Asthma and COPD Treatments

Question 1

Bronchodilators: Beta-2 Agonist

Answer 1

Albuterol, salmeterol

Question 2

Bronchodilator: Methylxanthines

Answer 2

Theophylline

Question 3

Bronchodilator: Anticholinergics

Answer 3

Ipratropium

Question 4

Anti-Inflammatory Agent: Glucocorticoids

Answer 4

Fluticasone, prednisone

Question 5

Anti-Inflammatory Agent: Leukotriene modifiers

Answer 5

Montelukast, zileuton

Question 6

Anti-Inflammatory Agent: Mast cell stabilizer

Answer 6

Cromolyn

Question 7

Anti-Inflammatory Agent: IgE antagonist

Answer 7

omalizumab

Question 8

Major and Minor MOA for Beta-2 agonists

Answer 8

Major: stimulation of beta-2 receptors , elevates cAMP, produces relief from bronchospasm.
Minor: anti-inflammatory effect of beta-2 receptor: inhibits release of histamine from mast cells.

Question 9

Rapid onset/short-acting inhaled beta-2 agonist

Answer 9

Albuterol- onset in 1-5 minutes, last ~4hrs

Question 10

Slower onset/ long acting inhaled beta-2 agonist

Answer 10

Salmeterol- USED ALWAYS in combination with a glucocorticoid- lasts 10-12 hours

Question 11

T/F: When used alone, long-acting inhaled agents INCREASE the risk of severe asthma attacks and asthma related death

Answer 11

TRUE

Question 12

Adverse effects of beta-2 agonists

Answer 12

Tachycardia, palpitations, tremor can occur at high doses and oral admin.

Question 13

Name a methylxanthine and the MOA:

Answer 13

Theophylline: Unclear MOA. Non-specific inhibitor of phosphodiesterases that degrade cAMP (elevates cAMP).

1) PDE3 inhibition: bronchodilation
2) PDE4 inhibition- anti-inflammatory/ immuno-modulatory actions

Question 14

If you want to give a patient an alternative to LABAs with ICS therapy or your patient cannot take or poorly compliant with inhaled medications, what can you give?

Answer 14

THEOPHYLLINE

Question 15

Adverse effects of thephylline

Answer 15

1) Large variability in CYP-mediated metabolism leads to wide variations in blood levels.
2) Few effects at low doses
3) Higher doses cause nausea, nervousness, anxiety, headache, insomnia
4) Severe dysrhythmias and seizures at toxic doses.
5) Many drug interactions

Question 16

List an anticholinergic agent used for asthma and the MOA

Answer 16

Ipratropium: Blocks muscarinic (M3)receptors to attenuate vagal-stimulated bronchoconstriction- bronchodilation is slower onset and less intense that with beta agonists

Question 17

Therapeutic uses for ipratropium

Answer 17

FDA approved for only symptomatic COPD used off label for asthma

Question 18

Name that drug: An anti-inflammatory drug that has no effect on acute broncoconstriction, binds to GC receptors to inhibit inflammation thus reducing bronchial hyper-reactivity, and decreases airway mucus production increasing responsiveness of beta-2 agonists?

Answer 18

Fluticasone

Question 19

Therapeutic uses for fluticasone

Answer 19

First-line for chronic asthma prophylaxis; inhalation on a fixed schedule. Controls symptoms, improves function, prevents irreversible airway changes and may alter course of disease.

Question 20

Giving fluticasone can have what adverse effects?

Answer 20

Oropharyngeal candidiasis and dysphonia

Question 21

List a mast cell stabilizer and the MOA

Answer 21

Cromolyn: MOA unclear- Stabilizes cytoplasmic membrane of mast cells preventing release of histamine.

Question 22

Leukotriene Modifiers and MOA

Answer 22

Montelukast and Zileuton: Suppress the effects of leukotrienes.
Montelukast: Leukotriene (LTD4) receptor antagonist
Zileuton: Leukotriene synthesis inhibitor

Question 23

Therapeutic uses of Leukotriene modifiers

Answer 23

Taken orally. Alternatives to inhaled steroids and as an add-on therapy. Aspiring sensitive asthma. Limited usefulness for acute attacks.

Question 24

List an IgE antagonist and the MOA

Answer 24

Omalizumab: Monoclonal antibody against IgE. Reduces amount of IgE capable of binding to receptors on mast cells. Limits the ability of allergens to trigger histamine release from mast cells.