Asthma

Question 1

Albuterol

Answer 1

• B2 adrenergic agonist
• Quick relievers – stimulate adenyl cyclase and cAMP to induce relaxation of bronchial smooth muscle
• Fewer side effects
• Inhaled form – short term relief of asthma

Question 2

Salmeterol w/ fluticasone

Answer 2

• B2 adrenergic agonist
• Quick relievers – stimulate adenyl cyclase and cAMP to induce relaxation of bronchial smooth muscle
• Increased side effects (tachycardia, muscle tremors, headache)
• Inhaled form but longer acting relief of asthma

Question 3

• Beclomethasone
• Budesonide
• Fluticasone
• Triamclinolone

Answer 3

• Corticosteroid
• Long-term reduction of asthma symptoms – inhibition of PLA2 expression, reduced synthesis of chemotactic factors and recruitment of leukocytes, inhibition of cytokine expression
• Generally well tolerated because of low bioavailability
• Aerosol inhalation for asthma

Question 4

Prednisone

Answer 4

• Corticosteroid
• For when symptoms aren’t well controlled - inhibition of PLA2 expression, reduced synthesis of chemotactic factors and recruitment of leukocytes, inhibition of cytokine expression
• Abnormalities in glucose metabolism and diabetes, HTN, Cushing’s syndrome, increased infection
• Oral – intermediate term relief, reduction in inflammation and hyper-responsiveness to control asthma

Question 5

• Montelukast

- Zafirlukast

Answer 5

• Leukotriene modulator
• Long-term controller – LTD4 receptor antagonist to reduce bronchoconstriction and edema
• Well tolerated
• Oral administration – can reduce corticosteroid dosage for asthma

Question 6

Zileuton

Answer 6

• Leukotriene modulator
• Long-term controller – inhibition of 5-LOX inhibits synthesis of LTB4 and LTD4
• Liver toxicity and can decrease metabolism of other drugs
• Oral administration – asthma

Question 7

• Cromolyn

- Nedocromil

Answer 7

• Degranulation inhibitor
• Long-term controller – inhibits degranulation of mast cells (Ca channels) and inhibition of Cl- channels (nerve activity to inhibit cough)
• Generally well tolerated
• Inhaled aerosol – effective prophylactically for asthma

Question 8

Ipratropium

Answer 8

• Muscarinic cholinergic antagonist
• Bronchodilator – slower acting, less effective than B2 agonists – inhibit parasympathetic responses
• 4 ammonium so doesn’t enter CNS
• Inhalation – useful for asthma patients intolerant of B2 agonists

Question 9

Theophylline

Answer 9

• Miscellaneous asthma
• Inhibit posphodiesterase degradation of cAMP (increase cAMP levels) and relaxes bronchial smooth muscle
• Tachycardia and CNS stimulation (monitor serum levels – variable metabolic clearance)
• Long-term maintenance – oral therapy of asthma