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respiratory > Asthma and drugs > Flashcards

Asthma and drugs Flashcards

1
Q

asthma mechanism

A

bronchial hyperresponsiveness causes reversible bronchoconstriction

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2
Q

asthma can be triggered by

A
  1. viral URI
  2. allergens
  3. stress
  4. exercise
  5. tobacco
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3
Q

test asthma with

A

metacholine challenge

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4
Q

asthma symptoms and clinical findings

A
  1. cough 2. wheezing 3. tachypnea 4. dyspnea
  2. hypoxemia 6. decreased inspiratory/expiratory ratio
  3. puslus paradoxous 8. mucus plugging
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5
Q

pulsus paradoxus - seen in

A
  1. cardiac teponade 2. asthma 3. obstructive sleep apnea

4. pericarditis 5. croup

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6
Q

pulsus paradoxus - definition

A

decreased in amplitude of systolic BP by >10 during inspiration

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7
Q

inspiratory/expiratory ratio in asthma

and why

A

decreased

expiration is prolonged

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8
Q

asthma - histology

A
  1. smooth muscle hypertrophy
  2. Curschmann spirals
  3. Charcot - Leyden crystals
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9
Q

Curschmann spirals

A

shed epithelium forms whorled mucus plugs (IN ASTHMA)

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10
Q

Charcot - Leyden crystals

A

eosinophilic, hexagonal, double-pointed, needle-like crystal from breakdown of eosinophils in sputum (IN ASTHMA)

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11
Q

Charcot - Leyden crystals - seen in

A

asthma

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12
Q

asthma bronchoconstriction is mediated by

A
  1. inflammatory process

2. parasympathetic tone

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13
Q

asthma drugs

A
  1. β2 agonists (albuterol, salmeterol, formoterol)
  2. corticosteroids (fluticasone, budesonide)
  3. Muscarinic antagonists (ipratropium)
  4. Antileukotrienes (montelukast, zafirlukast, zileuton)
  5. omalizumab
  6. Methylxanthines (theophylline)
  7. Metacholine
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14
Q

asthma - β2 agonists drugs

A
  1. albuterol
  2. saleterol
  3. formoterol
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15
Q

asthma - albuterol mechanism of action

A

β2 agonists–> relaxes bronchial smooth muscle

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16
Q

asthma - albuterol used in

A

during acute exacerbation

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17
Q

asthma - salmeterol mechanism of action

A

β2 agonists–> relaxes bronchial smooth muscle

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18
Q

asthma - formoterol mechanim of action

A

β2 agonists–> relaxes bronchial smooth muscle

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19
Q

asthma - β2 agonists mechanim of action

A

relaxes bronchial smooth muscle (increase cAMP)

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20
Q

asthma - salmeterol side adverse effects

A
  1. tremor

2. arrhythmia

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21
Q

asthma - formoterol side adverse effects

A
  1. tremor

2. arrhythmia

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22
Q

asthma - corticosteroids drugs

A
  1. fluticasone

2. budesonide

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23
Q

role of corticosteroids (fluticosine, budesonide) in asthma therpay

A

1st line therapy for chronic asthma

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24
Q

asthma - corticosteroids (fluticosine, budesonide) - mechanism of action

A

Inhibit the synthesis of virtually ALL CYTOKINES. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents

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25
Q

asthma - muscarinic antagonists drugs

A
  1. ipratropium

2. Tiotropium

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26
Q

asthma - muscarinic antagonists (ipratropium, tiotropium) mechanism of action

A

competitively blocks muscarinic receptors, PREVENTING BRONCHOCONSTRICTION

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27
Q

lung - muscarinic antagonists (ipratropium, tiotropium) -

used in

A
  1. athma

2. COPD

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28
Q

asthma - muscarinic antagonists (ipratropium, tiotropium) - except asthma is used in

A

COPD

29
Q

asthma - ipratropium vs tiotropium according to action

A

tiotropium is long acting

30
Q

metacholine mechanism of action

A

Muscarinic receptor M3 agonist –> bronchoconstriction

31
Q

metacholine - used in

A

used in bronchial challenge test to help diagnose astma

32
Q

asthma challenge test can also be with

A

histamine

33
Q

omalizumab - mechanism of action

A

Monoclonal anti-IgE antibody. It binds mostly unbound serum IgE and blocks binding to FcεRI

34
Q

omalizumab used in

A

allergic asthma resistant to inhaled steroids and long-acting β2-agonist

35
Q

omalizumab binds mostly

A

unbound serum IgE

36
Q

athma - antileukotrienes drugs

A
  1. montelukast
  2. zafirlukast
  3. Zileuton
37
Q

montelukast, zafirukast mechanism of action

A

block leukotriene receptor (CysLT1)

38
Q

Zileuton mechanism of action

A

5-lipoxygenase pathway inhibitor. Block conversion of arachnoid acid to leukotrienes

39
Q

montelukast, zafirukast - clinical use

A

asthma (especially aspirin-induced asthma)

40
Q

zileuton side effect

A

hepatotoxicity

41
Q

asthma - methylxanthines drugs

A

Theophylline

42
Q

theophylline mechanism of action

A

inhibits phosphodiesterase –> increased cAMP –> BRONCHODILATION

43
Q

theophylline is metabolized by

A

cytochrome P-450

44
Q

theophylline block action of

A

adenosine

45
Q

adenosine receptor antagonists

A
  1. theophylline

2. caffeine

46
Q

theophilline usage in asthma is limited because

A

narrow therapeutic index

47
Q

theophylline adverse effects

A
  1. cardiotoxicity

2. neurotoxicity

48
Q

asthma related response to mediators (leukotrienes, histamine etc) is divided to

A

early response –> bronchoconstriction –> symptoms

late response –> inflammation –> bronchial hyperreactivity

49
Q

late response in asthma?

inhibitors of this response?

A

inflammation

inhibited by steroids and abtuleukotrienes

50
Q

early response in asthma?

inhibitors of this response?

A

bronchoconstriction

inhibited by β-agonists, theophylline, muscarinic, antagonists

51
Q

cAMP in asthma therapy

A

it induces bronchodilation

52
Q

adenosine in lungs

A

bronchoconstriction

53
Q

ach in lungs

A

bronchoconstriction

54
Q

asthma treatment for acute exaceberation

A

albuterol

55
Q

1st line therapy for chronic asthma

A

corticosteroids (fluticasone, budesonide)

56
Q

aspirin-induced asthma treatment

A

montelukast

zafirlukast

57
Q

asthma drug with cardiotoxicity as a side effect

A

theophylline

58
Q

asthma drug with hepatotoxicity as a side effect

A

zileuton

59
Q

asthma drug with neurotoxicity as a side effect

A

theophylline

60
Q

asthma drug with narrow therapeutic index

A

theophylline

61
Q

allergic asthma resistant to inhaled steroids and long acting β-agonists

A

omalizumab

62
Q

omalizumab binds mostly unbound serum IgE and blocks

A

binding to FcεRI

63
Q

asthma’s symptoms vary over in time in their

A
  1. occurrence
  2. frequency
  3. intensity
64
Q

causes of prolonged expiration

A
  1. bronchoconstriction (airway narrowing)
  2. airway wall thickening
  3. increased mucus
65
Q

symptoms of asthma may be triggered or worsened by factors such as

A
  1. viral URI
  2. allergens
  3. stress
  4. exercise
  5. tobacco
66
Q

asthma full treatment

A

there is not full treatment, only control

67
Q

bronchial hyperresponsiveness in asthma is due to

A

inflammation

68
Q

think asthma as a diagnosis when

A
  1. Recurrent episodes of wheezing
  2. Cough at night
  3. Coughing or wheezing after exercise
  4. Cough, wheezing, chest tightness after exposure to allergens or pollutants
  5. Colds “go down to the chest” or take longer than 10 days

respiratory (27 decks)

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