Ashthma Wu1

Question 1

What are three factors that contribute to airway narrowing?

Answer 1

1. Spasm of the smooth muscle surrounding airways
2. Excessive secretion of mucus
3. mucosal inflammation and swellingWh

Question 2

What is the difference between early onset and late onset asthma?

Answer 2

Early onset involves an immune response related to allergy. Late onset is provoked by non-specific factors.

Question 3

85% of COPD is due to what? Does this direct treatment?

Answer 3

Due to long term smoking. Treatment resembles asthma because of the inflammatory/bronchospastic component of the disease.

Question 4

What are the two types of drugs used in asthma/COPD?

Answer 4

Bronchodilators and anti-inflammatory agents

Question 5

Why is inhalation the preferred route of delivery?

Answer 5

Faster onset, safer! smaller doses required and risk of systemic effects is lower.

Question 6

How does a Beta 2 agonist cause relaxation?

Answer 6

increase adenylyl cyclase activity, increase CAMP, inhibit exocytosis of mediators in mast and basophils, inhibit allergens induced bronchospasm and edema.

Question 7

How does the alpha receptor contribute?

Answer 7

Alpha receptors are activated which constricts bronchial mucosal vessel and decreases blood flow which prevents the mucosal gland from overacting, decreasing congestion and edema.

Question 8

What do we use to manage severe acute asthma attack?

Answer 8

Epinephrine- subcut/aerosol/ Rapid acting, peak 5-15 min. bad cardiac stim

Ephedrine- high b1affinity

Isoproterenol (aero) instantaneous effect, longer duration, does not affect alpha receptor. still cardio b/c B1

Question 9

What is the major contraindication of these non selective beta agonists?

Answer 9

Don’t use with coronary artery disease and hypertension!!! B1 effect will increase heart rate and force of contraction, leading to increased bp and tachy!! Also on alpha leads to vasoconstriction and increased BP

Question 10

what are examples of short acting beta 2 agonists?

Answer 10

Albuterol (salbutamol), levalbuterol, pirbuterol

Question 11

what are examples of long acting beta 2 agonists?

Answer 11

Formoterol, salmeterol

Question 12

What is the main advantage of beta 2 over beta agonists?

Answer 12

Relatively specific for B2 so less cardiac effects! Also, longer duration of action.

Question 13

A contra indication for selective beta agonists is…

Answer 13

Don’t take with non selective beta blockers!! decreased effects

Question 14

What does inhaled ipratropium bromide do?

Answer 14

anticholinergic agent used as a short-acting bronchodilator for chronic bronchitis or COPD

Question 15

What differentiates Tiotropium bromide from ipratropium?

Answer 15

Tio- inhaled as a powder! long-acting! one daily maintenance of bronchospasm from COPD.

BOTH not approved for asthma….

Question 16

Through what mechanism do the XANTHINES act?

Answer 16

ex = theophylline

inhibit the enzyme phosphodiesterase which increases cAMP production.

Question 17

Are xanthines administered orally or inhaled or intravenously?

Answer 17

Stage I and II- orally! 4-6x daily

Stage III and IV- IV

Question 18

Why is it important to monitor xanthine use?

Answer 18

Narrow therapeutic index! If [plasma]>25, seizure! also some hypotension and cardiac arrest.

Question 19

What are some drug interactions with xanthines?

Answer 19

Avoid barbiturates (which increase rate of elimination) and caffeine (chemically analogous so compete!!!)

Question 20

List of inhaled corticosteroids

Answer 20

beclomethasone
triamicinolone
budesonide
fluticasone propionate
mometasone furoate
flunisolide
ciclesonide

Question 21

Which anti-inflammatory corticosteroid is a PRO DRUG

Answer 21

Ciclesonide! ester prodrug converted by carboxyesterases and cholinesterases.

Question 22

What two therapies are combined ? what are examples?

Answer 22

Corticoid steroid and long acting beta-2 agonist are together.

salmeterol/fluticasone, formoterol/budesonide, formoterol/mometasone

Question 23

Which drug acts as a membrane stabilizer?

Answer 23

Cromolyn sodium… decrease mediator release.

probably via calcium channel blocker!

Question 24

What role do Zafirleukast and Montelukast play?

Answer 24

Leukotriene receptor blocker approved for treatmentof seasonal allergic rhinitis and perennial allergic rhinitis.

Question 25

monoclonal antibody given subQ that binds to IgE?

Answer 25

Omalizumab

Question 26

New remedies?

Answer 26

involving the IL5 AB/bacterial induced TH1 response.