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pharmacology > asthma > Flashcards

asthma Flashcards

1
Q

factors that regulate bronchial airway tone

A

sympathetic NS relaxation (beta-2)

parasympathetic NS contraction (M3)

Histamine contraction (H1)

leukotrienes inflammation (LT-1)

adenosine mast cell destabilization

cAMP relaxation

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2
Q

treatment of the acute symptoms (rescue) of asthma

A

beta agonist

anti-cholinergic

methylxanthine

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3
Q

treatment to prevent atacks (prophylactic/controller)

A

corticosteroids

anti-leukotrienes

plus rescue agent

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4
Q

intermittent attacks

A

<5 days/month

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5
Q

recurrent attacks

A

> 5 days/month

> 3 months/year or >50% of the days in any one month

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6
Q

short-acting b-adrenergic agonists

A

albuterol
terbutaline
pirbuterol
bitolterol

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7
Q

MOA and use of short-acting beta adrenergic agonists

A

(acute) to dilate bronchial smooth muscle

MOA: activation of b2-adrenergic receptors

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8
Q

long-acting b-adrenergic agonists

A

salmeterol

formoterol

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9
Q

MOA and use of long-acting b-adrenergic agonists

A

recommended as controller but can be used for acute

MOA: activation of b2-adrenergic receptors

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10
Q

methylxanthines

A

theophylline, theobromine, caffeine

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11
Q

MOA and use of methyxanthines

A

both controller and rescue

MOA: nonspecific inhibition of PDE inhibtion of adenosine receptors

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12
Q

difference between short and long-acting b- adrenergic agonists

A

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

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13
Q

similarity between short and long-acting b- adrenergic agonists

A

both produce bronchodilation

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14
Q

why are methylxanthines not used as often?

A

narrow therapeutic window

availability of newer, safer agents

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15
Q

actions of methylxanthines

A

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

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16
Q

glucocorticoids for tx of asthma

A

anti-inflammatory and use for prophylactic tx of asthma

17
Q

MOA of glucorticoids

A

acts at nuclear receptors to decrease the expressions of cytokines and PLA2 (decrease COX/LOX pathway activity)

18
Q

adverse effects of glucocorticoids

A

suppression of glucocorticoid production can cause immunosuppression and affect growth in children

reduces systemic effects when inhaled

19
Q

gluocorticoid agents for asthma

A

budesonide and beclomethasone

20
Q

anti-cholinergic agents for asthma

A

ipratropium and tiotroprium bromide

21
Q

MOA and use for anticholinergic agents

A

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

22
Q

tiotroprium (Spiriva)

A

much longer half life (qd)

23
Q

anti-leukotrienes for asthma

A

zafirlukast and montelukast

24
Q

MOA and use of anti-leukotrienes

A

MOA: inhibit 5-lipoxygenase (zileuton) or block actions of cytsinyl leukotrienes

use for prophylactic tx of asthma NOT RESCUE

25
Q

adverse effects of anti-leukotrienes

A

liver failure (zafirlukast-liver function tests)

neuropsychiatric “events” (agitation, hostility insomnia, and suicidal ideation)

26
Q

mast cell stabilizers

A

cromolyn and nedocromil sodium

27
Q

MOA and use of mast cell stabilizers

A

MOA: blockade of Cl- ion transport producing secondary effect to decrease intracellular Ca2+ and decrease cellular activation

prophylactic treatment of asthma and allergic rhinitis

28
Q

omalizumab (Xolair)

A

monoclonal antibody to decrease IgE bidning to mast cells and release of histamine

used in mod-severe asthma w/ high levels of circulating IgE (injetcion q4-6 weeks)

29
Q

adverse events of omalizumab (Xolair)

A

anaphylaxis (black box warning)

long term use could decrease immune surveillance (increase cancer and parasitic infection risk)

30
Q

intravenous MgSO4 in severe asthma

A

MOA: inhibit contraction of vascular, uterine and bronchial smooth muscles

emergency room situations for unresponsive patients w/ severe bronchoconstriction

other indication: pre-eclampsia, pre-term labor, hypertensive crisis w/ pheochromocytoma

pharmacology (3 decks)

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