Nur509 Pharmacology -- Asthma

Front 1

Symptoms of asthma result from a combination of what?

Back 1

Inflammation and bronchoconstriction. Treatment must address both of these concerns!

Front 2

Name the two main pharmacologic classes for asthma, and their two sub-classes

Back 2

1. Anti-inflamatory agents
Glucocorticoids
Cromolyn
2. Bronchodilators
Beta2 agonists
Methylxanthines

Front 3

Expert Panel Report 3 (EPR-3) guidelines for diagnosis and management of asthma:

Name the 6 steps

Back 3

1. Assessment and Monitoring
2. Patient education
3. Control of environmental factors/conditions that affect asthma
4. Medications
5. The stepwise asthma management (age groups)
6. Recommendations on medications (revised to include most recent info)

Front 4

Inhaled Corticosteroids

Back 4

best for long-term control of persistent asthma for kids/adults. Best benefit at low doses

Front 5

Long-acting beta-antagonists

Back 5

If inhaled steroids don't work at low dose, combine medium dose with these (SALMETEROL, FORMOTEROL) before going to a high-dose steroid

Front 6

Mast cell stabilizers

Back 6

CROMOLYN and NEDOCROMIL
These are no longer 1st line therapy for persistent asthma, instead give inhaled cortico to start

Front 7

Leukotriene Modifiers

Back 7

MONTELUKAST, ZAFIRLUKAST, ZILEUTON
Save these as alternatives or adjuncts to inhaled cortico for persistent asthma. Not first line

Front 8

OMALIZUMAB

Back 8

Save for patients with severe asthma and allergies who do not respond to inhaled cortico even at high dose + beta agonists

Front 9

3 types of inhalers for drug therapy

Back 9

1. Metered Dose Inhalers(MDIs) These are used with the spacers

2. Dry powder inhalers (DPIs) Easier to use--micro powder to lungs

3. Nebulizers
Small machine that converts medicine to a small mist

Front 10

3 advantages to using inhalation as a route of delivery for asthma drugs

Back 10

1. Therapeutic effects increased-delivers drug to site of action

2. Systemic effects are minimized

3. Relief of acute attacks is rapid

Front 11

Beta2 Adrenergic Agonists
Most effective at:
MOA:
Main Caution

Back 11

1. relief of acute bronchospasm and exercise-induced bronchospasm (long-acting formula can protect against bronchospasm for a long time)

2. selectively activate B2 receptors in the smooth muscle of lung, increasing bronchodilation, and suppress histamine release in the lung

3. Never use alone! Use as adjunctive therapy with glucocorticoids/corticosteroids

Front 12

Beta2 Andrenergic Antagonists
2 types of dosing and their potential adverse effects

Back 12

1. Inhaled preparations: tachycardia, angina, tremor

2. Oral preparations: excessive dosage can resule in tachydysrhythmias, angina pectoris, tremor

Front 13

Beta 2 Andrenergic Antagonists
Name 4 short-acting inhaled
Name 2 long-acting inhaled
Name 3 oral

Back 13

1. ALBUTEROL, LEVALBUTEROL, PIRBUTEROL, METAPROTERENOL

2. FORMOTEROL, SALMETEROL

3. ALBUTEROL, TERBUTALINE, METAPROTERENOL

Front 14

Glucocorticoids, or corticosteroids
Effectiveness
MOA
Main Caution

Back 14

1. Most effective anti-asthma drugs available

2. Suppress inflammation by decreasing synthesis of inflammatory mediators, decreasing airway edema, and decreasing activity of inflammatory cells (eosinophils, leukocytes)

3. May retard growth in children (does not affect adult height)

Front 15

Glucocorticoids
2 types of dosing and their potential adverse effects

Back 15

1. Inhaled preparations:
hoarseness, speaking difficulty -patients should gargle after dose or use a spacer to help with this

2. Oral dose:
cataracts, glaucoma, hyperglycemia, PUD (long term use)

Can also promote bone loss in premenopausal women(higher with oral vs inhaled) Give Ca and Vit D to help

Front 16

Glucocorticoids
Name 6 inhaled
Name 2 oral

Back 16

1. BECLOMETHASONE DIPROPIONATE, BUDESONIDE, FLUNISOLIDE, FLUTICASONE PROPIONATE, MOMETASONE FUROATE, TRIAMCINOLONE ACETONIDE

2. PREDNISONE, PREDNISOLONE

Front 17

Cromlyn
Effectiveness
MOA
Route & methods of dosing

Back 17

1. This is the safest of all antiasthma medications--must be given prior to attack on a fixed schedule

2. Mast-cell stabilizer, prevents the release of histamine and other mediators and inflammatory cells

Suppresses inflammation, but NOT a bronchodilator

3. Inhaler--Nebulizer and MDI

Front 18

Methylxanthines
Effectiveness
MOA
Route/methods of dosing

Back 18

1. Narrow therapeutic index. Can cause toxicity (nausea, vomiting, insomnia, severe dysrythmias, death--do not crush pill, this can cause dumping. Metabolized in liver, so 1/2 life greatly varies (age, etc). Interacts with caffeine to intensify adverse effects-competes w/ caffeine for receptors, so can increase the amount of the drug in the body.

Drugs that induce hepatic enzymes mean you'll need more of this drug to work, and drugs that inhibit hepatic enzymes raise levels in blood.

smoking also causes issues

2. Causes bronchodilation by relaxing smooth muscle of the bronchi

3. tablets, capsules, IV

Front 19

Leukotriene Modifiers
Effectiveness
MOA
Route/methods of dosing

Back 19

1. use as alternatives or adjunts to inhaled corticosteroids for persistent asthma. Not used as first-line therapy, use for maintenance, NOT to abort an attack

2. Suppreses efects of leukotrienes and decreases inflamation

Front 20

Leukotriene
Name 3 types and their individual issues

Back 20

1. ZILEUTON-can cause liver damage. Monitor baseline, every 2-3 months for a year. Competes for metabolism with THEOPHYLLINE, PROPRANOLOL, TIZANIDINE, and WARFARIN, increasing their levels-dosages of these drugs should be reduced

2. ZAFIRLUKAST-food reduces absorbtion, give 1 hour before or 2 hours after meals. It is a 3A4 inhibitor, contraindicated with RANOLAZINE, avoid ERYTHROMYCIN, CLARITHOMYCIN, can up levels of THEOPHYLLLINE, EPLERENONE, and WARFARIN levels

3. MONTELUKAST--it is a 2C8 inhibitor--avoid drugs metabolized in this pathway. Unlike others, not shown to have toxicity in liver. Rare: churg strauss syndrome reported with discontinuation. PHENYTOIN and RIFAMPIN and reduce montelukast levels

Front 21

Omalizumab
Effectiveness
MOA
Route/methods of dosing
Adverse reactions

Back 21

1. Used as second line only for allergy-related asthma, only when preferred options have failed.

2. antagonises IgE

3. SQ

4. Injection site reactions, viral infections, upper respiratory infections, SEVERE: malignancy and anaphylaxis (patients monitored after injections for signs of this).
Administrate SQ