Asthma

Question 1

MDI

Answer 1

Metered dose inhaler delivers an aerosol mist using a compressed gas propellant.
- Spacer can help deliver more of drug to actual airway.

Question 2

DPI

Answer 2

Dry powder inhaler uses no propellant.
- Deep breath from patient needed.

• Nasal sprays, nebulizers, oral pills too.

Question 3

Albuterol

Answer 3

• Most common B2 agonist.
• Primarily used as a “rescue inhaler” to stop an asthma attack.
- MDI (metered dose inhaler).
- Onset 5-15 minutes after inhalation.
- Duration 3-6 hours after inhalation.

Question 4

Combivent

Answer 4

• Combination of albuterol + Atrovent (ipratropium, a muscarinic ACh antagonist).
- Sympathetic agonists and parasympathetic antagonists can provide similar, synergistic effects.
• Used mainly for COPD.
- Chronic Obstructive Pulmonary Disease.
• MDI

Question 5

Salmeterol (Serevent)

Answer 5

• Long-acting B2 agonist.
- 12h half-life, but onset requires ~45 min.
- Prophylactic use, not for treating an attack.
• Most commonly used in combination with steroid fluticasone as Advair.
- DPI (dry powder inhaler).
• 2006 phase IV study suggests that while salmeterol helps relieve mild symptoms, it may actually increase risk of a severe asthma attack causing hospitalization or death.
- 2017: FDA removed boxed warning from Advair combo product.

Question 6

Fluticasone (Flovent)

Answer 6

• Inhaled steroid (MDI) to inhibit inflammation.
- Inhibits release of inflammatory cytokines & prostaglandins.
- Corticosteroids are immunosuppressants.
- Given qd, onset ~12h (faster than other steroids).
• Side-effects include yeast oral infections.
- Candida albicans
- “trench mouth” (acute gingivitis), thrush.
- should rinse mouth out after use of inhaled steroids.
• Also as Flonase for nasal allergies.
- Flonase available OTC (2014).

Question 7

Antihistamines

Answer 7

• Block H1 receptors of histamine.
- local signal for inflammation,
released by mast cells as part of allergic response.
• loratadine (Claritin) is a widely used “2nd gen” OTC non-drowsy antihistamine.
- cetirizine (Zyrtec) too.
• Older antihistamines like diphenhydramine (Benadryl) can cause drowsiness, cross BBB.

Question 8

montelukast (Singulair)

Answer 8

• Anti-leukotriene anti-inflammatory drug.
- Leukotrienes are inflammatory molecules released by mast cells of the immune system.
- montelukast blocks leukotriene receptors.
• Oral medication.
• Widely prescribed, patent expired 2012.
• [some possible neuropsychiatric side-effects, including insomnia, agitation, hallucination, suicidal behavior?].

Question 9

Corticosteroid

Answer 9

Anti-inflammatory drugs related to allergic responses. They are bound by nuclear receptors, so typically they have a very slow onset, and long duration of action.

Question 10

Beta2 agonist

Answer 10

Part of the sympathetic nervous system and they stimulate Beta2 receptors from the sympathetic nervous system. They are found in the smooth muscle cells surrounding the airways - bronchi and bronchioles causing them to relax and expand.

Question 11

Parasympathetic antagonist

Answer 11

Block the broncho constriction that can happen due to some parts of the parasympathetic system.