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Pharm 4 > Asthma > Flashcards

Asthma Flashcards

1
Q

What is asthma?

A

Inflammation of airway

Bronchospasm

Thickened mucous secretions

Edema

May be caused by external factors like exercise

Not COPD

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2
Q

Normal airway physiology

How do we prevent particulate matter from getting deep into lungs?

A

Initial response:

  • Activation of tracheal receptors→Cough reflex
  • Increase in stickiness and amount of mucous produced

Secondary response:

  • Prolonged irritation leads to activation of immune system
    • Immune mediators from mast cells, eosinophils, etc. migrate to lungs
  • This leads to inflammation of the lungs→activation of immune system

Airway walls become thicker

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3
Q

Status asthamticus

A

Severe asthma attack that does not respond to normal tx w/ bronchodilators

Can destroy some muscle to open up airway

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4
Q

What can provoke asthma?

A

B-blocker

Sulfites (dried fruit and wine)

Pollen

Etc

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5
Q

Epinephrine

A

Tx: Asthma

Bronchodilator–DOC for short term relief

Mech: Acts on all adrenergic receptors

SE

  • Tons of them
  • Increase HR+vasoconstriction→increase BP
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6
Q

Isoproterenol

A

“-nol”s and “-rol”s

Tx: Asthma

Bronchodilator–DOC for short term relief

Mech: More specific B2 agonist than epi. but B1 effects

Kinetics: Shorter T1/2

SE:

  • Tremors
  • Tachycardia
  • Heart palpitations

Has been supplanted by more specific B2 agonists

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7
Q

Relatively selective B2 agonists

A

Albuterol

Pirbuterol

Bitolterol

Levalbuterol

Tertbutaline

Relatively selective are the only B2 agonists with a “b” and a “rol” (and tertButaline)

Tx: Asthma

Bronchodilator–DOC for short term relief

Mech: More specific B2 agonist than isoproterenol

Kinetics: Longer T1/2=6hrs

Route: Inhalation–immediate onset

SE:

  • Tremors
  • Tachycardia
  • Heart palpitations
  • Fewer SE than isoproterenol but still some B1
  • Downregulation of receptor
    • Any receptor activators may do this
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8
Q

Longer lasting relatively selective B2 agonists

A

Formoterol

Arformoterol

Salmeterol

Indicaterol

“rols” w/o any “b”s​

Tx: Asthma

Bronchodilator–DOC for short term relief

Mech: B2 agonist–not completely selective

Cause even more down regulation of B2 receptors

Not as effective for rapid relief

SE:

  • Tremors
  • Tachycardia
  • Heart palpitations
  • Indigo Salmon Asked For More*
  • Indigo Salmon Asked Fo mo’*

_Ind_icaterol _Salmo_eterol _A_r_formo_terol _Formo_terol

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9
Q

Ipratropium

A

*“-trop-“ like atropine *

Tx: Asthma

Bronchodilator

Mech: Cholinergic blocker

Analog of atropine

Clinical use: Mainly for COPD but some use for asthma

Kinetics:

  • Inhaled–slower onset though (10 min)
  • Not well absorbed
  • Peak effect in hours
  • Weaker than B-blockers

SE: Anti-cholinergic effects​

Contraindications:

  • Urinary retention
  • Open angle glaucoma
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10
Q

Tiotropium

A

*“-trop-“ like atropine *

Tx: Asthma

Bronchodilator

Mech: Cholinergic blocker

Analog of atropine

Clinical use: Mainly for COPD but some use for asthma

Kinetics:

  • Inhaled–slower onset though (10 min)
  • Not well absorbed
  • Peak effect in hours
  • Weaker than B-blockers

SE: Anti-cholinergic effects​

Contraindications:

  • Urinary retention
  • Open angle glaucoma
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11
Q

Theophylline

A

Tx: Asthma

Mech: Inh. cAMP PDE→bronchodilation

Enzyme inh.

So increase in cellular cAMP

Methyl xanthine like caffeine

Clinical use: Chronic asthma

Low TI but used now b/c very cheap

SE:

  • Cardiac stimulation-arrythmias
  • CNS stim-tremors, insomnia, seizures
  • GI upset
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12
Q

Cromolyn sodium

A

“-crom-“

Tx: Asthma

Anti-inflammatory agent

Mech:

  • Inhibit release of mediators from immune cells
  • Inhibits Cl channels
  • Inhibits Ca uptake (Ca necessary for secretion)

Not bronchodilators

Route: inhalation

Not used much anymore

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13
Q

Nedocromil

A

“-crom-“

Tx: Asthma

Anti-inflammatory agent

Mech:

  • Inhibit release of mediators from immune cells
  • Inhibits Cl channels
  • Inhibits Ca uptake (Ca necessary for secretion)

Not bronchodilators

Route: inhalation

Not used much anymore

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14
Q

What are the glucocorticoids used for asthma?

  • Which are given inhaled?*
  • Which are not inhaled?*
A

Inhaled:

Beclomethasone**

Mometasone**

Fluticasone**

Budesonide**

Ciclesonide**

Mom _Be_at Bud’s _Fl_accid _C_ock

Not inhaled:

Dexamethasone**

Prednisone

Most end in asone or sonide

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15
Q

Budesonide

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Inhalation

1st pass metabolism

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
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16
Q

Beclomethasone

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Inhalation

1st pass metabolism

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
17
Q

Fluticasone

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Inhalation

1st pass metabolism

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
18
Q

Mometasone

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Inhalation

1st pass metabolism

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
19
Q

Ciclesonide

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Inhalation

1st pass metabolism

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
20
Q

Prednisone

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Not inhaled

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
21
Q

Dexamethasone

A

Tx: Asthma

DOC for prophylaxis

Mech: Bind intracellular receptor→altered DNA transcription

Activate receptor

Increase lipocortin→inh. synth of phospholipase A2 (precursor of prost and leukotriene)

Route: Not inhaled

SE:

  • Infections (esp mouth)-thrush
  • Dysphonia (diff. speaking)
  • Systemic effects
22
Q

Omalizumab

A

Tx: Asthma

Mech: Blocks IgE receptor

Receptor blocker

Route: Injection–like all monoclonal antibodies

23
Q

Zileuton

A

Tx: Asthma

Mech: Inh. 5-lipoxygenase

Blocks leukotriene synthesis

Enzyme inh.

SE: increases liver enzymes

zileutoN for eNzyme inhibitor

24
Q

“-lukast”s

A

Zafirlukast

Montelukast

Tx: Asthma

Mech: Leukotriene receptor blocker

25
Q

ACh and asthmatic response

A

ACh binds to bronchial smooth m→Constriction

26
Q

Leukotrienes and asthmatic response

A

IgE binds to immune cell→synthesis and secretion of leukotrienes and cytokines

Leukotrienes bind to bronchial smooth m cell→constriction

27
Q

B2 receptors and asthmatic response

A

B2 receptors on bronchial smooth m and immune cells

Immune cell: B2 activation→cAMP→decrease immune resp.

Bronchial s.m.: B2 activation→cAMP→relaxation

28
Q

Phosphodiesterase and asthmatic response

A

Breaks down cAMP in both bronchial sm and immune cell

29
Q

IgE and asthmatic response

A

IgE receptor activation→increase synth and secretion of leukotrienes and cytokines

30
Q

Cytokines and asthmatic response

A

IgE receptor activation→increase synth and secretion of leukotrienes and cytokines

Cytokines→mobilization of immune cells

Pharm 4 (9 decks)

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