Asthma

Question 1

Definition of asthma

Answer 1

Chronic inflammatory disease of the airways characterized by ep. of ACUTE bronchoconstriction => shortness of breath, caugh, cest tightness, weezing and rapid respiration.

Question 2

Airflow obstruction is due to bronchoconstriction from …

Answer 2

1.contraction of bronchial smooth muscle
2.inflamation of the bronchial wall
3.increased secretion of mucus

Question 3

To remember…

Answer 3

Not a progressive disease
Therapy for long term control to reverse and prevent airway inflammation
Asthma attack: allergens,exercise,stress and respiratory infections

Question 4

Beta 2 Adrenergic agonists

Answer 4

Directly relax airway smoth muscle
1.quick relief
2.long term control

Question 5

SABA

Answer 5

Rapid onset of action 5-30 min and last for 4 to 6h
No anti-inflammatory eff. do not use as monotherapy (mild a. or exercise induced bs)
Albuterol and levalbuterol
AE: tachycardia, hyperglycemia, hypokalemia,hypomagnesemia,beta 2 mediated muscle tremors(reduced by inhaled adm)

Question 6

LABA

Answer 6

Salmeterol and Foroterol
Chemical analogs of albuterol
Long duration of acting at least 12h
No monotherapy!!! Just + ICS

Question 7

ICS

Answer 7

Inhibit the release of arachidonic acid through inhibition of phospholipase A2=>direct AI properties in the airway
Decreasing the inflammatory cascade, reversing mucosa edema,decreasing the permeability of capillaries, inhibiting the release of leukotrienes
Must be used regularly
Inhalation and Oral/systemic
AE orofaringeal candidiasis- use spacer

Question 8

Leukotriene modifiers

Answer 8

LTB4, LTC4, LTD4, LTE4- prod. of 5-lipooxigenase pathway of arachidonic ac. metabolism and inflm. cascade
Zileuton-selective and specific inhibitor of 5-lipooxigenase-prevent formation of LTB4 and LTC4,LTD4-urine
Zafirlukast and Montelukast- selective antagonist CysLT1 receptor-biliary excretion
Oral active and highly protein bound
Food impairs the abs of zafirlukast
Extensive hepatic met
AE-elevation in serum hepatic enzymes, headache and dyspepsia ; Zafirlokast inhib of CYP, isoenzymes 2C8,2C9 and 3A4; Zileuton inhibits CYP1A2

Question 9

Cromolyn

Answer 9

Profilactic anti-inflammatory agent that inhibits mast cell degranulationand release of histamine
Short duration of action (3,4x/daily)- nebulizer sol.
Minor AE caught, irritation and unpleasant taste

Question 10

Cholinergic antagonists

Answer 10

Block vagaly mediated contraction of airway smooth muscle and mucus secretion
Ipatropium- short acting quaternary derivate of atropine- astma-COPD overlap syndrom; acute asthma exacerb
Tiotropium-long-acting anticholinergic ag- ad-on treatment in adults; AE xerostomia and bitter taste

Question 11

Theophylline

Answer 11

Bronchodilatator
Overdose=>seizures and fatal arrhythmia
Met. In liver, CYP1A2 and 3A4 substrate

Question 12

Monoclonal antibodies

Answer 12

Omaluzumab- binds to human immunoglobulin E
Mepolizumab(SC), Benralizumab(SC), Reslizumab(IV)- interleukine-5 antagonists - eozonophilic asthma
AE anaphilactic reactions, arthralgias, fever, rash, infections