asthma

Question 1

factors that regulate bronchial airway tone

Answer 1

sympathetic NS relaxation (beta-2)

parasympathetic NS contraction (M3)

Histamine contraction (H1)

leukotrienes inflammation (LT-1)

adenosine mast cell destabilization

cAMP relaxation

Question 2

treatment of the acute symptoms (rescue) of asthma

Answer 2

beta agonist

anti-cholinergic

methylxanthine

Question 3

treatment to prevent atacks (prophylactic/controller)

Answer 3

corticosteroids

anti-leukotrienes

plus rescue agent

Question 4

intermittent attacks

Answer 4

<5 days/month

Question 5

recurrent attacks

Answer 5

> 5 days/month

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

Question 6

short-acting b-adrenergic agonists

Answer 6

albuterol
terbutaline
pirbuterol
bitolterol

Question 7

MOA and use of short-acting beta adrenergic agonists

Answer 7

(acute) to dilate bronchial smooth muscle

MOA: activation of b2-adrenergic receptors

Question 8

long-acting b-adrenergic agonists

Answer 8

salmeterol

formoterol

Question 9

MOA and use of long-acting b-adrenergic agonists

Answer 9

recommended as controller but can be used for acute

MOA: activation of b2-adrenergic receptors

Question 10

methylxanthines

Answer 10

theophylline, theobromine, caffeine

Question 11

MOA and use of methyxanthines

Answer 11

both controller and rescue

MOA: nonspecific inhibition of PDE inhibtion of adenosine receptors

Question 12

difference between short and long-acting b- adrenergic agonists

Answer 12

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

Question 13

similarity between short and long-acting b- adrenergic agonists

Answer 13

both produce bronchodilation

Question 14

why are methylxanthines not used as often?

Answer 14

narrow therapeutic window

availability of newer, safer agents

Question 15

actions of methylxanthines

Answer 15

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

Question 16

glucocorticoids for tx of asthma

Answer 16

anti-inflammatory and use for prophylactic tx of asthma

Question 17

MOA of glucorticoids

Answer 17

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

Question 18

adverse effects of glucocorticoids

Answer 18

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

reduces systemic effects when inhaled

Question 19

gluocorticoid agents for asthma

Answer 19

budesonide and beclomethasone

Question 20

anti-cholinergic agents for asthma

Answer 20

ipratropium and tiotroprium bromide

Question 21

MOA and use for anticholinergic agents

Answer 21

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

Question 22

tiotroprium (Spiriva)

Answer 22

much longer half life (qd)

Question 23

anti-leukotrienes for asthma

Answer 23

zafirlukast and montelukast

Question 24

MOA and use of anti-leukotrienes

Answer 24

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

use for prophylactic tx of asthma NOT RESCUE

Question 25

adverse effects of anti-leukotrienes

Answer 25

liver failure (zafirlukast-liver function tests) neuropsychiatric "events" (agitation, hostility insomnia, and suicidal ideation)

Question 26

mast cell stabilizers

Answer 26

cromolyn and nedocromil sodium

Question 27

MOA and use of mast cell stabilizers

Answer 27

MOA: blockade of Cl- ion transport producing secondary effect to decrease intracellular Ca2+ and decrease cellular activation prophylactic treatment of asthma and allergic rhinitis

Question 28

omalizumab (Xolair)

Answer 28

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)

Question 29

adverse events of omalizumab (Xolair)

Answer 29

anaphylaxis (black box warning) long term use could decrease immune surveillance (increase cancer and parasitic infection risk)

Question 30

intravenous MgSO4 in severe asthma

Answer 30

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