Asthma Flashcards
Drugs used in asthma
Bronchodilators
Anti-inflammatory
Leukotriene modifiers
Bronchodilators
Beta agonists
Antimiscarinic agents
Methylxanthines
Anti-inflammatory agents
Corticosteroids
Mast cell stabilizers
Leukotriene modifiers
Leukotriene receptor antagonists
Lipoxygenase inhibitor
MOA of beta agonists
Stimulate beta-2 adrenergic receptors
Activate adenyl cyclase
Non selective adrenergics
Epinephrine
Ephedrine
Non selective beta adrenergic which is a bronchodilator and cardiac stimulant
Isoproterenol
Adverse effect of isoproterenol
Cardiac arrhythmias
DOC for ACUTE asthma
Selective beta-agonists
Adverse effects if beta agonists
Tachyphylaxis
Loss of drug response over time
Tachyphylaxis
Rapid onset, short duration
Salbutamol
Terbutaline
Fenoterol
Slow onset, long duration
Salmeterol
Bambuterol
Rapid onset, long duration
Formoterol
Medium potency bronchodilators
Narrow therapeutic index
Methylxanthines
MOA of methylxanthines
Increase cAMP by inhibition of phosphodiesterase
Inhibition of adenosine receptor
MOA of anticholinergics
Inhibit acetylcholine effects by blocking M2 RECEPTOR which leads to BRONCHODILATION
Anticholinergics
Atropine sulfate
Ipratropium bromide
Glycopyrrolate
No use in the treatment if acute asthma attacks
Mast cell stabilizers
Most effective anti-inflammatories for asthma
Inhaled Corticosteroids
Systemic corticosteroids are for
Status asthmaticus
Common first-line therapy for moderate to severe asthma
Inhaled corticosteroids
Precautions of inhaled corticosteroids
Oral thrush
Retardation of growth in children
Potent neutrophil chemoattractant
LTB4
A clinical syndrome comprising severe asthma associated with vasculitis
Churg-Strauss syndrome
inihibits 5lipoxygenase thereby preventing leukotriene synthesis
Lipoxygenase inhibitor
Other drugs for asthma
Calcium channel blockers
Nitric oxide donora
Potassium channel openers: Cromokalim
OMALIZUMAB
Prevents binding of gE to mast cells preventing degranulation (prophylaxis)
Omalizumab
Humanized murine monoclonal antibody
Omalizumab
Preferred treatment for asthma in young children
Inhaled corticosteroids
Alternative for asthma in young children
Montelukast and cromolyn
Adults may develop _________ with inhaled corticosteroids
Weak bones
COPD is preventable by avoiding
Precipitating factors
Permanent abnormal enlargement of the air sacs distal to the terminal bronchiole with destruction of alveolar septa and attachments to the bronchial walls
Emphysema
Emphysema results to the
Breakdown of elastin by proteases
Excessive tracheobronchial mucus production
Inflammation of the major and small airways
Chronic bronchitis
Primary factor of COPD
Smoking
Genetic factor that may cause COPD
Alpha1-antitrypsin deficiency
Supplement therapy includes
Pulmonary rehabilitation
Oxygen therapy
Mainstay treatment for COPD
Bronchodilators
Added to drug regimen after an unsuccessful trial of ipratropium bromide and B2 agonists
Theophylline
Added to the drug regimen after maximal ipratropium bromide and B2 agonist therapy
Reduce airway inflammation
Corticosteroids
As a result of asthma, more energy is needed for ventilation, requiring accessory muscles called
Sternocleidomastoid
A severe condition in which asthma attacks follow one another without pause
Status asthmaticus
For ACUTE ASTHMA ATTACKS
Provide prompt relief
Bronchodilators
Most important sympathomimetics which reverse asthmatic bronchoconstriction
Beta agonists
Beta agonists are given by
Inhalation
MOA of beta agonists
Stimulate beta adrenergic receptors
Activate adenyl cyclase
Adverse effects of epinephrine
Tachycardia
Arrhythmias
Worsenig of angina pectoris
Chest pain or discomfort die to coronary heart disease
Angina pectoris
Used infrequently due to the advent of selective beta agonists
Ephedrine
Systemic adverse effects of atropine sulfate
Urinary retention
Loss of visual accommodation
Agitation
Tachycardia
Quaternary anmonium derivative of atropine sulfate but is more preferred due to lesser adverse affects
Ipratropium bromide
Ipratropium bromide is not indicated as initial treatment for bronchospasm because it can cause
Prostatic hypertrophy
Glaucoma
Used in combination with beta agonists for SEVERE ACUTE ASTHMA
Glycopyrrolate
Methylxanthines
Aminophylline
Oxtriphylline
Theophylline
MOA of Mast Cell Stabilizers
Inhibit mast cell DEGRANULATION
Mast cesll stabilizers in asthma are only for
Prophylaxis
MOA of Corticosteroids
Inhibits:
1) phospholipase A2 -> inhibits reduce arachidonic acid
2) COX-2 expression
3) leukotriene production
4) cytokine
Most frequently used corticosteroids
Prednisone PO
Systemic corticosteroids
Hydrocortisone IV
Prednisone PO
Prednisolone IV
Methylprednisone IV
Contraindications of SYSTEMIC CORTICOSTEROIDS
Immunosuppression
Systemic fungal infections
Positive of candida
Sustemic effects of inhaled corticosteroids
Osteoporosis
Skin changes
Change in adrenal function
Cataract formation
To prevent oral thrush, use
Spacer or
Holding chamber
Newest anti-inflammatory agents used in asthma
Leukotriene antagonists
LTC4 and LTD4 causes
Bronchoconstriction
Increased bronchial reactivity
Mucos edema
Mucus hypersecretion
Leukotriene receptor antagonists
Zafirlukast and Montelukast
MOA of leukotriene receptor antagonists
Prevent leukotrienes from interacting with their receptors
Zafirlukast is a ______ receptor antagonist
Dose:
LTD4
20mg twice daily
Dose of zileuton
600 mg 4x a day
Calcium channel blockers
Verapamil
Nifedipine
Other drug for asthma that inhibit airway hyperactivity
Potassium channel openers: Cromakalim
Omalizumab is given __________ one or two times a month
Parenterally
When taking inhaled corticosteroids, older adults should also take
Calcium and vit D pills