asthma Flashcards
(30 cards)
factors that regulate bronchial airway tone
sympathetic NS relaxation (beta-2)
parasympathetic NS contraction (M3)
Histamine contraction (H1)
leukotrienes inflammation (LT-1)
adenosine mast cell destabilization
cAMP relaxation
treatment of the acute symptoms (rescue) of asthma
beta agonist
anti-cholinergic
methylxanthine
treatment to prevent atacks (prophylactic/controller)
corticosteroids
anti-leukotrienes
plus rescue agent
intermittent attacks
<5 days/month
recurrent attacks
> 5 days/month
> 3 months/year or >50% of the days in any one month
short-acting b-adrenergic agonists
albuterol
terbutaline
pirbuterol
bitolterol
MOA and use of short-acting beta adrenergic agonists
(acute) to dilate bronchial smooth muscle
MOA: activation of b2-adrenergic receptors
long-acting b-adrenergic agonists
salmeterol
formoterol
MOA and use of long-acting b-adrenergic agonists
recommended as controller but can be used for acute
MOA: activation of b2-adrenergic receptors
methylxanthines
theophylline, theobromine, caffeine
MOA and use of methyxanthines
both controller and rescue
MOA: nonspecific inhibition of PDE inhibtion of adenosine receptors
difference between short and long-acting b- adrenergic agonists
short-acting = “as needed” for acute sx
long acting = prophylaxis (nocturnal); NOT RECOMMENDED for tx of acute sx due to beta-adrenergic receptor desensitization but can be used in emergency
similarity between short and long-acting b- adrenergic agonists
both produce bronchodilation
why are methylxanthines not used as often?
narrow therapeutic window
availability of newer, safer agents
actions of methylxanthines
at concentration can inhibit PDE4 to increase cAMP and cause bronchodilation
at low concentrations can at on A2A receptor to promote wakefulness via vasoconstriction of cerebral blood vessels
act on A2B to block adenosine-mediated mast cell degranulation
glucocorticoids for tx of asthma
anti-inflammatory and use for prophylactic tx of asthma
MOA of glucorticoids
acts at nuclear receptors to decrease the expressions of cytokines and PLA2 (decrease COX/LOX pathway activity)
adverse effects of glucocorticoids
suppression of glucocorticoid production can cause immunosuppression and affect growth in children
reduces systemic effects when inhaled
gluocorticoid agents for asthma
budesonide and beclomethasone
anti-cholinergic agents for asthma
ipratropium and tiotroprium bromide
MOA and use for anticholinergic agents
relaxes bronchial smooth muscle via muscarinic cholinergic antagonist
tx of COPD and off-label use for mod-severe asthma w/ short-acting beta agonist
not recommended for tx of acute attacks
tiotroprium (Spiriva)
much longer half life (qd)
anti-leukotrienes for asthma
zafirlukast and montelukast
MOA and use of anti-leukotrienes
MOA: inhibit 5-lipoxygenase (zileuton) or block actions of cytsinyl leukotrienes
use for prophylactic tx of asthma NOT RESCUE