Asthma Flashcards by Aqeel Nabijohn

What is the class for Albuterol; Terbutaline; Metoproterenol; Pirbutal

Bronchodilator - short-acting ?2 agonist)

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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

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What are the therapeutics for Albuterol; Terbutaline; Metoproterenol; Pirbutal

Prevent or reduce exercise-induced bronhospasms; mild asthma & acute exacerbations

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What are the important side effects for Albuterol; Terbutaline; Metoproterenol; Pirbutal

Musculoskeletal tremor, Tachycardia, hyperglycemia, hypokalemia, hypomagnesemia

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What are the other side effects for Albuterol; Terbutaline; Metoproterenol; Pirbutal

Tolerance with chronic use, Prolonged QTc, lactic acidosis, paradoxical bronchospasm

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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.

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What is the class for Salmeterol (Serevent); Formoterol; Indacaterol

Bronchodilator - long-acting ?2 agonist

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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

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What are the therapeutics for Salmeterol (Serevent); Formoterol; Indacaterol

used for long-term control of asthma symptoms (always in comination with inhaled steroids)

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What are the important side effects for Salmeterol (Serevent); Formoterol; Indacaterol

Musculoskeletal tremor, Tachycardia, hyperglycemia, hypokalemia, hypomagnesemia

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What are the other side effects for Salmeterol (Serevent); Formoterol; Indacaterol

Tolerance with chronic use, Prolonged QTc, lactic acidosis, paradoxical bronchospasm

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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

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What is the class for Theophylline (Theolair); Theobromine; Caffeine

Bronchodilator (Methylxanthine)

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What is the mechanism for Theophylline (Theolair); Theobromine; Caffeine

Phosphodiesterase inhibition and enhanced signalling via increased cAMP and cGMP; relax bronchial smooth muscle

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What are the therapeutics for Theophylline (Theolair); Theobromine; Caffeine

Reduce inflammation and bronchospasm in moderate to severe asthma, night symptoms

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What are the important side effects for Theophylline (Theolair); Theobromine; Caffeine

CNS stimulation or seizures, tachycardia/arrythmias, anorexia, nausea

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What are the miscellaneous for Theophylline (Theolair); Theobromine; Caffeine

Low therapeutic index! Metabolized by liver; cimetidine and quinoline increase blood levels

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What is the class for Roflumilast

Methylxanthine

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What is the mechanism for Roflumilast

Selective PDE4 inhibitor; more of an anti-inflammatory agent than bronchodilator

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What are the therapeutics for Roflumilast

COPD

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What are the important side effects for Roflumilast

CNS stimulation or seizures, tachycardia/arrythmias, anorexia, nausea

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What is the class for Ipratropium (Atrovent); Tiotropium; Atropine

Quarternary amine antimuscarinic

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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