Asthma

Question 0

Salmeterol

Answer 0

B2 adrenergic agonist

Long acting (12 hours or more)
- Must be combined with corticosteroids when used as part of maintenance therapy

Question 1

Albuterol

Answer 1

B2 selective Adrenergic Agonist

Bronchodilator

• Short term relief during acute asthmatic episode
• 30 min onset (lasts for 3-4 hours)
• Fewer side effects (no tachycardia, muscle tremors, headache)

Increased usage means lack of effective control of maintenance therapy

Question 2

Salmeterol with fluticasone

Answer 2

B2 adrenergic agonist with CORTICOSTEROID

Long acting (12 hours)

Question 3

Fluticasone

Answer 3

Corticosteroid

Used as long term controller of asthma

Can be used with B2 Agonist (salmeterol)

Administered topically by aerosol inhalation for long term reduction in symptoms of asthma

Question 4

Beclomethasone

Answer 4

Corticosteroid

Long term, administered topically for long term reduction of symptoms

Question 5

Budesonide

Answer 5

Corticosteroid

Long term controller of asthma

Administered topically through aerosol
- Can be combined with beta-2 agonist for maintenance therapy

Question 6

Prednisone

Answer 6

Corticosteroid

Given orally
- Useful when symptoms are not adequately controlled by maintenance therapy and treatment with bronchodilators

If patient given anti-IL-5 antibodies it has shown that reduced dosage of predinosone may be illicited due to reduced airway eosinophilia

Question 7

Triamcinolone

Answer 7

Corticosteroid

Administered topically in the airway via aerosol for long term reduction of symptoms of asthma

Question 8

Montelukast

Answer 8

Leukotriene modulator

Leukotriene Receptor Antagonist

Can allow reduction in corticosteroid dosage

Reduced bronchoconstriction and edema associated with inflammatory responses

Question 9

Zafirlukast

Answer 9

Leukotriene Modulator

Leukotriene receptor antagonist

Allows lowered dosage of corticosteroids

LTD4 receptor antagonists reduced bronchoconstriction and edema associated with inflammatory response

Question 10

Zileuton

Answer 10

Leukotriene modulator

Leukotriene synthesis inhibitor

Inhibits 5-lipoxygenase:
- Inhibits synthesis of LTB4 and LTD4 in mast cells and eosinophils

Effectiveness varies, but can be effective in long term therapy

Associated with liver toxicity, and inhibitied activity of cytochrome p450, 1A2, 2C9, and 3A4
- Decreases metabolism of other drugs

Question 11

Cromolyn

Answer 11

Degranulation inhibitor

Early Asthma Reaction controller, if symptoms iniate can be palliated with Beta 2 adrenergic receptor agonist

Anti-inflammatory agent, inhibits mast cell degranulation

Must be topically absorbed

Only effective prophylactically as part of a long term maintenance therapy

Mechanism:

• Inhibits degranulation of mast cells, associated with inhibition of Ca channels
• Inhibition of Cl channels may also contribute to reduced nerve activity and inhibition of cough

Question 12

Nedocromil

Answer 12

Degranulation Inhibitor

Must be topically absorbed

Only effective prophylatically

Inhibits mast cell degranulation either through inhibition of Ca channels as well as Cl channels (may be why decreased nerve conduction/cough

Question 13

Ipratropium

Answer 13

Muscarinic Antagonist

Quaternary ammonium Derivative of Atropine

Does not enter CNS

Administered by inhalation

Slower acting and less effective as compared to Beta 2 agonist

ONly inhibit responses associated with parasympathetic responses

May be useful in patients who are INTOLERANT of B2 agonist

Question 14

Theophylline

Answer 14

Bronchodilator

Methylxanthines

• Inhibits phosphodiesterase degradation of cAMP
• Increases cAMP levels and relaxation of bronchial smooth muscle
• Block adenosine receptors

Can be used as long term maintenance

Significant variability in individual metabolic clearance rates

Therapeutic plasma range (10-20 micrograms/milliter)