Asthma and COPD pharmacotherapy Flashcards
What are the two main therapeutic interventions?
bronchodilators and inflammatory agents
Beta2 receptor stimulation causes…
relaxation of bronchial smooth muscle
inhibition of inflammatory mediator release
stimulation of mucocilliary clerance
Potential adverse effects of non-selective bronchodilators?
Beta 1 and alpha agonist activity can cause myocardial stress by increasing HR and vasoconstriction.
Whats the MOA of selective Beta 2 agonists?
causes smooth muscle relaxation via B2 agonism, leads to increase adenyl cyclase, leads to increased CAMP leads to antagonism of bronchoconstriction
What are the three short acting beta 2 agonists?
Albuterol, levalbuterol, pirbuterol
What are the long acting beta 2 agonists?
salmeterol, formeterol, arfomotrol, albuterol ER, indacaterol, vilanterol
can asthmatics use long acting beta2 agonists as monotherapy?
no!!! but CAN be used as monotherapy for COPD!
Whats the mechanism of action for anticholinergics?
inhibit muscarining cholinergic receptors and reduce intrinsic vagal tone of the airway
What is an example of short acting anticholinergic?
Ipratropium
What are side effects of anticholinergics?
dry mouth for ipratropium, pharyngitis/sinusitis/cough/diarrhea for others
What are the long acting anticholinergics?
tiotropium, aclidinium
Which drugs selectively and competitively inhibit the Cys LT1 receptor?
Montelukast and Zafirlukast
leukotriene receptor antagonists
What is the MOA for Zileuton?
5-Lipox inhibitor:
inhibits production of leukotrienes from arachidonic acid, ltb4 and cysteiyl leukotrienes
Are the antileukotriene agents short or long acting?
long!
What type of toxicity should we watch for in zafirlukast and zileuton?
hepatitis! elevated LFTs
What’s the corticosteroid MOA?
inhibit leukocyte recruitment to airway
inhibit enzyme PLA2 so decrease production of prostaglandins and leukotrienes
decrease inflammation by stabilizing lysosomes in neutrophils (prevent degran)
upreg of antiinflamm genes
decrease stabilityh of some mRNA
What is the main difference between all of the inhaled corticosteroids?
DOSAGE!! same efficacy just different number of puffs per day
what are side effects of corticosteroids?
COUGH, dysphonia, oral thrush (just rinse after using!), high dose adrenal suppression, low dose decrease growth velocity in children
What’s the methylxanthine MOA?
nonselective inhibition of phoshpodiesterase (inc cAMP, smooth muscle relax)
direct/indirect effects on calcium
mild anti-inflamm
Which class of drugs has the most narrow Therapeutic index?
methylxantines!
what’s the drug class of Roflumilast?
PDE-4 inhib
accum cAMP
What is Roflumilast used for?
ONLY COPD! (late stage)
what’s the difference between PDE-4 inhibitors and methylxanthines?
PDE-4 inhib is a selective phosphodiesterase inhibit AND it is available as a tablet
What drug is a mast cell stabilizer?
Cromolyn
