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PMCOL 343 > Asthma > Flashcards

Asthma Flashcards

1
Q

What is the early phase of asthma characterized by?

A

bronchospasm

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2
Q

What is the late phase of asthma characterized by?

A

inflammation

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3
Q

What are the 4 main types of drugs that can be used to reverse bronchospasm? (hint: these drugs are bronchodilators)

A

beta agonists
theophylline/aminophylline
cysteinyl leukotrine receptor antagonists
muscarinic antagonists

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4
Q

Which phase of asthma do beta2 agonists treat? Explain the beta2 agonist mechanism behind of action in treating asthma?

A

phase: bronchospasm/constriction

mechanism: Gs STIMULATION –> activate adenylate cyclase –> increase cAMP –> activate PKA –> DECREASE Ca2+ –> bronchodilation

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5
Q

are beta2-agonists usually given to asthma patients via inhalation, oral route, or injection?

A

inhalation

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6
Q

What are 2 short acting beta2 agonists? What is the duration of action? Are they taken as needed or as adjunctive therapy?

A

drugs: salbutamol and terbutaline
duration: 3-5 hours
taken as needed

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7
Q

What are 2 long-acting beta2 agonists? What is the duration of action? Are they taken as needed or as adjunctive therapy?

A

drugs: salmeterol and formoterol
duration: 8-12 hours
adjunctive therapy

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8
Q

What are the adverse effects of beta2 agonists in treating asthma?

A

tachycardia
dysrhythmias
tremor
peripheral vasodilation
hypokalemia
hyperglycemia

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9
Q

Are theophylline/aminophylline usually given to patients via inhalation, oral route, or injection?

A

oral route

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10
Q

Which phase of asthma do beta2 agonists treat? What is theophylline/aminophylline’s mechanism of action?

A

phase: bronchospasm/constriction

mechanism: INHIBIT PHOSPHODIESTERASE –> prevent breakdown of cAMP –> increase cAMP levels –> decrease Cas2+ –> bronchiole dilation

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11
Q

What are the side effects of taking theophylline and aminophylline as treatment for asthma?

A

dysrhythmia
headache
seizure
nausea and vomiting
insomnia and restlessness

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12
Q

What are the 2 cysteinyl leukotrine receptor antagonistic drugs used to treat asthma?

A

montelukast and zafirlukast

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13
Q

What phase of asthma do montelukast and zafirlukast treat? What are the therapeutic actions of montelukast and zafirlukast in treating asthma?

A

phase: bronchospasm/constriction

actions: bronchodilation, decrease secretion

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14
Q

TRUE or FALSE: Montelukast and Zafirlukast are more effective at relaxing airways than beta2 agonists

A

FALSE: beta2 agonists are more effective

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15
Q

TRUE or FALSE: beta2 agonists and zafirlukast ca be used additively together to treat asthma.

A

TRUE

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16
Q

What are the adverse effects in using montelukast/zafirlukast to treat asthma?

A

headache and GI disturbances (generally well tolerated)

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17
Q

Are montelukast and zafirlukast usually given to patients via inhalation, oral route, or injection?

A

oral route (in combination with inhaled corticosteroid)

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18
Q

Which enzyme does zafirlukast inhibit? Inhibiting this enzyme may increase effects of which drug?

A

inhibit CYP3A4 –> increase effects of WARFARIN

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19
Q

What anti-inflammatory agents are used to treat asthma? Name the 6 drugs that call under this category of anti-inflammatory agents.

A

glucocorticoids:
- beclometasone
- budenoside
- fluticasone
- mometasone
- ciclesonide
- prednisolone

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20
Q

Which glucocorticoid is reserved for patients with the severest disease?

A

prednisolone

21
Q

Are glucocorticoids usually given to patients via inhalation, oral route, or injection?

A

inhalation

22
Q

What are the 2 mechanisms of glucocorticoid gene expression control? Explain both.

A

basic transactivation: ligand binds to GR dimer –> upregulate transcription

basic transrepression: ligand binds to GR dimer –> binds a nGRE –> turns off transcription

23
Q

Describe the glucocorticoid mechanism of action in asthma.

A
  1. reduce transcription of IL2 gene
  2. inhibit Th cell proliferation
  3. reduce formation of Th2 cytokines and activation of eosinophils
  4. reduce Il5/IL3 –> inhibit allergen-induced influx of eosinophils into the lung
  5. reduce production of IgE and expression of IgE receptors
24
Q

What are the adverse effects of taking inhaled glucocorticoids to treat asthma?

A

oropharyngeal candidiasis (thrush)
dysphonia (croaky voice)
adrenal suppression (with beclometasone and budenoside)

25
Q

What are the adverse effects of taking oral glucocorticoids to treat asthma?

A

increased risk of infection
hyperglycemia
osteoporosis

26
Q

When taking glucocorticoids to treat asthma, is the risk of systemic side effects common? Why or why not?

A

risk of systemic side effects is UNCOMMON b/c LOW systemic absorption and bioavailability

27
Q

What pharmacokinetic consideration should we make when it comes to administering glucocorticoids in the treatment of asthma?

A

steroids are highly lipophilic and enter cells easily

28
Q

What drugs are glucocorticoids frequently administered with for chronic asthma? Why?

A

beta2 agonists

  • dilation of bronchial smooth muscle will enhance deliver of glucocorticoids to airways
  • glucocorticoids increases expression of beta2 adrenoreceptors in the airways
29
Q

What drug is used as an anti-IgE treatment in asthma?

A

omalizumab

30
Q

Which drug should be administered to treat asthma is high doses of corticosteroids are not effective?

A

omalizumab

31
Q

What is the mechanism of omalizumab?

A

binds to IgE and prevents their interaction with IgE receptors

32
Q

bWhat is an adverse effect of using omalizumab to treat asthma?

A

anaphylaxis

33
Q

How is omalizumab administered?

A

subcutaneously

34
Q

Which drugs are used to treat eosinophilic asthma? What is the mechanism?

A

drug: mepolizumab/reslizumab
mechanism: bind to and inhibit IL5

35
Q

What are the adverse effects of taking mepolizumab and reslizumab when treating asthma?

A

headache
injection site reactions
oropharyngeal pain

36
Q

Even though glucocorticoids are generally ineffective in treating COPD, why are they still used when treating COPD?

A

asthma can coexist with COPD

37
Q

TRUE or FALSE: bronchodilators deal with the underlying inflammation of COPD.

A

FALSE…however, they can still improve symptoms

38
Q

What are 2 main drugs that can be used to treat COPD?

A

inhaled anticholinergics and roflumilast

39
Q

Which 2 inhaled anticholinergics are used to treat COPD?

A

ipratropium and tiotropium

40
Q

What is the mechanism of anticholinergics in treating COPD?

A

decreases parasympathetic stimulation of M3 –> bronchodilation and decrease secretion

41
Q

Which anticholinergic used to treat COPD has greater selectivity for M3?

A

tiotropium

42
Q

Which anticholinergic used to treat COPD is nonspecific for M1-M3?

A

ipratropium

43
Q

what pharmacokinetic consideration should be made when administering inhaled anticholinergics to treat COPD?

A

anticholinergics are polarized –> do not readily cross hydrophobic cell membranes

44
Q

What are the adverse effects of using inhaled anticholinergics to treat COPD?

A

minimal side effects; local reactions include dry mouth, nasal irritation, nose bleeds

45
Q

What is COPD?

A

chronic obstructive pulmonary disease –> inflammation of airways

46
Q

What is the mechanism of roflumilast in treating COPD?

A

long-acting inhibitor of phosphodiesterase 4 –> reduce inflammation

47
Q

What are the adverse effects of roflumilast?

A

diarrhea
nausea
abdominal pain
weight loss
nausea
headache
insomnia

48
Q

How is roflumilast administered?

A

orally

PMCOL 343 (27 decks)

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