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Pharm III Unit II > 3 Asthma and COPD > Flashcards

3 Asthma and COPD Flashcards

1
Q

Asthma is primarily a disease of ________

A

Inflammation

Involves narrowing of the small airways and an increased response to stimuli

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2
Q

Treatment strategies for asthma include …

A

Dilation of airways

DECREASE INFLAMMATION**

Prevention

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3
Q

Bronchioles are constricted by _________ and relaxed by ________

A

Cholinergic innervation

Beta-2 receptors (stimulated by epi, not NE)

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4
Q

What are the different mediators of bronchial asthma?

A

Nerves (Acetylcholine, Neurokinin A and Substance P) and Histamine —> bronchoconstriction, microvascular leakage, and mucus secretion

Cytokines (cysteinyl leukotrienes, Leukotrienes B, and platelet activating factor) —> inflammatory cell infiltration and activation

Cationic proteins and reactive O2 metabolites —> epithelial damage

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5
Q

Symptoms of asthma

A

WHEEZING - but not all asthmatics wheeze***

Tightness, burning feeling, SOB

Mucous

Allergens, exercise, cold air, pollution (COCKROACHES)

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6
Q

COPD is characterized by…

A

Chronic bronchitis

Inflammation and irritation of lung passages

Cilia immobilized, particles not kept out

Goblet cells make more mucous

Plugged bronchioles susceptible to infection

Airways narrowed

Chronic cough

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7
Q

Emphysema is characterized by…

A

Breakdown of alveoli walls —> fewer, larger alveoli —> less surface area for gas exchange —> fibrosis, loss of elasticity —> difficulty breathing

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8
Q

What is the most widely used treatment for asthma?

A

B2 selective receptor agonists

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9
Q

How do B2 receptor agonists work?

A

B2 receptors increase cAMP —> relax airway smooth muscle/inhibit histamine release from mast cells

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10
Q

How are B2-agonists administered?

A

Generally inhaled

Aerosol nebulizer and oral forms available too

Can be injected in emergency situations

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11
Q

Examples of B2-agonists

A 
ALBUTEROL
Levalbuterol
Pirbuterol
Terbutaline
Bitolterol
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12
Q

Characteristics of short acting B2 agonists (ie Albuterol)

A

Effects generally last 4-6 hours

Act IMMEDIATELY

Stops an attack in progress

Usually inhaled

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13
Q

What is the prototype long-acting B2-agonist?

A

Salmeterol

Used for prevention and prophylaxis rather than acute treatment

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14
Q

How is Salmeterol used?

A

For prevention and prophylaxis

Decreases nocturnal asthma

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15
Q

Characteristics of Salmeterol (LABA)

A

Effects take 20-30 min (so not for attack in progress but for prevention)

Should always be combined with a steroid (ie Advair)

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16
Q

Why are long-acting B2 agonists (ie Salmeterol) combined with a steroid?

A

To counteract the down regulation of B2 receptors with long term use

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17
Q

Side effects of long-acting B2 agonists

A 
Tachycardia
Nervousness
Dizziness (usually short term)
Tremor (if using orally)
Tolerance (use a steroid if given chronically)
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18
Q

Muscarinic antagonist used for patients who are intolerant of B2 agonists

A

Ipratoprium (Atrovent)

Used for COPD, not so much for chronic asthma (though can be used in attacks)

19
Q

Pharmacokinetics of Ipratroprium (Atrovent)

A

Inhaled

Poorly soluble —> not absorbed (so few systemic effects)

20
Q

Other muscarinic antagonists (other than Ipratropium)

A

Combo with albuterol (Combivent)

Belladonna cigarettes

21
Q

Drug of last choice for asthma

A

Theophylline - it’s like drinking 5 c of coffee lol

22
Q

MOA for Theophylline

A

Increases cAMP - phosphodiesterase inhibitor

Blocks adenosine receptor

Relaxes smooth muscle and stimulates CNS/heart (decreases fatigue of the diaphragm

23
Q

How is Theophylline used?

A

For asthma or COPD not controlled by B-agonists or muscarinic antagonists

Long-acting forms generally used

24
Q

Why is Theophylline the drug of last choice?

A

LOW THERAPEUTIC INDEX - blood level important and may vary with genetics

WATCH FOR DRUG INTERACTIONS (esp CIMETIDINE)

25
Q

Side effects of theophylline

A

CNS: nervousness, insomnia, anxiety, tremor

CV: tachycardia, arrhythmias

Muscle: decreases diaphragm fatigue, increases contraction

Weak diuretic

26
Q

What are the signs of OD with theophylline?

A

Palpitations
HA
N/V
Seizures

27
Q

What anti-inflammatory drugs are used in the treatment of asthma?

A

Corticosteroids (#2 after albuterol)

Leukotrienes inhibitors

Cromolyn sodium

28
Q

MOA for corticosteroids

A

Decrease inflammation and reduce bronchial reactivity

Help improve patient’s response to B-agonists

29
Q

How are corticosteroids used in asthma treatment?

A

Inhaled steroids becoming first line even in kids

Few side effects when inhaled (mainly local lung effects) vs systemic effects

Can be used orally in severe asthma or during exacerbation

30
Q

Side effects of inhaled corticosteroids

A

ORAL CANDIDIASIS (THRUSH)*****

Hoarseness

Osteoporosis?? Cataracts???

Oral steroids have more systemic effects if used long term

31
Q

What is the biggest patient ed for inhaled corticosteroids?

A

Rinse mouth out after use to prevent oral candidiasis

32
Q

Which drug inhibits the conversion of Arachidonic Acid to Leukotriene A4?

A

Zileuton (Zyflo CR) - by inhibiting 5-lipoxygenase

33
Q

Which drugs block the action of leukotrienes —> less mucous and Eosinophilic recruitment?

A

Leukotriene Inhibitors (the “Lukasts”)

Montelukast
Pranlukast
Zafirlukast

34
Q

Downside of leukotriene inhibitors

A

No effect on an attack in progress - you still need your good ole SABA

35
Q

Upside of leukotriene inhibitors

A

May allow for decreased steroid dose

36
Q

Side effects of leukotriene inhibitors

A 
URIs
Sore throat
HA
Abdominal pain
SLEEPINESS*******
37
Q

_______ may decrease aspirin-sensitive asthma

A

Zileuton

B/c aspirin dumps a bunch of arachidonic acid into your system and Zileuton is the only leukotriene inhibitor that targets conversion of arachidonic acid into Leukotriene A4

38
Q

Monoclonal antibody to IgE’s high affinity Fc receptor

A

Omalizumab (Xolair)

Prevents binding of IgE to cells associated with allergic response —> lowers free serum IgE concentrations

39
Q

Which drug has been used in desensitization studies for kids with food allergies?

A

Omalizumab (Xolair)

40
Q

How is Omalizumab (Xolair) used?

A

For moderate to severe ALLERGIC asthma (Eosinophilic asthma)

41
Q

Side effects of Omalizumab (Xolair)

A

Rash
Injection site reactions
Small decrease in platelets

42
Q

Which drug inhibits the release of histamine from mast cells but are not bronchodilators?

A

Cromolyn sodium, Nedcromil

43
Q

How is Cromolyn sodium used?

A

Mainly in children

Taken 4x/day chronically (takes time to work)

Good for prevention

Non-toxic but it tastes bad

Also available as eye drops for conjunctivitis and as OTC nasal spray

44
Q

What is the asthma step up therapy?

A

Beta agonist as needed —> ICS or cromolyn —> LABA or bronchodilator —> Leukotriene inhibitor —> Oral steroid

Step down when possible

Pharm III Unit II (8 decks)

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