ANTI-INFLAMMATORY AGENTS

Question 1

drugs included in corticosteroids:

Answer 1

1. beclomethasone
2. budesonide
3. dexamethasone
4. flunisolide
5. fluticasone
6. momethasone
7. prednisone (IV)
8. methylprednisolone (IV)

Question 2

mechanism of action → corticosteroids:

Answer 2

• reduce arachidonic acid by phospholipase A2 & inhibit expression of COX2
• result in → reduction of prostaglandins & leukotriene

Question 3

pharmacokinetics → corticosteroids:

Answer 3

• local AEROSOL → systemic only when local are NOT successful
• 12x/day
• IV for status asthmaticus = ACUTE state (prednisone, methylprednisolone)

Question 4

indications → corticosteroids:

Answer 4

1. first line option → in MODERATE to SEVERE asthma

2. IV dose in severe exacerbation (status asthmaticus)

Question 5

side effects → corticosteroids:

Answer 5

1. frequent aerosol admin can result in small adrenal suppression (rare)
2. deposition in pharynx → candidiasis

Question 6

drugs that “decrease release of mediators”:

Answer 6

1. cromolyn

2. nedocromil

Question 7

mechanism of action → drugs that “decrease release of mediators”:

Answer 7

• not fully understood
• decrease mediators from mast cells → also called “mast cell stabilizers”
• can prevent bronchoconstriction

Question 8

pharmacokinetics → in drugs that “decrease release of mediators”

Answer 8

1. given by AEROSOL → could be given in combination with LABA ex. salmeterol or formoterol
2. non-preferable alternative to corticosteroids

Question 9

indications → in drugs that “decrease release of mediators”

Answer 9

1. asthma → esp. children
2. hay fever → nasal & eye drops
3. food allergy → ORAL formulation

Question 10

side effects → in drugs that “decrease release of mediators”

Answer 10

1. cough
2. irritation
3. unpleasant taste

Question 11

drugs included in leukotriene ANTAGONISTS:

Answer 11

1. zileuton
2. montelukast
3. zafirlukast

Question 12

mechanism of action → leukotriene ANTAGONISTS:

Answer 12

1. zileuton → inhibit 5-lipooxygenase → prevent formation of LTB4 & cysteinyl leukotrienes
2. montelukast & zafirlukast → block leukotriene receptor LTD4

Question 13

pharmacokinetics → leukotriene ANTAGONISTS:

Answer 13

1. zileuton → ORALLY, excreted in urine → combined with steroids
2. montelukast & zafirlukast → ORALLY, excreted in bile → combined with steroids

Question 14

indications → leukotriene ANTAGONISTS:

Answer 14

1. zileuton → prevention of bronchospasm, pat. poorly controlled by conventional therapy in children & adults
2. montelukast & zafirlukast → prevention of exercise, antigen & aspirin-induced bronchospasm

Question 15

side effects → leukotriene ANTAGONISTS:

Answer 15

1. elevation of liver enzymes
2. headache
3. dyspepsia

Question 16

drugs included in anti-IgE antibodies:

Answer 16

omalizumab

Question 17

mechanism of action → anti-IgE antibodies:

Answer 17

• monoclonal antibody to IgE

- block binding of IgE to receptors on inflammatory cells

Question 18

pharmacokinetics → anti-IgE antibodies:

Answer 18

• SUBCUTANEOUS

- reduce asthma exacerbations

Question 19

indications → anti-IgE antibodies:

Answer 19

poorly controlled SEVERE asthma

Question 20

side effects → anti-IgE antibodies:

Answer 20

1. serious anaphylaxis (rare)
2. arthralgias fever, rash
3. secondary malignancies