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pharm ch 23
| Question | Answer |
|---|---|
| Spiriva | long acting anticholinergic - used primarily for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. |
| LABAS | not to be used as monotherapy /they must be combined with an inhaled corticosteroid (ICS - increases the risk of severe asthma Once asthma symptoms are controlled should be tapered off or discontinued, Provide long-lasting relaxation |
| Mild asthma | “as-needed” reliever medication alone or with low-intensity controller treatment such as low-dose inhaled corticosteroids (ICSs) or leukotriene receptor antagonists |
| Moderate asthma | low-dose ICS/long-acting beta2-agonists (LABAs) |
| Severe asthma | high-dose ICSs/LABAs |
| Short-acting beta2-adrenergic agonists | Treatment of Acute Symptoms: Relievers ends in - uterol provide rapid relief of asthma or COPD symptoms within 15–30 minutes, reach their peak effect in 30–120 minutes, and last for 2–6 hours. |
| Short-acting beta2-adrenergic agonists MOA | Bind to beta2 receptors: • Relaxes bronchial smooth muscle • Reverses bronchospasm |
| What does Stimulation of beta2 receptors do? | Activates adenylcyclase - lowers calcium= relaxation • Increasing intracellular cyclic AMP • Bronchodilation |
| Peak flow meter | Home monitoring of breathing A handheld device used to measure the volume of air exhaled and how rapidly the air is moved out |
| Albuterol/Salbutamol- Airomir, Ventolin Diskus, Ventolin HFA, Ventolin Nebules Terbutaline- Bricany | Short-acting beta2-adrenergic agonists |
| •Arformoterol •Formoterol •Salmeterol -eterol | long-acting beta2-adrenergic agonists |
| ICS | Inhaled Corticosteroids - Beclomethasone, Budesonide, Fluticasone, Mometasone. : Reduce airway inflammation, mucus, and swelling |
| ICS/LABA combinations | one keeps swelling and mucus down (the steroid), and the other keeps your airways open for longer (the bronchodilator) Formoterol + Mometasone- Zenhale Formoterol + Budesonide- Symbicort Salmeterol + Fluticasone- Advair |
| Leukotriene Modifiers | •Montelukast •Zafirlukast •Zileuton |
| •Zileuton | Inhibits the action of 5-lipoxygenase a Leukotriene Modifier |
| Montelukast and zafirlukast: | Interfere with binding of cysteinyl leukotrienes C4, D4, and E4 to their receptor on airway smooth muscle Act as antagonists Drug-receptor binding =Reduces allergen-induced airway inflammation, produces airway relaxation |
| Warning Labels: Leukotriene Modifiers | Take with a large glass of water—chewable tab (montelukast) • Discard unused portion of granules within 15 minutes (montelukast) • Take on an empty stomach zafirlukast) • Take with food (zileuton) • Swallow whole(zileuton) |
| Mast Cells | immune cells that play a central role in allergic reactions. When exposed to allergens, mast cells release histamine that causes airway inflammation, swelling, and narrowing. |
| Mast Cell Stabilizers | Cromolyn sodium Tiotropium |
| Mast Cell Stabilizer MOA | Make mast cells less reactive to antigens Inhibit the degranulation of mast cells - the process where mast cells break open and release their chemical mediators. Prevent the release of histamine |
| Xanthine Derivatives | Aminophylline •Theophylline |
| Xanthine Derivatives: MOA | block prostglandins that cause airway inflammation/constriction blocks calcium causing relaxation of airways stimulate catecholamines that cause bronchodilation inhibits mast cells blocks adenosine contributing to bronchodialtion |
| Xanthine Derivatives : Adverse Reactions | Extensively metabolized by the CYP450 enzyme = high drug interactions Patients are advised to stick with the same manufacturer for refills to avoid fluctuations in drug absorption and blood levels. |
| Warning Labels: Xanthine Derivatives | Swallow whole; don’t crush or chew—extended release (aminophylline) •Take 30 to 60 minutes before meals with a full glass of water (theophylline |
| Monoclonal Antibodies | Omalizumab INJ |
| monoclonal Antibodies: MOA | By blocking IgE binding, reduces the release of histamine and allergic reactions Prohibit IgE’s binding to mast cells- prevents mast calls from allergic activation Prevent early- and late-stage allergic response |
| Monoclonal Antibodies: Adverse Reactions | black box warning for anaphylaxis |
| CAUSES OF Chronic Obstructive Pulmonary Disease | Cigarette smoking or exposure to second-hand smoke •Occupational irritants to the lungs: Asbestos, industrial chemicals, dust, and air pollution •Viral infections: Respiratory syncytial virus and adenovirus |
| Symptoms of Chronic Obstructive Pulmonary Disease | Airflow obstruction: Shortness of breath Chronic persistent cough Wheezing Increased sputum production |
| hypoxia | low levels of oxygen |
| Anticholinergics (pratropium and tiotropium) in the treatment of COPD | blocks ACEYTLCHOLINE causes airway constriction Bind to muscarinic receptors - relaxed bronchial smooth muscle |
| most common side affect anticholinergics | dry mouth |
| Warning Labels: Treatment of COPD | Shake well (ipratropium) Do not swallow capsules (for inhalation device use only) (tiotropium) |
| when to get Pneumococcal vaccine | once before the age of 65, high dose after 65 |
| Spacer device | attached to the end of the MDI (MEDICATION IN LIQUID FORM INHALER) to hold the medication while the person slowly inhales |
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