3- Asthma

Question 1

What drugs prevent bronchoconstriction (early phase treatment)

Answer 1

Beta Agonists
Theophylline
Anticholinergics
Mediator antagonists

Question 2

What meds prevent irritation reactions

Answer 2

Lipooxygenase and LT inhibitors

Question 3

What are phosphodiesterases

Answer 3

Enzymes that degrade cyclic nucleotides (cAMP)

Question 4

What is asthma

Answer 4

episodic ro chronic airflow obstruction that is reversible (per PFT)

Question 5

Pathologic changes in bronchus due to asthma include

Answer 5

Narrow lumen
BM hypertrophy 
Mucus plug
Constriction
Inflammatory cells cause edema

Question 6

What happens in the 3 phases of asthma

Answer 6

Minutes: Mast cells release inflammation cells and cause bronchoconstriction
Hours: Neutro, Eosino, Macro, and Monocytes cause submucosal edema
Days: Eosino and lymphocytes cause epithelial damage and increase mucus

Question 7

What is the MOA of Beta 2 Agonists

Answer 7

Stimulate adenylyl cyclase= increased cAMP= bronchodilation

Question 8

What are the Beta 2 Agonists

Answer 8

Short: albuterol, terbuterol, metaproterenol
Long: Salmeterol, formeterol, indacaterol

Question 9

What are side effects of beta 2 agonists

Answer 9

Tremor, tachycardia

Long acting: also CV events

Question 10

What is the MOA of theophylline (Methylxanthine)

Answer 10

Inhibits PDE= increased cAMP= bronchodilation
Blocks adenosine
(increases diaphragm strength in COPD)

Question 11

What is unique about the clearance of Theophylline

Answer 11

it varies with age;
Highest in young teens
High in smokers

Question 12

What is Theophylline used for

Answer 12

Asthma prophylaxis against night attacks

Question 13

Side effects of Theophylline are

Answer 13

Insomnia
Tremor
Anorexia
Seizures
Arrhythmias

Question 14

How do Caffeine and theobromine work

Answer 14

Caffeine: similar but W/ increased CNS effects
Theobromine: similar but W/ increased cardiac effects

Question 15

What can help reverse the cardiac effect of Theophylline

Answer 15

Beta blockers!

Question 16

What is the MOA of anticholinergics

Answer 16

Competitively block muscarinic receptors= no Vagal bronchoconstriction

Question 17

What are the Anti-muscarinics

Answer 17

Atropine (belladonna alkaloid)
Ipratropium (SAMA)
Tiotropium (LAMA)

Question 18

Side effects of antimuscarinics are

Answer 18

dry mouth

cough

Question 19

How do corticosteroids work

Answer 19

Block phospholipase A2= decrease in Arachidonic acid
Inhibit COX2
decrease mediator release (LT)
Increase B adrenoreceptor response

Question 20

What are side effects of corticosteroids

Answer 20

Pharyngeal candidiasis
Adrenal suppression
Mild growth retardation in kids

Question 21

What is Prednisone

Answer 21

systemic oral steroid for acute exacerbations/severe refractory asthma
Dexamethasone is most powerful

Question 22

What are the aerosol corticosteroids

Answer 22

Beclamethosone
Budesonide
Flusonide
Fluticasone

Question 23

What is prednisolone

Answer 23

IV corticosteroid for status asmathacus (+ hydrocortisone)

Question 24

What are the effects of ICS

Answer 24

reduced mediator inflammation

Question 25

How do Zafirlukast and Montelukast work

Answer 25

Interfere with LTD4 receptors and prevent exercise, antigen, and aspirin induced bronchospasm *NOT for acute use

Question 26

How does Zileuton work

Answer 26

inhibits 5-lipooxygenase = AA not converted to LT | prevents exercise, antigen, and aspirin induced asthma

Question 27

What are the S/E of Zileuton

Answer 27

elevates liver enzymes

Question 28

How does Cromolyn work

Answer 28

Decreases the release of mediators (histamine) from mast cells = prevents acute bronchospasm

Question 29

When is cromolyn mainly used

Answer 29

for ophthalmic, nasopharyngeal, and GI allergies for specific events, like going to a garden party *not really used for prophylaxis

Question 30

S/E of Cromolyn are

Answer 30

cough

Question 31

What is the MOA of Omalizumab

Answer 31

anti-IgE Antibody; binds to IgE on mast cells and prevents activation

Question 32

Omalizumab is used to

Answer 32

decerase frequency of exacerbations

Question 33

S/E of omalizumab are

Answer 33

unknown; but it's very expensive

Question 34

What is the MOA of mepolizumab

Answer 34

Antibody to IL5 great for eosinophilic ashma | Sub-Q administration

Question 35

Side effects of Mepolizumab are

Answer 35

increase in zoster- must be immunized with varicella zoster vaccine at least 4 weeks prior to starting med

Question 36

When should you add SLIT

Answer 36

in adults with house dust mite sensitivity with allergic rhinitis if Sx not relieved with ICS and FEV1 is >70%

Question 37

What are the step treatments GINA provides

Answer 37

1: SABA prn 2: + low dose ICS 3: + low dose ICS and LABA 4: Med/high dose ICS and LABA 5: Refer for add on Tx (tiotropium, anti-IgE, anti-IL5)

Question 38

What does GINA recommend for most patients

Answer 38

low dose ICS- even if Sx are infrequent, they'll help reduce risk of exacerbations