Asthma and COPD Flashcards
Acute anti-asthmatic regime
Bronchodilators
(Quick relief medications)
• Short acting B2- Agonists
• Antimuscarinics
• Methylxanthines
AIDs:
GCs
mast cell stabilizers
Leukotrienes antagonists
IgE antibody
Long acting B2-agonists
B2 agonists for asthma
Short acting:
Salbutamol
Terbutaline
Long acting: (with inhaled GCs)
Salmetrol
Formoterol
MOA for Bronchodilators: β2 -agonists
Stimulate adenylyl cyclase = ↑↑cAMP in smooth muscles»_space; bronchodilation
ADRs of Bronchodilators: β2 -agonists
Muscle tremor
(direct effect on skeletal muscle β2 receptors)
Tachycardia
(direct effect on atrial β2 receptors) & arrhythmias
Hypokalemia
(due to β2 receptor stimulation of potassium entry into skeletal muscle)
Metabolic effects
(↑ FFA, glucose, lactate, pyruvate, insulin) •
TOLERANCE
Contraindicated: β receptor antagonists
Bronchodilators: Anti-muscarinic agents
IPRATROPIUM (short acting)
TIOTROPIUM (long acting)
MOA of Bronchodilators: Anti-muscarinics
Competitively inhibition of acetylcholine at airways muscarinic receptors
˃» Prevent Ach mediated bronchoconstriction & inhibit mucus secretion
Bronchodilators: Anti-muscarinic Caution?
patients with benign prostatic enlargement or glaucoma
Bronchodilators: Methylxanthines Agents
THEOPHYLLINE (oral)
AMINOPHYLLINE (IV)
MOA of Methylxanthines
Inhibit phosphodiesterase (PDE-3) resulting in ↑cAMP»_space;
bronchodilation
Also block adenosine receptors.
PK of Methylxanthines
- Narrow TW
- Metabolized by CYP1A2 and 3A4
- Age dependent metabolism
- half-life in children is shorter
ADRs of Methylxanthines:
-Tachicardya
- Arrhthmia
- palpitations
- Tremors
- Insomnia
-Nervousness and Seizures
Use Beta blockers for cardia toxicity
What two corticosteroids that have great first-pass metabolism
Budesonide and Fluticasone
GCs MoA
-inhibition of Phospholipase-A2
-mast cell stabilization
-Upregulation of B2 adrenergic receptors
ADRs of GCs
Inhaled:
- fungal Infection and hoarseness of voice (prevented by gargle)
-Large dose —- systemic
systemic:
- Na and H2O retention, hypertension, peptic ulcer, hyperglycemia, cataract
- immune suppression
-Cushing’s syndrome and adrenal suppression
-withdrawal cause adrenal insufficiency
Leukotriene modifiers drugs
Lipoxygenase inhibitor:
(↓↓ Leukotriene synthesis):
-ZILEUTON
Leukotriene receptor antagonists:
-MONTELUAST
-ZAFIRLUKAST
Adrs of Leukotriene modifiers (antagonists)
Churg-Strauss syndrome:
vasculitis that may affect the heart, peripheral nerves, and kidney
Mast cell stabilizers
CROMOLYN
NEDOCROMIL
IgE antibody for treatment of severe asthma
Omalizumab
Bronchodilators used for COPD and MOA
ipratropium
Mucolytic agents used for COPD
acetylcysteine
bromohexine
ambroxol
Roflumilast moa
Long-acting selective phosphodiesterase-4 inhibitor
▪ ↓↓ frequency of exacerbations of COPD
