Asthma

Question 1

Isoproterenol

Answer 1

Non-selective beta agonist activates AC and increases cAMP- causes bronchiole smooth muscles to relax
Lasts 1-2 hours
SE: Tachy, nervous, other Beta-2 concerns
increase risk of death from tolerance

Question 2

Albuterol
Levalbuterol
Pirbuterol

Answer 2

Selective B2 agonists for bronchodilation
SHORT ACTING B2 AGONIST for RESCUE (4-6 duration)
Greater bronchodilation and better tolerated in Leva

Question 3

Salmeterol

Formoterol

Answer 3

LAB2A

20 minute onset then 12 hour bronchodilation

Question 4

Ipratropium (Atrovent)

Answer 4

Muscarinic antagonist
bronchodilation slower than B2
Use: Addition to LABA (or instead of)
SE: Cough, dry mouth, nausea, paradoxical vasoconstriction
+ albuterol=COMBIVENT
Tiotroprium (Spiriva) is longer duration (once a day admin)

Question 5

Theophylline

Answer 5

BLOCKS ADENOSINE AND INHIBITS BRONCHOCONSTRICTION; also blocks the release of inflammatory mediators; also INCREASES cAMP and causes BRONCHODILATION
LAST CHOICE DRUG (COPD that doesn’t respond to LABA)
LOW THERAPEUTIC INDEX
SE: ARRHYTHMIAS (fatal), SEIZURES, hypotension, HA, etc

Question 6

Theophylline interactions

Answer 6

DO NOT SWITCH BETWEEN BRANDS

Increase clearance: OCPs, SMOKING, RIFAMPIN, PHENYTOIN (x2)

Question 7

Inhaled corticosteroids

Answer 7

Beclamethasone
Flunisolide
Triamcinolone
Fluticasone
Budesonide

Question 8

ICS info

Answer 8

Decrease inflam response in aw, stimulates repair and damage prevention in epithelium
ALWAYS USE IN COMBO WITH LABA TO PREVENT AND REVERSE TOLERANCE, ALSO IMPROVES RESPONSE
SE: Oral candidiasis

Question 9

Oral corticosteroids

Answer 9

Methylprednisolone
Prednisone
Used in more severe cases of asthma for short periods to control sx
short term SE: psych, increase appetite, GI upset
long term SE: typical steroids

Question 10

Leukotriene inhibitors

Answer 10

Montelukast (Singulair), other -lukasts (plus Zileuton)
Block leukotriene receptors to decreases asthma response to exercise and cold and decreases amount of ICS!
WILL NOT STOP ACUTE ATTACH!
All oral
SE: URI, SORE THROAT

Question 11

Zileuton

Answer 11

BLOCKS 5- LIPOXYGENASE TO DECREASE LT SYNTHESIS

May decrease ASA/NSAID asthma

Question 12

Cromolyn

Nedromil

Answer 12

Inhibits release due to histamine from mast cells– 2-3 months to see effect!
DOC for anti-inflammatory childhood asthma
inhaled
SE: Bad taste in mouth
may be effective in allergic induced asthma

Question 13

Omalizumab

Answer 13

Monoclonal AB for IgE TO PREVENT BINDING TO MAST CELLS
USE: SEVERE ASTHMA!
SQ injection 2-4x/week