Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology - Winter > 10 - Drugs & Asthma/COPD > Flashcards

10 - Drugs & Asthma/COPD Flashcards

1
Q

What is COPD?

A
  • Slowly progressive airway obstruction due to chronic inflammation
  • Includes chronic bronchitis (inflammation of bronchi) and emphysema (destruction of alveolar structures)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are clinical sx of COPD?

A
  • Cough
  • Mucous hypersecretion
  • Dyspnea (SOB)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is asthma?

A
  • Chronic inflammatory disorder of airways
  • Recurring episodes of hyper-responsiveness to stimuli that causes bronchoconstriction
  • Based on triggering stimuli characterized as extrinsic (allergenic) or intrinsic (non-allergenic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the clinical sx of asthma?

A

Recurring episodes of cough, wheezing, tight chest, and dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What occurs in extrinsic asthma?

A
  • External stimuli (dust, mold, pollen, animal dander) trigger plasma cells to produce antigen specific IgE antibodies
  • Allergen and IgE bind to mast cells => degranulation and release of inflammatory mediators
  • Allergens usually have some glycoproteins that immune cells recognize as an antigen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some non-allergenic factors that can trigger asthma?

A

Anxiety, stress, cold air, dry air, smoke, exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the mechanism of intrinsic asthma?

A
  • Not completely understood
  • Abnormalities in autonomic regulation of airway functions
  • Involvement of innate immune system
  • ACh is released during stress, and stimulates muscarinic receptors which control smooth muscle of bronchi
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the acute and prolonged responses of asthma?

A
  • Acute = bronchoconstriction (w/in minutes)

- Prolonged = vasodilation, mucous secretion, edema, and bronchoconstriction (occurs hours later)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which symptoms of asthma and COPD can be helped w/ drug therapy?

A
  • Excessive airway smooth muscle tone
  • Inflammation
  • Mucous plugging
  • Pulmonary edema
  • Non-productive cough
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which drugs are bronchodilators?

A
  • Beta-adrenergic agonists
  • Methylxanthines
  • Anticholinergics
  • Leukotriene modifiers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which drugs are anti-inflammatory agents?

A
  • Corticosteroids
  • Mast cell stabilizers
  • Anti-IgE monoclonal antibody
  • Leukotriene modifiers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are bronchodilators?

A

Agents that interact w/ smooth muscle cells lining the airways and relax smooth muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Examples of beta-adrenergic agonists used for asthma and COPD

A
  • Albuterol/salbutamol
  • Terbutaline
  • Salmeterol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Example of methylxanthine used for asthma and COPD

A

Theophylline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Examples of anticholinergics used for asthma and COPD

A
  • Tiotropium

- Ipratropium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Examples of leukotriene modifiers used for asthma and COPD

A
  • Zileuton
  • Zafirlukast
  • Montelukast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the symp NS effect on bronchiole smooth muscle?

A

Beta 2 receptor causes bronchodilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the para NS effect on bronchiole smooth muscle?

A

Muscarinic receptor (M3) causes bronchoconstriction and increased secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe how the para NS causes bronchoconstriction

A

ACh binds to M3 receptors => activation of Gq => PLC activation => increased DAG and IP3 hydrolysis => increased cytoplasmic Ca2+ => Ca2+-calmodulin activates myosin, which binds to actin => contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What effect does adenosine have on Ca2+ levels?

A

Adenosine increases Ca2+ levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe how the symp NS causes bronchodilation

A

Activation of beta 2 receptor => activation of Gs => adenylyl cyclase activation => ATP converted into cAMP => PKA activation => decrease in cytoplasmic Ca2+ and prevents myosin binding to actin => dilation/relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the MOA of beta agonists for asthma?

A

Stimulate adenylyl cyclase => increased formation of cAMP which relaxes airway smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How are beta agonists administered for asthma?

A

Typically via inhalation (terbutaline can be administered subcutaneously and in tablet form and albuterol can be administered in tablet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which beta agonists are long acting and which are short acting?

A
  • Short acting = albuterol and terbutaline

- Long acting = salmeterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the drug of choice for acute asthma attacks?

A

Albuterol inhaler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the drug of choice for severe asthma attacks?

A

Subcutaneous injection of terbutaline or epinephrine may be required along w/ corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why are beta agonists recommended to be administered w/ corticosteroids for asthma?

A

Prevent development of desensitization and promote efficacy of beta agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are adverse effects of beta agonists?

A
  • Beta 1 receptors on heart may get stimulated, causing tachycardia
  • Skeletal muscle tremor
  • Tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are drug interactions w/ beta agonists?

A

Propranolol for HTN or other heart conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the MOA of methylxanthines?

A
  • Inhibits phosphodiesterase => increased cAMP which relaxes airways
  • Inhibits adenosine receptors
  • Can stimulate contractility of diaphragmatic muscles
31
Q

What is the safest route of administration for theophylline?

A

Aerosol

32
Q

What is theophylline indicated for?

A
  • Second choice for acute asthmatic attacks
  • COPD
  • May reverse steroid insensitivity
33
Q

What are some adverse effects of theophylline?

A
  • Common = headache, insomnia, tremors

- Serious = anaphylactic shock, N/V, fever, seizures

34
Q

What is a caution w/ theophylline?

A

Increased CV effects if given w/ beta 2 agonists

35
Q

Which anticholinergics are short acting and which are long acting?

A
  • Short = ipratropium

- Long = tiotropium

36
Q

What is the MOA of anticholinergics?

A
  • Blocks muscarinic receptors, preventing bronchial constriction and mucous secretion
  • No effect on inflammation
37
Q

How are anticholinergics administered?

A

Aerosol

38
Q

What is the indication for ipratropium?

A
  • Tx of COPD and chronic bronchitis
  • Tx of acute asthma attacks in children, adults and those intolerant to beta agonists
  • Enhances bronchodilation produced by beta agonists
39
Q

What are adverse effects of ipratropium?

A
  • Aerosol is generally well tolerated, but excessive use may cause atropine like effects (dry mouth, dilated pupils, tachycardia)
  • Caution w/ glaucoma and prostatic hypertrophy
40
Q

What effect do leukotrienes have in the lungs?

A

Cause bronchoconstriction, increased bronchial reactivity, mucosal edema, and secretion of mucous

41
Q

What are leukotriene modifiers?

A

Drugs that inhibit synthesis of leukotrienes or block the receptors that leukotrienes act upon

42
Q

What is the MOA of zileuton?

A

Inhibits 5-lipoxygenase, which is the enzyme that catalyzes formation of leukotrienes from arachadonic acid

43
Q

What is the route of administration of zileuton?

A

Oral, administered 4 times per day

44
Q

What is the indication of zileuton?

A
  • Tx of persistent asthma in adults and ASA-induced asthma

- Prevents exercise and antigen-induced bronchospasm

45
Q

What is an adverse effect of zileuton?

A

Possible hepatotoxicity

46
Q

What is the MOA of zafirlukast and montelukast?

A

Selective reversible inhibitors of CysLT1 receptor, preventing leukotriene induced bronchoconstriction and airway wall edema

47
Q

What is the route of administration for zafirlukast?

A

Oral, administered twice daily

48
Q

What is the indication for zafirlukast?

A
  • Tx of mild to moderate asthma (only for px 8 y/o and older)
  • Less effective than corticosteroids
49
Q

What are some adverse effects of zafirlukast?

A
  • Headache, GI disturbance

- Inhibits CYP450, which may interfere w/ metabolism of other drugs

50
Q

What is the route of administration for montelukast?

A

Oral, administered once daily

51
Q

What is the indication of montelukast?

A
  • Modestly effective in tx of persistent asthma in children over 6 y/o and adults
  • Less effective than corticosteroids
52
Q

What do anti-inflammatory agents do?

A
  • Reduce inflammation, edema, and mucous production

- Counteract airway inflammation, reducing asthma attacks and COPD flares/progression

53
Q

What are examples of corticosteroids for asthma and COPD? How is each administered?

A
  • Beclometasone
  • Flunisolide
  • Fluticasone
  • Budesonide
  • Mometasone (first 5 are inhaled)
  • Methylprednisolone (IV)
  • Prednisone (oral)
54
Q

What are examples of mast cell stabilizers?

A

Cromolyn sodium and nedocromil

55
Q

What is an example of an anti-IgE monoclonal antibody?

A

Omalizumab

56
Q

What is the difference between glucocorticoids and mineralocorticoids?

A
  • Glucocorticoids regulate glucose metabolism

- Mineralocorticoids regulate salt and water balance

57
Q

What is the MOA of corticosteroids for asthma and COPD?

A
  • Block release of arachidonic acid
  • Increase sensitivity of beta receptors and prevents their desensitization
  • Prevent long term changes in airway structure and function
58
Q

What is the route of administration of corticosteroids for asthma?

A
  • Aerosol is preferred to limit systemic side effects

- Severe exacerbations may require IV (methylprednisolone) or oral (prednisone)

59
Q

What are indications of corticosteroids?

A
  • Aerosol used in moderate cases of asthma and COPD

- First line of anti-inflammatory therapy

60
Q

What are some adverse effects of corticosteroids?

A
  • Aerosol can cause oropharyngeal candidiasis and hoarseness
  • Chronic use may suppress adrenal glands
  • Common and permanent = osteoporosis and cataracts in adults; growth retardation in children
  • Common and reversible = edema, weight gain, delayed wound healing
61
Q

How can adverse effects of corticosteroids be reduced?

A

Alternate day therapy for oral medication and morning administration

62
Q

What are the indications for mast cell blockers?

A
  • Cromolyn sodium = tx of mild to moderate asthma of all ages
  • Nedocromil = tx of mild to moderate asthma in px 12 y/o and older
  • Anti-inflammatory drug of choice for tx of allergenic asthma in children (over 2 y/o)
  • Prevention of exercise induced asthma
63
Q

What is the MOA of mast cell blockers?

A
  • Poorly understood
  • Inhibit release of mediators from mast cells, possibly by blocking ion channels required for degranulation
  • Helps w/ intrinsic and extrinsic asthma
64
Q

What is the route of administration for mast cell blockers?

A

Aerosol, administered 2-4 times per day

65
Q

Should mast cell blockers be used in acute asthmatic attacks?

A

Doesn’t reverse ongoing bronchoconstriction, but regular use reduces bronchial hyper-reactivity and inhibits acute and chronic responses

66
Q

How long should mast cell blockers be trialed?

A

4-6 weeks

67
Q

What are some adverse effects of mast cell blockers?

A
  • Throat irritation, dryness, cough, nasal secretion, congestion
  • Anaphylaxis, hives, low BP, tightness in chest
68
Q

What is the MOA of omalizumab?

A
  • Selectively binds human free IgE, preventing IgE binding to cells and reduces IgE levels
  • Reduces both acute and prolonged inflammatory responses
69
Q

What is the indication of omalizumab?

A

Allergic asthma

70
Q

What is the route of administration of omalizumab?

A

Subcutaneous injection

71
Q

What are the goals of therapy for asthma and COPD?

A
  • Maintain normal activity levels
  • Maintain near normal pulmonary function rates
  • Prevent troublesome sx (cough, breathlessness at night or during exertion)
  • Avoid adverse effects of medications
  • Avoid drug interactions
72
Q

What are the characterizations for severity of asthma?

A
  • Mild intermittent = less than 2 bronchoconstrictive episodes per week, peak expiratory flow (PEF) normal
  • Mild persistent = more than 2 episodes per week; PEF above 80%
  • Moderate persistent = 6 episodes per week or daily episodes; PEF over 60%
  • Severe = continual; PEF less than 60%
73
Q

What is the recommended COPD tx by severity?

A
  • Mild = bronchodilators
  • Moderate = bronchodilators and anti-inflammatories
  • Severe = antibiotics, bronchodilators, and anti-inflammatory drugs w/ oxygen therapy
74
Q

What is the recommended asthma tx by severity?

A
  • Every px w/ asthma should use environmental control and should have a short acting beta 2 agonist on demand
  • As severity goes from mild to severe, dosing of inhaled corticosteroid should increase

Pharmacology - Winter (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions