COPD and Asthma Meds- Heemer

What 2 classes of meds are used for BOTH asthma and COPD?

• bronchodilators

• corticosteroids

What are 3 broad classes of bronchodilators?

• b2- agonists

• anticholinergics

• methylxanthines

What are two examples of short acting inhaled b2 agonists (SABA)?

• albuterol

• levoalbuterol

What are SABAs like albuterol indicated for?

• acute symptom relief

• exercise-induced bronchospasm- preventative

Can epinephrine be used for relief of acute symptoms and preventative exercise-induced bronchospasm?

NO

What are 3 warnings/cautions with SABAs like albuterol?

• bronchospasm (lungs close instead of open)

• CV effects

• hypokalemia

What long-acting b2-agonists (LABA) can be used for both asthma and COPD?

• salmeterol

• formoterol

What long-acting b2-agonists (LABA) can only be used in COPD?

• arformoterol

• indacaterol

• olodaterol

LABAs are used in asthma and COPD for what?

NOT FOR ACUTE

• asthma- long term tx

• COPD- maintenance tx of bronchospasm

• prevention of exercise-induced bronchospasm

What is the only Short Acting Anticholinergics (SAMA)? What is it approved for?

Ipratropium

• ONLY approved for COPD

  • for acute bronchospasm

Long term acting Anticholinergics (LAMA) are ALL for long term _________ control. What is the 1 exception?

are ALL for long term COPD control

• NOT FOR ASTHMA!!!!!!!!!!

• 1 exception: Tiotropium Respimat

Would I use a LAMA for acute tx of asthma?

NOOO!

• 1st off- LAMA not for asthma

• 2nd off- Long acting—> not for acute tx

Methylxanthines, another class of bronchodilators, include what medications?

Theophylline

Aminophylline

Explain why or why not methylxanthines are commonly used in asthma?

methylxanthines NOT used a lot anymore due to the LARGE and MANY side effects and interactions they cause

Practice:

Which of the following medications could I use for acute symptoms?

a. Tiotropium

b. Theophylline

c. Salmeterol

d. albuterol

d

Practice:

Which of the following medications is only indicated for long term COPD control?

a. Aclidinium

b. Levoalbuterol

c. Salmeterol

d. Aminophylline

a

Practice:

What ADRs would I expect to see from Ipratropium?

a. Polyuria

b. suicidal ideation

c. anticholinergic

d. N/V

c

Corticosteroids, in addition to bronchodilators, can also be used for both COPD and asthma. What are the names of 5 INHALED corticosteroids used?

• beclomethasone

• mometasone

• fluticasone

• budesonide

• ciclosonide

Inhaled Corticosteroids are used 1st line in ____________ and add-on tx for ___________.

Inhaled Corticosteroids are used 1st line in asthma and add-on tx for COPD.

What is the MOST IMPORTANT counseling point for Inhaled corticosteroids?

MUST RINSE MOUTH and SPIT after each use

Why do you have to rinse your mouth and spit after inhaling corticosteroids?

risk of oral candidiasis or oral thrush (a fungal infection)

Which of the following is NOT a counseling point for inhalers?

a. prime the device if necessary

b. follow the dose counters

c. Do not swallow capsules (Handihaler)

d. Keep using inhaler past expiration date if there are still doses left

d

What are 2 classes of COPD SPECIFIC MEDS?

• Phosphodiesterase Inhibitors (PDE-4)

• α1- antitrypsin replacement therapy

What are 2 classes of ASTHMA SPECIFIC MEDS?

• Leukotriene modifiers

• Immunomodulators

What PDE-4 Inhibitor is used for COPD specifically?

Roflumilast

What is an ADR of Roflumilast and Montelukast that is very serious?

suicidal thoughts

What are 2 Leukotriene modifiers used specifically for asthma?

• Zafirlukast

• Montelukast (extremely popular)

What are the indications of Leukotriene Modifiers like Montelukast and Zafirlukast?

• long-term asthma control and prevention of symptoms

• used in combo with an inhaled steroid for severe asthma

• exercise induced bronchospasm

Immunomodulators are used when?

for add-on tx for SEVERE asthma

What Immunomodulators are specifically used for add-on tx in severe asthma WITH eosinophil phenotype?

• Reslizumb, Mepolizumab, Benralizumab

  • Anti IL-5

• Dupilumab

  • Anti IL-4

Immunomodulators are sub-q injections and must be monitored for what and for how long?

must monitor for anaphylaxis for 2 hours following 1st 3 injections

What 2 vaccines are recommended in patients with asthma and COPD?

• influenza (flu shot)

• pneumococcal vaccines (pneumonia)

What are the 2 options for pneumococcal vaccines available?

• PCV20 - one shot and done

• PCV15, then PPSV23 a year after