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Pharmacology Exam #3 > Asthma > Flashcards

Asthma Flashcards

1
Q

Pathologic increase in the bronchoconstrictor response to antigens and irritants
Caused by bronchial inflammation

A

Bronchial hyperreactivity

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2
Q

Phosphodiesterase (PDE)

A

Enzymes that degrades cAMP (active) to AMP (inactive)

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3
Q

Tacyhphylaxis

A

Rapid loss of responsiveness to a stimulus (e.g. drug)

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4
Q

Asthma Diagnosis

A
  1. Airflow obstruction
  2. Reversibility of airflow obstruction
  3. Prolonged expiration and diffuse wheezes
  4. LIMITATION OF AIRFLOW on PFTs or bronchoprovocation challenge
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5
Q

What is drug therapy aimed to target?

A
  1. Narrow airway
  2. Tightened muscles
  3. Inflammation
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6
Q

What are the asthma treatment goals?

A
  1. Prevent bronchoconstriction-early phase, rescue
  2. Reduce inflammation- Late/Chronic phase, controller
  3. Prevent irritant reaction (IgE)- Late/Chronic phase
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7
Q

What drugs target early response phase (bronchoconstriction)?

A
  1. Beta agonists
  2. Theophylline
  3. Muscarinic antagonists
  4. Leukotriene antagonist
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8
Q

What drugs target late response phase (inflammation)?

A
  1. Steroids
  2. Cromolyn
  3. Leukotriene antagonists
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9
Q

What is the ultimate goal in drug therapy?

A

Relax bronchial tone

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10
Q

Beta Agonists MOA

A

Stimulate adenylyl cyclase (AC)
Increases cAMP in smooth muscle cells
Bronchodilator response

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11
Q

When would you use Albuterol (Short acting beta agonist )?

A

Acute asthma–>Rescue

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12
Q

When would you use Salmeterol (long acting beta agonist)?

A

Asthma proyphlaxis

COPD

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13
Q

Albuterol SEs

A

Tremor

Tachycardia

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14
Q

Salmeterol SEs

A

Tremor
Tachycardia
CV events

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15
Q

Lists antimuscarinic agents

A

Ipatropium

Tiotropium

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16
Q

antimuscarinic agents MOA

A

Competitively block muscarinic receptors

Prevent bronchoconstriction mediated by vagal discharge

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17
Q

When would you use antimuscarinic agents?

A

Asthma

COPD

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18
Q

antimuscarinic agents SEs

A

Dry mouth

Cough

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19
Q

What is unique about antimuscarinic agents?

A

REVERSE bronchoconstriction in some asthma pt’s (esp. children)
AND in COPD pt’s

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20
Q

Where can you find Methylxantines?

A

Plants:

  1. Caffeine
  2. Tea (Theophylline)
  3. Cocoa (Theobromine)
21
Q

Methylxantines MOA

A
  1. Inhibits phosphodiesterase (PDE)
    - increases cAMP–>Bronchodilation
  2. Adenosine receptor antagonist
22
Q

Who would we consider using Methylxantines in?

A

Prophylactic for nocturnal asthma attacks

23
Q

Methylxantines effects

A
  1. Bronchodilation
  2. Cardiac stimulation
  3. CNS effect
  4. Increased muscle strength
24
Q

Methylxantines SEs

A
  1. Insomnia
  2. Seizures
  3. Tremor
  4. Arrhythmias
  5. Anorexia
25
Q

What drug can reverse Theophylline (Methylxantine) CV toxicity?

A

Beta blockers

26
Q

What does Theophylline clearance depend on?

A

Age

27
Q

Who is Theophylline clearance increased in?

A
  1. Young adolescents

2. Smokers

28
Q

What is first line therapy for moderate-to-severe asthma?

A

ICS:

  • Beclomethasone
  • Fluticasone
  • Mometasone
  • Budesonide
29
Q

ICS MOA

A
  1. Inhibition of phospholipase A2
  2. Inhibit expression of COX-2
  3. Increase B adrenoreceptor responsiveness
  4. Prevent full expression of inflammation and allergy
30
Q

ICS SEs

A
  1. Pharyngeal candidiasis
  2. Minimal systemic steroid toxicity
  3. Mild growth retardation
31
Q

Who would we consider using oral Prednisone in?

A

Severe refractory chronic asthma

Acute exacerbations

32
Q

What is the number one cause of adrenal insufficiency?

A

Exogenously administered glucocorticoids (catabolic steroids)

33
Q

What are important medications for status asthmaticus?

A

IV Prednisolone

IV Hydrocrotisone

34
Q

What is the most potent systemic steroid?

A

Dexamethosone

35
Q

List a leukotriene receptor blocker

A

Montelukast (singulair)

LTD4 receptor antagonist

36
Q

What is Montelukast effective in preventing?

A

Exercise, antigen and ASA induced bronchospasm

Prophylaxis

37
Q

List a Lipoxygenase inhibitor

A

Zileuton

38
Q

what allergy is Zileuton effective against?

A

ASA

39
Q

Zileuton MOA

A

selectively inhibits 5-lipoxygenase

reduces synthesis of leukotrienes

40
Q

Zileuton drug toxicity

A

elevated liver enzymes

41
Q

What drugs would we use prior to gardening?

A

Cromolyn and Nedocromil

42
Q

Cromolyn and Nedocromil SEs

A

Cough

43
Q

Omalizumab MOA

A

Antibody that binds to the IgE on sensitized mast cells

44
Q

Omalizumab effects

A

Decreases inflammatory mediator release
Decrease allergic inflammation
Prevents exacerbation of asthma

45
Q

Mepolizumab MOA

A

Monoclonal antibody to IL-5

46
Q

Who would we use Mepolizumab in?

A

Severe eosinophilic asthma

47
Q

What is there an increase in when we treat adults with Mepolizumab?

A

Herpes Zoster

48
Q

What should we consider adding in adult house dust mites sensitive patients with allergic rhinitis who have exacerbations despite ICS tx provided FEV1 is 70% predicted?

A

Sublingual immunotherapy (SLIT)

Pharmacology Exam #3 (6 decks)

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