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Pharmacology Unit 4 > Asthma > Flashcards

Asthma Flashcards

1
Q

What are some of the main differences between asthma and COPD?

A
  • asthma is reversible, and is episodic

- COPD is not reversible, is preventable, and is progressive

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2
Q

Tell me if the following are present in COPD, Asthma or Both:

1) inflammation
2) airway smooth muscle thickening
3) basement membrane thickening
4) Eosinophil mediated
5) T-Lymphocyte mediated
6) Responsive to steroids
7) Mainly in Children
8) Bronchial Hyperreactivity

A

1) both
2) mainly in asthma, some in COPD
3) Asthma
4) Asthma
5) Both: asthma TH2, COPD TH1
6) asthma
7) asthma
8) asthma

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3
Q

Is asthma more prevalent in males or females? which race is it more common in?

A

Males, african americans

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4
Q

Which cells are predominately involved in the early response in asthma? Late response?

A

early-mast cells (IgE)

late- T-cells (TH2)

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5
Q

Which two cells are activated by the smoke or other noxious particles in the initiation of COPD?

A
  • macrophages–>alveolar wall destruction and mucus secretion (through many steps)
  • Epithelial cells–>activate fibroblasts–>small airway fibrosis
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6
Q

What are the 2 main categories for therapies of asthma and COPD?

A

bronchodilators and anti-inflammatory agents

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7
Q

Name the 4 classes/medications that fall into the bronchodilator category of therapy.

A
  • short acting B2 agonists
  • long acting B2 agonists
  • anticholinergics
  • theophylline
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8
Q

Name the 4 classes/medications that fall into the anti-inflammatory category of therapy.

A
  • inhaled corticosteroids
  • antileukotrienes
  • cromones
  • anti-IgE
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9
Q

How do B2 agonists function?

A

activate G Protein–>activation of adenylyl cyclase–>increase in cAMP–>increase in PKA–>Bronchodilation (in simplified terms)

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10
Q

How do Theophyllines function is asthma treatment?

A

they inhibit PDE3 which normally breaks down cAMP–> increase in cAMP–>increase in PKA–>bronchodilation

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11
Q

Name 4 medications in the short acting B2 agonist category, when their onset of action is and how long they last.

A
  • albuterol, terbutaline, metoproterenol, pirbutol
  • onset-5 minutes
  • duration-4-6hrs
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12
Q

How are the short acting B2 agonists used? (albuterol, terbutaline, metoproterenol, pirbutol)

A
  • as needed for acute asthma exacerbation

- prevent exercise induced bronchospasm

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13
Q

What is Levalbuterol?

A

-R isomer of albuterol

was thought to decrease side effects of albuterol but has not proven to do so in clinical use

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14
Q

What are some of the adverse effects of short acting B2 agonists (albuterol, terbutaline, metoproterenol, pirbutol)?

A
  • tremor
  • tachycardia
  • hypokalemia (can be used to tx hyperkalemia)
  • paradoxical bronchospasm-from downregulation of receptors
  • tolerance
  • prolonged QTc
  • lactic acidosis
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15
Q

Name the 3 long acting B2 agonists used in asthma and COPD.

A
  • Salmetrol, Formoterol, and indacaterol
  • onset-10-30mins
  • duration-12+ hrs
  • *used for long term control of symptoms**
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16
Q

What are the long acting B2 agonists always use din combination with for asthma?

A

inhaled corticosteroids

FDA Black Box Warning

17
Q

Which of the following is used only in COPD? -Salmetrol, Formoterol, and indacaterol

A

Indacaterol

18
Q

What are the 4 antimuscarinics used in asthma and COPD?

A 
atropine
ipratropium bromide
tiotropium
aclidinium bromide
**Block M3 receptor that is present on airway smooth muscle**
19
Q

Which of the antimuscarinics has a longer half life at the M3 receptor?

A

Tiotropium (aclidinium bromide is a close 2nd)

20
Q

What are some of the other effects of Tiotropium?

A
  • inhibits via muscarinic receptors on inflammatory cells–>decreased neutrophil migration and decreased airway remodeling
  • decreased mucus production
21
Q

Which of the antimuscarinic drugs is aclidinium bromide similar to and what is different about it?

A
  • similar to tiotropium
  • less systemic and CNS side effects
  • higher dose can be given safely
22
Q

What are some side effects associated with antimuscarinic use?

A
  • dry mouth
  • bladder outlet obstruction
  • acute angle glaucome
  • paradoxical bronchospasm
  • possible cardiovascular mortality
23
Q

What is tiotropium used to treat?

A
  • chronic, stable COPD
  • chronic asthma
  • NOT for acute exacerbation of asthma or COPD!!
24
Q

What is Ipratropium bromide used to treat?

A

Chronic COPD-less preferred than tiotropium

-NOT for chronic asthma!!

25
Q

What are the 3 methylxanthines and what is their mechanism of action?

A
  • theophylline, theobromine, and caffein
  • PDE inhibitor, anti-inflammatory though histone deacetylation, improve contractility of diaphragm in COPD
  • *can also restore corticosteroid sensitivity at low doses**
26
Q

What are some of the problems with using methylxanthines?

A
  • Narrow therapeutic window
  • N/V, headache, insomnia, GERD at 15-20mg/l
  • arrhythmia and seizure at >40mg/l
  • Bronchodilation at 10-20mg/l
27
Q

What are corticosteroids used for?

A
  • persistent asthma (with long acting B2 agonists)
  • Used in COPD but limited proof
  • Steroid resistant inflammation
28
Q

Why are corticosteroids useful with a long acting B2 agonist?

A

-they increase the transcription of the B2 receptor gene

29
Q

What are the 3 leukotriene inhibitors? What are the used to treat?

A
  • montelukast, pranlukast, zafirlukast
  • mild asthma, aspirin induced asthma, prophylaxis for exercise induced bronchospasm
  • *Not used in COPD**
30
Q

What are some of the side effects of the leukotriene inhibitors? (montelukast, pranlukast, zafirlukast)

A
  • Liver toxicity

- Churg Strauss?–>likely coincidental

31
Q

What is the mechanism of action of sodium cromoglycate and Nedocromil sodium?

A
  • orevent mast cell degranulation and mediator release from macrophages and eosinophils
  • *Used as preventable tx before exercise of unavoidable exposure to known allergens**
32
Q

Name the 1 anti-IgE monoclonal antibody and what it is used for.

A
  • Omalizumab-given SubQ every 2-4 weeks
  • decreases requirement for corticosteroids
  • decreases asthma exacerbations
  • *Only used for those with very severe asthma who are poorly controlled on oral corticosteroids**
33
Q

How are acute exacerbations of asthma and COPD treated?

A
  • systemic corticosteroids 5-7 days
  • inhaled short acting B2 agonist and anticholinergic (nebulizer)
  • Antibiotics for exacerbation of COPD
  • *DO NOT use long acting B2 agonists or long acting anticholinergics**

Pharmacology Unit 4 (9 decks)

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