3- Asthma Flashcards

(38 cards)

1
Q

What drugs prevent bronchoconstriction (early phase treatment)

A

Beta Agonists
Theophylline
Anticholinergics
Mediator antagonists

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2
Q

What meds prevent irritation reactions

A

Lipooxygenase and LT inhibitors

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3
Q

What are phosphodiesterases

A

Enzymes that degrade cyclic nucleotides (cAMP)

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4
Q

What is asthma

A

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

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5
Q

Pathologic changes in bronchus due to asthma include

A
Narrow lumen
BM hypertrophy 
Mucus plug
Constriction
Inflammatory cells cause edema
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6
Q

What happens in the 3 phases of asthma

A

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

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7
Q

What is the MOA of Beta 2 Agonists

A

Stimulate adenylyl cyclase= increased cAMP= bronchodilation

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8
Q

What are the Beta 2 Agonists

A

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

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9
Q

What are side effects of beta 2 agonists

A

Tremor, tachycardia

Long acting: also CV events

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10
Q

What is the MOA of theophylline (Methylxanthine)

A

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

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11
Q

What is unique about the clearance of Theophylline

A

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

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12
Q

What is Theophylline used for

A

Asthma prophylaxis against night attacks

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13
Q

Side effects of Theophylline are

A
Insomnia
Tremor
Anorexia
Seizures
Arrhythmias
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14
Q

How do Caffeine and theobromine work

A

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

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15
Q

What can help reverse the cardiac effect of Theophylline

A

Beta blockers!

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16
Q

What is the MOA of anticholinergics

A

Competitively block muscarinic receptors= no Vagal bronchoconstriction

17
Q

What are the Anti-muscarinics

A

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

18
Q

Side effects of antimuscarinics are

A

dry mouth

cough

19
Q

How do corticosteroids work

A

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

20
Q

What are side effects of corticosteroids

A

Pharyngeal candidiasis
Adrenal suppression
Mild growth retardation in kids

21
Q

What is Prednisone

A

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

22
Q

What are the aerosol corticosteroids

A

Beclamethosone
Budesonide
Flusonide
Fluticasone

23
Q

What is prednisolone

A

IV corticosteroid for status asmathacus (+ hydrocortisone)

24
Q

What are the effects of ICS

A

reduced mediator inflammation

25
How do Zafirlukast and Montelukast work
Interfere with LTD4 receptors and prevent exercise, antigen, and aspirin induced bronchospasm *NOT for acute use
26
How does Zileuton work
inhibits 5-lipooxygenase = AA not converted to LT | prevents exercise, antigen, and aspirin induced asthma
27
What are the S/E of Zileuton
elevates liver enzymes
28
How does Cromolyn work
Decreases the release of mediators (histamine) from mast cells = prevents acute bronchospasm
29
When is cromolyn mainly used
for ophthalmic, nasopharyngeal, and GI allergies for specific events, like going to a garden party *not really used for prophylaxis
30
S/E of Cromolyn are
cough
31
What is the MOA of Omalizumab
anti-IgE Antibody; binds to IgE on mast cells and prevents activation
32
Omalizumab is used to
decerase frequency of exacerbations
33
S/E of omalizumab are
unknown; but it's very expensive
34
What is the MOA of mepolizumab
Antibody to IL5 great for eosinophilic ashma | Sub-Q administration
35
Side effects of Mepolizumab are
increase in zoster- must be immunized with varicella zoster vaccine at least 4 weeks prior to starting med
36
When should you add SLIT
in adults with house dust mite sensitivity with allergic rhinitis if Sx not relieved with ICS and FEV1 is >70%
37
What are the step treatments GINA provides
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)
38
What does GINA recommend for most patients
low dose ICS- even if Sx are infrequent, they'll help reduce risk of exacerbations