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Y2 Pharmaco > Anti-asthmatics > Flashcards

Anti-asthmatics Flashcards

1
Q

Characteristics of asthma:

A
  • chronic airway inflammation
  • hyper-responsiveness of airway
  • wheezing, shortness of breath, cough
  • recurrent reversible airway obstruction
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2
Q

List the anti-asthma controllers:

A
  1. Inhaled corticosteroids (ICS) (fluticasone)
  2. Leukotrienes receptor antagonist (LTRA) (montelukast)
  3. Inhaled Na Cromoglycate
  4. Anti-IgE mAb (omalizumab)
  5. Anti-IL-5 mAb/Anti-IL-5R mAb (mepolizumab/benralizumab)
  6. Anti-IL-4R mAb (dupilumab)
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3
Q

List the anti-asthma relievers:

A
  1. β2 agonists
  2. Methylxanthines (theophylline)
  3. Muscarinic antagonists
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4
Q

What is the difference between a anti-asthma controller n reliever?

A

Controller: anti-inflammatory, prevention of recurrent attack
Reliever: bronchodilators, reversal of airway constriction

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5
Q

What are the 2 major forms of asthma?

A
  1. Allergic asthma
    - driven by type 1 inflammation (IgE mediated)
    - IL-4 & IL-13 play a role in IgE pdn
  2. Eosinophilic asthma
    - driven by type 2 inflammation (cell mediated)
    - IL-4 & IL-13 contribute to eosinophilic inflammation in the airway
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6
Q

LABAs (long-acting β2 agonists) ___________________ in asthma patients.

A

‘Cannot be used alone’, must be used w corticosteroid!

  • controller
  • use of LABAs alone makes asthma outcomes worse.
  • it is contraindicated for asthma in patients of all ages without concomitant use of an asthma-preventer medication such as an inhaled corticosteroid.
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7
Q

Salbutamol is a (reliever/controller)

A

Salbutamol is a reliever!
- for relief of bronchoconstriction during acute asthma attacks
- fast-acting beta-2 agonist

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8
Q

Name the β2 agonist drugs.

A

Fast & Short acting, 4-6h: Salbutamol
- IV in emergencies
Fast & Long-acting, 12h: Formoterol, Salmeterol
Slow & Long-acting, 24h: Indacaterol
- usually thru inhalation
- long-term maintenance

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9
Q

What do the β2-adrenoceptor agonists do?

A
  • airway smooth muscle relaxation (bronchodilation
  • mast cell stabilisation
  • decrease microvascular leakiness
  • increase mucociliary clearance
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10
Q

Which form of asthma is more common?

A

Allergic asthma (usually starts as this then may develop into other forms of asthma)

If patient gets a asthma attack in the day (likely type 1 inflammatory), patient is actually susceptible to another asthma attack in the night (type 2 eosinophilic) which may be more dangerous cuz patient prolly sleeping.

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11
Q

What are the adverse effects of β2 agonist bronchodilators?

A
  1. Tremors and muscle cramps (most common)
  2. Peripheral vasodilatation (e.g. flushing)
  3. Palpitations & tachycardia (β1adrenoceptor effects)
  4. Hypokalemia/hyperglycemia
    - usually transient/insignificant but beware of drug-drug interactions w other drugs causing hypokalemia/hyperglycemia
  5. β2 adrenoceptor tolerance
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12
Q

Which drug is both a relieve and a controller?

A

Formoterol

  • fast acting long acting
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13
Q

Must take______ whenever u take a β2agonist?

A

Inhaled corticosteroids must be taken whenever u take a β2 agonist.

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14
Q

What kind of drug is theophylline?

A

Methylxanthine, anti-asthma reliever

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15
Q

What kind of drug is aminophylline?

A

Methylxanthines.
- aminophylline is actually theophylline + ethylenediamine 2:1

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16
Q

When is magnesium sulphate (MgSO4) given?

A
  • only given in emergency asthma treatment
  • through IV or nebulized (but evidence of efficacy of nebulized mgso4 remains controversial)
17
Q

What does magnesium sulphate do?

A
  • relaxes airway smooth muscle (bronchodilation)
  • modulates release of ACh n histamine
  • anti-inflammatory effect
  • improves pulmonary function when used as an adjunct to standard therapy in patients with very severe, acute asthma.
18
Q

Name some ICS (inhaled corticosteroids)

A

Budenoside, Fluticasone, Ciclesonide

19
Q

Uses of inhaled corticosteroids:

A
  1. First line prophylactic(prevent disease) for asthma treatment
  2. Preventing nocturnal asthma (high freq of attacks come at night)
20
Q

Why must corticosteroids be prescribed with β2 agonists?

A
  • increases expression of β2 receptors on airway smooth muscle (aids β2 agonist
  • prevents airway wall remodeling-> reduces need for β2 agonist in long run
  • decreases 1. Airway hyper-responsiveness 2. Frequency of acute asthma exacerbations -> reduces need for β2 agonists n thus, risk of death from asthma in long run
21
Q

What are leukotriene receptor antagonists used for

A
  • adjunct therapy for mild to moderate asthma
  • not strong enough as a reliever during an acute asthma attack
  • ‘addon’ drug: additive effects w β2 agonists
  • 1/3rd efficiency of salbutamol
22
Q

What class of drug is Fluticasone + what does it do?

A

Inhaled corticosteroid (ICS), anti-asthma controller

  • reduces the symptoms of inflammatory conditions and allergic reactions such as swelling, redness and itching
  • specifically: anti-inflammatory, prevents recurrent asthma attacks
23
Q

What class of drug is Montelukast + what does it do?

A

Leukotrienes Receptor Antagonist (LTRA), anti-asthma controller

TLDR: blocks role of LTC4/LTD4 in asthma => bronchodilation, prevents airway hyper-responsiveness, prevent ASM hyperplasia

24
Q

What class of drug is Omazulib + what does it do?

A

Anti-IgE mAb, anti-asthma controller

What it does:
1. Inhibit IgE-induced mast cell & basophil degranulation
2. Decrease expression of high affinity receptors on mast cell & basophil
3. Decrease mediator release=> decrease inflammation=> prevent asthma exacerbation

25
Q

What class of drug is Mepolizumab?

A

Anti-IL-5 mAb/Anti-IL-5R mAb, anti-asthma controller

26
Q

What class of drug is Benralizumab?

A

Anti-IL-5 mAb/Anti-IL-5R mAb, anti-asthma controller
- acts on eosinophils
- for severe asthma

27
Q

What class of drug is Dupilumab?

A

Anti-IL-4R mAb, anti-asthma controller

  • binds to IL-4R
  • for severe asthma
28
Q

Name all the anti-_______ mAb drugs

A
  1. Omalizumab (anti-IgE)
    - effective against allergic astham & rhinitis
    - subcutaneous injection every 2-4 weeks
  2. Mepolizumab/Benralizumab (anti-IL5/anti-IL5R)
    - for severe asthma (esp if px does not respond well to ICS)
    - binds to IL-5 on eosinophil => decrease eosinophil function
  3. Dupilumab (anti-IL4R)
    - for severe asthma
29
Q

Name the muscarinic antagonists.

A
  1. Short acting (SAMA), 3-5h: Ipratromium bromide (non-selective)
  2. Long-acting (LAMA), 24h: Tiotropium bromide (M3 selective)
30
Q

Uses of Muscarinic antagonists in anti-asthma:

A

MOA:
- bind & block M3 receptor on airway smooth muscle => inhibit bronchoconstriction
- bind & block M3 receptor on submucosal gland => decrease bronchospasm & mucus secretion induced by vagal nerves

31
Q

Uses for Tiotropium bromide:

A

Tiotropium Bromide is a LAMA, more potent
=> only for COPD & severe asthma, once daily
=> muscarinic antagonists mostly for patients intolerant of b2 agonists

Y2 Pharmaco (22 decks)

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