Asthma and COPD Flashcards
extrinsic asthma
external stimuli trigger IgE antibody formation causing mast cell degranulation and inflammation
intrinsic astham
non allergic factors such as dry air, stress, viruses
four things in airway hypertrophy
fibrosis
muscle hypertrophy
mucus hypersecretion
angiogenesis
bronchodilator drugs
leukotriene modifiers
beta agonists
anticholinergic
methylxanthine
anti inflammatory drugs
leukotriene modifiers
corticosteroids
mast cell stabilizers
anti - IgE monoclonal antibodies
examples of beta agonists
salbutamol
salmeterol - long acting
terbutaline
albuterol
example of methylxanthine
theophylline
example of leukotriene modifier
montelukast
zileuton
zafirlukast
example of anticholingerics
ipratropium
tiotropium
autonomic effects on airway smooth muscle
para muscarinic - contraction, increased secretion
sym adrenergic - dilation
how is calcium decreased to cause dilation
increase in camp causes SR to pump out calcium
how is calcium increased to cause constriction
ach binds to GPCR which activates PLC and cause release of IP3 and DAG
adenosine also activates PLC
beta agonist moa
increase adenylate cyclase which causes a decrease in calcium so dilation
routes of bate agonists
inhlaed
tablet albuterol and terbutaline
sc terbutaline
indication of beta agonists
acute attacks
epinephrine or sc for severe attacks
what else should beta agonists be administered with and why
corticosteroids to prevent desensitization of teh recepors and improve efficacy
adverse effect of beta agonists
tachycardia
muscle tremor
tolerance
drug interactions with beta agonists
propranolol
mechanism of methylxanthines
inhibit adenosine receptors
inhibit phosphodiesterase resulting in an increase in camp
stimulate contractility of diaprahgm muscles
theophylline route
aerosol safest
other have heart and cns effects
indication of theophylline
second choice for acute exacerbations
copd
must be monitored due to narrow TI
common side effects of teophylline
headache
tremor
insomnia
drug interactions with theophylline
metabolized by cyp enzymes
increased cardiac effects if given with a beta agonist
anticholinergics moa
block muscarinic receptors resulting in decreased mucus secretion and bronchoconstrition
no effect on inflammation
anticholinergics route of admin
aerosol
indications for ipatropium
copd
asthma if intolerant to beta agonists
chronic bronchitis
can be used in combo with beta agonists
why do leukotriene modifiers help with nsaid induced asthma
nsaids inhibit cox enzymes so increase in leukotriene synthesis. block lipoxygenase to prevent the leukotriene synthesis
zileuton moa
inhibit 5 lipoxygenase
zileuton admine
oral 4 times a day
indication of zileuton
asa induced asthma
severe asthma in adults
exercise inducced
adverse effects of zileuton
possible hepatotoxicity monitor liver enzymes
drug interactions of zileuton
inhibits cyp 450, dont take with theophylline or warfarin
zafirlukast and montelukast moa
inhibit cyslt1 receptor
prevents bronchoconstriction, airway wall edema, chemotaxis
zafirlukast adverse reactions ad montelukast
headache
gi disturbance
liver hepatotoxicity - monitor
drug interactions of zafirlukast and montelukast
inhibits cyp450
mast cell stabilizers
cromolyn sodium
nedocromil
anti IgE monoclonal antibody
omalizumab
corticosteroid moa
blocks release of arachidonic acid
increase sensitivity of beta adrenergic receptos
prevents airway remodelling
coticosteroid route of admin
aerosol for moderate asthma and copd
iv or oral for severe cases
adverse effects of aerosol glucocorticoids
thrush
hoarseness
why take glucocorticoids in the morning
night is when they are normally synthesized endogenously by the body
mast cell blockers moa
inhibt release of mediators from mast cells
route of admin for mast cell blockers
aerosol 3-4 times a day
mast cell blocker indication
mild to moderate asthma in children of all ages
does not inhibit ongoing bronchoconstriction but reduces hypersensitivity
side effects of mast cells blockers
throat irriation
cough
congestion
moa of omalizumab
binds to free IgE reducing the amount and preventing binding
indication for omalizumab
allergic asthma
route of admin for omalizumab
subcutaneous
adverse reaction for omalizumab
anaphylaxis
mild copd treatment
bronchodilators
moderate copd treatment
bronchodilators and anti inflammatory
severe copd therapy
bronchodilators
anti inflammatory
antibiotics
oxygen therapy
