60 mg/d or less)

-Potential for causing gastropathy, particularly gastric ulcer and gastritis

Front 5

Short-Acting Beta2-Agonists (SABAs) -

1) Medications

2) MOA

3) Indication

Back 5

1) Medications:

- Albuterol (Ventolin, Proventil)

- Pirbuterol (Maxair)

-Levalbuterol (Xopenex)

2) MOA:

-Beta2-agonists; bronchodilation via stimulation of beta2-receptor site

3) Indication:

-Rescue drugs for treatment of acute bronchospasm

Comments:

-Albuterol and Pirbuterol:

*Onset of action - 15 mins

*Duration of action - 4-6 hours

-Compared w/ albuterol and pirbuterol, levalbuterol, a single isomer of the racemate albuterol, is often better tolerated w/ potentially better bronchodilation than the other short-acting beta2-agonists, owing to its lower recommended dose.

Front 6

Long-Acting Beta2-Agonists (LABAs) -

1) Medications

2) MOA

3) Indication

Back 6

1) Medications:

-salmeterol (Serevent)

-formoterol (Foradil)

-arformotorol (Brovana)

2) MOA:

- LABAs; bronchodilation through stimulation of receptor site beta2

3) Indication:

-Prevention of bronchospasm

Comments:

- Salmeterol:

*Onset of action: 1 hr

*DOA: 12 hrs

- Formoterol:

*Onset of action: 15-30 mins

*DOA: 12 hrs

-LABAs are indicated for prevention rather than treatment of bronchospasm

-Patient should also have SABA as rescue drug

-Although LABA use decreases number of asthma episodes, the use of these meds may increase the chance of a severe asthma episode and, rarely, increase risk of asthma death -- FDA-mandated box warning about this risk

Front 7

Anticholinergic Agents -

1) Medications

2) MOA

3) Indication

Back 7

1) Medications:

-ipratropium bromide (Atrovent)

-tiotropium bromide (Spiriva)

2) MOA:

-Anticholinergic and muscarinic antagonist, yielding bronchodilation

3) Indication:

-Treatment of bronchospam, mild anti-inflammatory

Comments:

-Onset of Action ≥ 30 mins

-Best used to avoid rather than treat bronchospasm assoc. w/ COPD and asthma

-Well tolerated

Front 8

Theophylline:

1) MOA

2) Indication

Back 8

1) MOA:

-Mild bronchodilator via non-phosphodiesterase inhibitor

-Possible mild anti-inflammatory effect

2) Indication:

-Prevention of bronchospasm, mild anti-inflammatory

Comments:

-Narrow therapeutic index drug w/ numerous potential drug interactions

-Monitor carefully for toxicity by checking drug levels and clinical presentation