Asthma Flashcards
What is the class for Albuterol; Terbutaline; Metoproterenol; Pirbutal
Bronchodilator - short-acting ?2 agonist)
What is the mechanism for Albuterol; Terbutaline; Metoproterenol; Pirbutal
Relax bronchial smooth muscle, inhibit mediator release (mast cells, basophils), increase mucociliary clearance, suppression of microvascular permeability
What are the therapeutics for Albuterol; Terbutaline; Metoproterenol; Pirbutal
Prevent or reduce exercise-induced bronhospasms; mild asthma & acute exacerbations
What are the important side effects for Albuterol; Terbutaline; Metoproterenol; Pirbutal
Musculoskeletal tremor, Tachycardia, hyperglycemia, hypokalemia, hypomagnesemia
What are the other side effects for Albuterol; Terbutaline; Metoproterenol; Pirbutal
Tolerance with chronic use, Prolonged QTc, lactic acidosis, paradoxical bronchospasm
What are the miscellaneous for Albuterol; Terbutaline; Metoproterenol; Pirbutal
5 minutes to take action, 4-6 hours duration; nebulizer delivers more, but greater side effects. Note: Levalbuterol is R-isomer of albuterol.
What is the class for Salmeterol (Serevent); Formoterol; Indacaterol
Bronchodilator - long-acting ?2 agonist
What is the mechanism for Salmeterol (Serevent); Formoterol; Indacaterol
Relax bronchial smooth muscle, inhibit mediator release (mast cells, basophils), increase mucociliary clearance, suppression of microvascular permeability
What are the therapeutics for Salmeterol (Serevent); Formoterol; Indacaterol
used for long-term control of asthma symptoms (always in comination with inhaled steroids)
What are the important side effects for Salmeterol (Serevent); Formoterol; Indacaterol
Musculoskeletal tremor, Tachycardia, hyperglycemia, hypokalemia, hypomagnesemia
What are the other side effects for Salmeterol (Serevent); Formoterol; Indacaterol
Tolerance with chronic use, Prolonged QTc, lactic acidosis, paradoxical bronchospasm
What are the miscellaneous for Salmeterol (Serevent); Formoterol; Indacaterol
10-15 minutes to take action, 6-12 hours (max) of duration; nebulizer delivers more, but greater side effects; oral is least effective (requires more dose –> side effects); can be used night symptoms, but not ideal
What is the class for Theophylline (Theolair); Theobromine; Caffeine
Bronchodilator (Methylxanthine)
What is the mechanism for Theophylline (Theolair); Theobromine; Caffeine
Phosphodiesterase inhibition and enhanced signalling via increased cAMP and cGMP; relax bronchial smooth muscle
What are the therapeutics for Theophylline (Theolair); Theobromine; Caffeine
Reduce inflammation and bronchospasm in moderate to severe asthma, night symptoms
What are the important side effects for Theophylline (Theolair); Theobromine; Caffeine
CNS stimulation or seizures, tachycardia/arrythmias, anorexia, nausea
What are the miscellaneous for Theophylline (Theolair); Theobromine; Caffeine
Low therapeutic index! Metabolized by liver; cimetidine and quinoline increase blood levels
What is the class for Roflumilast
Methylxanthine
What is the mechanism for Roflumilast
Selective PDE4 inhibitor; more of an anti-inflammatory agent than bronchodilator
What are the therapeutics for Roflumilast
COPD
What are the important side effects for Roflumilast
CNS stimulation or seizures, tachycardia/arrythmias, anorexia, nausea
What is the class for Ipratropium (Atrovent); Tiotropium; Atropine
Quarternary amine antimuscarinic
What is the mechanism for Ipratropium (Atrovent); Tiotropium; Atropine
Blocks vagal pathways and decreases vagal tone to bronchial smooth muscle; also blocks the reflex bronchoconstriction caused by inhaled irritants
What are the therapeutics for Ipratropium (Atrovent); Tiotropium; Atropine
First-line agent for chronic COPD; status asthmaticus (w/ nebulized ?2-agonists); no role in chronic stable asthma
What are the important side effects for Ipratropium (Atrovent); Tiotropium; Atropine
Typical antimuscarinic effects; acute angle glaucoma; paradoxical bronchospasm
What are the miscellaneous for Ipratropium (Atrovent); Tiotropium; Atropine
Note: tiotropium has anti-inflammatory properties and decreases mucus secretion.
What is the class for Aclidinium Bromide
Quarternary amine antimuscarinic
What is the mechanism for Aclidinium Bromide
Blocks vagal pathways and decreases vagal tone to bronchial smooth muscle; also blocks the reflex bronchoconstriction caused by inhaled irritants
What are the therapeutics for Aclidinium Bromide
Functionally similar to tiotropium
What are the important side effects for Aclidinium Bromide
Less systemic & CNS side effects than other antimuscarinics due to extremely short circulation half-life.
What is the class for Budesonide; Fluticasone propionate; beclomethasone
Corticosteroid - anti-inflammatory agent
What is the mechanism for Budesonide; Fluticasone propionate; beclomethasone
Anti-inflammatory effects: inhibition of growth factor secretion, inhibition of arachidonic acid metabolites and platelet activation factor, inhibition of leukocyte accumulation, decreased vascular permeability, inhibition of neuropeptide-mediated responses, inhibition of mucous glycoprotein secretion
What are the therapeutics for Budesonide; Fluticasone propionate; beclomethasone
Cornerstone treatment of persistent asthma; beneficial comination with beta-2 agonist; limited role in COPD
What are the important side effects for Budesonide; Fluticasone propionate; beclomethasone
Inhaled has thrush, hoarseness, dry cough, mild adrenal suppression (higher doses); oral has mood-swings, increased appetite, and suppression of adrenocorticotropic hormone secretion (Cushing’s Syndrome)
What is the class for Ciclesonide
Corticosteroid - anti-inflammatory agent
What is the mechanism for Ciclesonide
Same as other corticosteroids, but is a prodrug and only activated by airway esterase.
What are the therapeutics for Ciclesonide
Cornerstone treatment of persistent asthma; beneficial comination with beta-2 agonist; limited role in COPD
What are the important side effects for Ciclesonide
Less side effects than other corticosteroids (on site activation required)
What is the class for Sodium cromoglycate; Nedocromil sodium
Anti-inflammatory agent
What is the mechanism for Sodium cromoglycate; Nedocromil sodium
Prevent mast cell degranulation and mediator release from mast cells
What are the therapeutics for Sodium cromoglycate; Nedocromil sodium
Prophylaxis for inhibiting both early and late phase reactions; best results in mild and allergic asthma
What are the important side effects for Sodium cromoglycate; Nedocromil sodium
Minimal local side effect (cough & throat irritation)
What is the class for Montelukast (Singulair); Pranlukast (Azlaire); Zafirlukast (Accolate)
Leukotriene inhibitor
What is the mechanism for Montelukast (Singulair); Pranlukast (Azlaire); Zafirlukast (Accolate)
Leukotriene receptor antagonist
What are the therapeutics for Montelukast (Singulair); Pranlukast (Azlaire); Zafirlukast (Accolate)
Add-on therapy in mild persistent asthma; aspirin-induced asthma; prophylaxis for exercise-induced bronchospasm
What are the important side effects for Montelukast (Singulair); Pranlukast (Azlaire); Zafirlukast (Accolate)
Well tolerated
What are the miscellaneous for Montelukast (Singulair); Pranlukast (Azlaire); Zafirlukast (Accolate)
Must monitor liver function test.
What is the class for Zileuton (Zyflo)
Leukotriene inhibitor
What is the mechanism for Zileuton (Zyflo)
Inhibits 5-lipoxygenase and blocks leukotriene synthesis
What are the therapeutics for Zileuton (Zyflo)
Add-on therapy in mild persistent asthma; aspirin-induced asthma; prophylaxis for exercise-induced bronchospasm
What are the important side effects for Zileuton (Zyflo)
Liver toxicity
What is the class for Omalizumab
Anti-IgE mAB
What is the mechanism for Omalizumab
Blocks IgE function.
What are the therapeutics for Omalizumab
Poorly controlled severe asthma
What are the miscellaneous for Omalizumab
Administered by subQ injection every 3 weeks
