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PHARMACOLOGY > asthma > Flashcards

asthma Flashcards

1
Q

Episodic narrowing of airway walls thought to be caused by an underlying chronic inflammatory disorder

A

Asthma

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2
Q

SYMPATHOMIMETIC AGENTS
Bind to β receptors on airway smooth
muscle cells → stimulate adenylyl cyclase →
increase cyclic AMP →

A

relaxing airway smooth muscle

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3
Q

Bronchodilation is promoted by__

A

Camp (adenylyl cyclase or PDE)

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4
Q

Epinephrine_ max bronchodilati

A

15 minutes and last about 60-90 minutes

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5
Q

● Potent, non-selective β1 and β2 bronchodilator
● Inhalation of 80-120 mcg as aerosol with maximal
bronchodilation in 5 mins and duration of 60-90 mins
● Increased mortality in the UK (1960s) due to cardiac
dysrhythmias
● Now rarely used for asthma

A

isoproterenol

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6
Q

Non-selective adrenergic

A

Epinephrine, isoproterenol, ephedrine

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7
Q

S/e of epinephrine

A

Tachycardia, arrhythmia, worsening angina pectoris

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8
Q

Isoproterenol: ___ mcg as aerosol with maximal broncodilation in _ min and duration of -

A

80-120mcg, 5 min. 60-90 min

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9
Q

Longer duration than epinephrine, lower potency, central effects

A

Ephedrine

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10
Q

Results from frequent or overuse of LABA and SABA

A

Tachyphylaxis

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11
Q

SABA

A 
Salbutamol 
terbutaline 
levalbuterol 
metaproterenol 
pributerol
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12
Q

Optimal size

A

1-5um

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13
Q

LABA

A

Salmeterol
Formoterol
Fenoterol
clenbuterol

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14
Q

Given as an add-on for inhaled steroids

A

LABA

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15
Q 
Neurotransmitter  in  the
parasympathetic NS (released by vagus nerves) that promotes bronchoconstriction
A

Acetylcholine

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16
Q

Blocks bronchoconstrictive effects of histamine, bradykinin, and eicosanoids
(mediators released during asthma attacks)

A

atropine (Datura stramonium)

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17
Q

Inhaled irritants are sensed by the _____ pathways of the vagus nerve

A

Efferent

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18
Q

Parasympathetic - 2 possible mechanisms

A

Triggers chemical mediators, initiate reflex bronchoconstriction or release tachykinins

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19
Q

May last up to 6 hrs, quaternary ammonium derivative of atropine

A

Ipatropium Br

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20
Q

Particular good response in subgroup of asthmatics with psychogenic exacerbations

Also useful in patient intolerant of β2 agonists

A

ipatropium br

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21
Q

Drug of choice for rapid symptomatic relief of

dyspnea in asthma bronchoconstriction

A

SABA

22
Q

 Longer duration of action

 Maintenance therapy for COPD

A

Tiotropium br

23
Q

Dissociates most rapidly from M2 receptors

some degree of receptor selectivity

A

Tiotropium br, Aclidinium

24
Q

Tiotropium: __mcg OD (24hr duration)

A

18mcg

25
Q

Aclidinium: ___ mcg BID (12hr duration)

A

Aclidinium

26
Q

T or F

Antocholinergic agents have only modest inhibition to histamine, bradykinin or PGF2a

A

T

27
Q

Anticholinergics only frequent side effect

A

dry mouth

28
Q

prototype drug of methylxanthines

A

Aminophylline

29
Q

Theophylline-ethylenediamine complex, commonly used in IV preparation

A

aminophylline

30
Q

METHYLXANTHINES USED IN ASTHMA: BRONCHODILATOR
DRUGS
(Phosphodiesterase inhibitors)

A

o THEOPHYLLINE
o AMINOPHYLLINE
o DOXOFYLLINE

31
Q

Methylxanthines toxicity

A
  • adverse cns effects

- urticaria

32
Q

Do not directly relax airway smooth muscles, no
value in acute bronchoconstriction – central to the
pathophysiology of asthma is that it is a chronic
inflammatory disease so steroids are very important
because of their anti-inflammatory action.

A

glucocorticoids

33
Q

Greatly enhances therapeutic index of these drugs
(Can be given higher doses with very little side
effects), targets the drug directly to site of inflamm

A

inhale glucocorticoids

34
Q

Inhaled glucocorticoids includes:

A

o Fluticasone
o Budesonide
o Betamethasone
o Fluticasone Furoate

35
Q

For acute and chronic severe asthma

A

Glucocortiloid:systemic

prednisolone, methylprednisolone

36
Q

Dose for exacerbations:

Prednisolone:

A

40-60mg/day
children: 1-2mg/kg/day
5-10 days max

37
Q

for persistent asthma

A

alternate-day therapy with oral prednisolone

38
Q

better tx (gold standard)

A

inhaled glucocorticoids

39
Q

Inhaled steroids systemic adverse effect

A 
HPA axis suppression
Bone resorption
Carbohydrate and lipid metab
Cataracts
Skin thinning
Purpura
Dysphonia
Candidiasis
Growth retardation
40
Q

Known adverse effects of systemic steroids:

A 
o  Consequences that result from PA
suppression
o  Fluid and electrolyte abnormalities 
o  Hypertension 
o  Hyperglycemia 
o  Increased susceptibility to infection (due to
decreased immunity) 
o  Osteoporosis 
-myopathy
-behavioural disturbances
-cataracts
-growth arrest
-cushing syndrome
41
Q

Inflammatory mediators produced from the

lipoxygenase pathway

A

Cysteinyl Leukotrienes (CysLTs)

42
Q

∼1000 times more potent than Histamine

as a bronchoconstrictor.

A

LTD4

43
Q

LTRAs

A

Montelukast

Zafirlukast

44
Q

 Potent and selective inhibitor of 5-
lipoxygenase  Not commonly prescribed due to hepatic
toxicity  Not locally available

A

Leukotriene Synthesis Inhibitors

o Zileuton

45
Q

o Selective high-affinity competitive antagonists for
the CysLT1 receptor
o Orally active
o Antagonists of LTC4 and LTD4

A

LTRA

46
Q

has effectiveness in asthma-induced asthma, and exercised-induces asthma

A

LTRAs

47
Q

LEUKOTRIENE PATHWAY INHIBITORS: TOXICITY

A

Very rarely: systemic eosinophilia and vasculitis with
features similar to Churg-Strauss syndrome.
o Often associated with a reduction in
glucocorticoid therapy, may represent the unmasking of a pre-existing disease.

48
Q

may interact with warfarin and increase

prothrombin times.

A

Zafirlukast

49
Q

First biological agent approved for the treatment of asthma

A

Omalizumab

50
Q

Indicated for adults and adolescents >12 years of age
with allergies and moderate-to-severe persistent
asthma

A

Omalizumab

51
Q

Oxygen therapy: GOAL

A

02 saturation of atleast 95%

PHARMACOLOGY (13 decks)

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