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Pharmacology > ASTHMA > Flashcards

ASTHMA Flashcards

1
Q

asthma abnormality

A

insufficient expiration

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2
Q

drugs used in asthma symptom relief

A

symptom relief: beta2 agonists (fast/long-acting), ipratropium, theophylline (less often)

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3
Q

drugs used in asthma long term control

A

corticosteroids; cromolyn, nedocromil; leukotriene modifiers; anti-IgE antibody

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4
Q

adjunct drugs used in asthma

A

antibiotics; mucolytics; oxygen (sedatives ci’d)

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5
Q

asthma last resort drugs

A

general anesthesia; muscle relaxation; controlled respiration; bronchial lavage; ketamine

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6
Q

summary of asthma drugs

A

http://o.quizlet.com/mZlov6PMUBNIRC-iseizdw.png

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7
Q

short-acting beta2 agonists

A

albuterol, levalbuterol, pirbuterol, terbutaline, metaprotenerol - for acute episodes

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8
Q

long-acting beta2 agonists

A

salmeterol, formoterol - for prophylaxis, long term therapy

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9
Q

beta2 agonists adverse effects

A

selectivity is relative; beta2 - muscle tremor, diabetogenic; beta1 - tachy, arrhythmogenic; loss of responsiveness; high dose continuous use - hypokalemia;

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10
Q

beta2 agonists uses

A

NOT anti-inflammatory; can be for preventative i.e. b4 going to gym

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11
Q

beta2 agonists and theophylline moa

A

can have over-additive effect!

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12
Q

theophylline characteristics

A

methylxanthine, related: caffeine, theobromine

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13
Q

theophylline pk

A

oral, sustained release; iv; many drug interactions; low therapeutic margin

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14
Q

theophylline adverse effects

A

cns - nervousness, tremor; cv - catecholamine release, +inotropy/chronotropy; arrhythmogenic; GI - hyperacidity, nausea

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15
Q

theophylline toxicities

A

convulsions, coma

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16
Q

theophylline uses

A

controversial -> dec in US (seizure risk - last choice); considered safe/useful in Europe esp in emergencies; more used for intermittent claudication

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17
Q

theophylline molecular moa

A

induce histone deacetylase -> dec inflammatory gene expression -> promotes corticoid action (unrelated to phosphodiesterase) -> controller/preventer drug

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18
Q

anticholinergics

A

ipratropium, thiotropium

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19
Q

ipratropium characteristics

A

polar compound; mostly local effect when used as inhalant; ineffective in 30% of asthma pt’s

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20
Q

ipratropium adverse effects

A

rare w/usual doses; dry mouth; NO tremor, tachy, dyskrinia (thickening mucous)

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21
Q

ipratropium uses

A

esp COPD w/vagal components; asthma in kids/old; psychogenic exacerbations of asthma; combo with beta2 agonists

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22
Q

thiotropium characteristics

A

much longer half-life; limited absorption from bronchial mucosa into system; some selectivity for M1, M3 receptors; labeled for COPD (combo tx)

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23
Q

corticosteroids inhalants

A

beclomethasone, budesonide, flunisolide, fluticasone

24
Q

corticosteroids systemic

A

any e.g. prednisone, dexamethasone

25
Q

corticosteroids adverse effects

A

depends on dose/asthma severity; inhalant low dose - local ae’s, insig systemic ae’s; inhalant high dose - local ae’s, minor systemic (avoid in kids); oral/systemic - severe systemic ae’s; single high dose (emergencies) - no systemic except risk of infection, aggravate DM

26
Q

beclomethasone, budesonide, flunisolide, fluticasone pd

A

dec asthm symptoms; dec hyperreactivity; improve bronchial/pulmonary epithelial fxns

27
Q

beclomethasone, budesonide, flunisolide, fluticasone pk

A

10% inhaled deployed into bronchial tree

28
Q

beclomethasone, budesonide, flunisolide, fluticasone application

A

use application aids (e.g. spacer); in combo - apply 10 mins after b2 agonist inhaled

29
Q

beclomethasone, budesonide, flunisolide, fluticasone local adverse effects

A

oral/esophageal candidiasis, hoarseness -> apply b4 meals

30
Q

beclomethasone, budesonide, flunisolide, fluticasone systemic adverse effects

A

little bioavail -> minor ae’s compared to systemic corticosteroids

31
Q

cromolyn, nedocromil characteristics

A

mast cell stabilizers

32
Q

cromolyn, nedocromil pk

A

topical aerosol (for other indications - nasal spray, eye drops, oral)

33
Q

cromolyn, nedocromil pd

A

inhibit early/late response by stabilizing mast cells, eosinophils -> dec hyperreactivity

34
Q

cromolyn, nedocromil uses

A

preventative tx of antigen/exercise-induced asthma; INEFFECTIVE in acute exacerbation

35
Q

cromolyn, nedocromil adverse effects

A

cough, airway irritation; RARE: drug allergies, gastroenteritis

36
Q

leukotriene modifiers pd

A

effective in antigen/exercise-induced asthma, esp aspirin-asthma

37
Q

leukotriene modifiers adverse effects

A

inc LFT, headache, dyspepsia

38
Q

leukotriene modifiers

A

zileuton, montelukast, zafirlukast

39
Q

zileuton moa

A

5-lipoxygenase antagonist; rarely used

40
Q

montelukast, zafirlukast moa

A

LTD4 anatagonist, also blocks LTE4

41
Q

leukotriene modifiers characteristics

A

less effective than inhaled corticosteroids, but used to dec cort. dose; definite position in asthma therapy not established

42
Q

mucolytics pd

A

facilitate expectoration by dec viscosity of bronchial mucus

43
Q

mucolytics

A

water (most important); acetylcysteine

44
Q

acetylcysteine pd

A

disrupts S-S bonds in mucoproteins

45
Q

mucolytics application

A

nebulizer, oral, iv, endotracheal lavage; tastes, smells like rotten eggs -> oral is best

46
Q

mucolytics adverse effects

A

mechanical airway irritation, GI disturbances; allergic rxns; use w/CAUTION in severe acute asthma, gastric ulcer pt’s

47
Q

asthma absolute contraindications

A

ALL beta-blockers; cholinergic drugs; centrally-acting anticholinergic drugs; codeine, dextrometorphane; aspirin, other nsaids

48
Q

asthma relative contraindications

A

diuretics; ace-inhibitors; cns depressants; sedatives

49
Q

treatment of mild intermittent asthma

A

reliever - inhaled short-acting beta2 agonist as needed - less than 1x/day; controller - none or cromolyn b4 allergen exposure

50
Q

treatment of mild persistent asthma

A

reliever - inhaled short-acting beta2 agonist as needed, but less than 4x/day; controller - inhaled low dose corticosteroid or cromolyn, nedocromil

51
Q

treatment of moderate persistent asthma

A

reliever - inhaled long-acting beta2 agonist; controller - inhaled corticosteroid

52
Q

treatment of severe persistent asthma

A

reliever - (plus oral theophylline); controller - oral corticosteroid

53
Q

asthma prevention of acute exacerbation

A

short oral prednisolone ‘rescue’ at anytime

54
Q

emergency treatment of asthma

A
  1. oxygen, monitor
55
Q

NO-NO’S in asthma emergency treatment

A

nedocromil, cromolyn; uncritical sedation

Pharmacology (15 decks)

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