Asthma Flashcards
What is known about the etiology of asthma?
Not a ton exactly. The etiology is far from completely understood. It does related to genes, environmental and biological triggers.
What are the characteristics of asthma?
Airway inflammation
Airway obstruciton-REVERSIBLE
Hyperresponsiveness
Define IAR and LAR
Immediate asthmatic response-Occurs over minutes
Late asthmatic response- Occurs over hours
What is the key cell involved in immediate asthmatic response?
Mast cells. They release histamines, also leukotrienes and other inflammatory responses
What triggers mast cell activation?
Antigen
What is getting activated in lat asthmatic responses?
Activation of other inflammatory mediators like eosinophils that is activated by mast cells and lymphocytes
How many levels are there of asthma classification?
Four
What is the definition of FEV1
Forced expiratory volume in 1 second
What is the definition of PEF
Peak expiratory flow, the speed of the air moving out of your lungs at the beginning of the expiration
What is COPD mediated by?
Neutrophils
What are the four components of treating and managing asthma?
1- Measures of asthma assessment and monitoring
2- Education
3- Control of environmental factors and other triggers
4- Meds
What is the main thing needed for component 2?
A written asthma action plan for daily management and how to recognize/handle worsening asthma symptoms
What is the key points of component 3?
Avoid non selective beta blockers
Reducing allergens
Avoid triggers
What are the SABAs? Short acting beta 2 agonists
Albuterol and levolbuterol
What changed in the mid 2020s for management of asthma?
Use inhaled corticosteroids instead of SABA for patients over 12
What are the LABAs for asthma? Long acting beta agonists
Salmeterol and formoterol
What are the LABAs for COPD?
Aformoterol, indacaterol, vilanterol (Can be used for asthma I guess), olodaterol,
Which LABA is highly selective for B2 over B1?
Olodaterol
What is the mnemonic for short acting beta agonists?
Effective, BUT short acting
alBUTerol
levalBUTerol
What is the pneumonic for LABAs for COPD?
Airway-Arformoterol
Is- Indacaterol
Very- Vilanterol (can be used for asthma)
Obstructed- Olodaterol
What is the MOA of Beta 2 agonists?
Stimulation of adenylyl cyclase, increasing cAMP and increasing bronchial dilation
What are the potential problems with inhaled beta 2 agonists?
Regular use is associated with diminished control of asthma
What medication should never be used with asthma without concurrent ICS use?
LABAs
What is the MOA of antimuscarinic compounds?
Inhibit the action of ach at muscarinic receptors
-Basically prevents bronchoconstriction
What is the pneumonic for long acting muscarinic antagonists?
Is- Ipatropium- Only for asthma That- Tiotropium- COPD for the rest All- Aclindinium Understood- Umeclidinium Go- Glycopyrrolate Roos- Revefenacin
What serious side effects can aclidinium cause?
Diabetes, cardiac effects
What is the MOA of theophylline?
Blocks adenosine, preventing bronchoconstriction. Also inhibits PDE, causing more cAMP to cause bronchodilation
What are the inhaled corticosteroids?
Fluticasone, budesonide, beclomethasone, ciclesonide, and mometasone
How large of a dose of theophyliline will cause vomiting, arrhythmias, or intractable seizures?
Greater than 20mcg/ml
What is inhaled corticosteroids MOA?
Inhibit multiple cell types involved in process of inflammation.
What is the age cut off for use of inhaled corticosteroids?
12 years and older CAN use it
What is a situation to be cautious with when it comes to giving ICS?
When a patient has an infection like HIV
What class of drug is cromolyn?
Mast cell stabalizer
What is cromolyns MOA?
Prevents release of inflammatory chemicals, histamine from mast cells, but may do more
What is cromolyn not good for?
Acute attacks
What has cromolyn been replaced by predominately?
LTRA
What is an LTRA?
Leukotriene receptor antagonist
What are the LTRAs?
Motelukast and zafirlukast
What is the MOA of LTRAs?
Block binding of leukotrienes to CysLT1 receptors
What class is Zileuton?
Lipoxygenase inhibitor
What drug class is Omalizumab?
Immunomodulator
Anti-Ige
What scenario is Omalizumab ideal for?
Asthma of allergic etiology
What are some other immunomodulators? The pneumonic?
Mepolizumab Reslizumab Benralizumab Dupilumab MRBD- For eosinophillic
Only Omalizumab for allergic asthma
What infection is contraindicated for use of biologics that treat eosinophillic asthma?
Helminth infection
What are the treatment options for COPD?
SABA, LABA, ICS, theophylline
Phosphodiaterase 4 inhibitor- Roflumilast
Antibiotics- Azithromycin
Antimuscarinics- Tiotropium, aclidinium
