Asthma/COPD

Question 0

Salmeterol

Answer 0

long term asthma/COPD
-beta-2 agonist (long acting) LABA
-“-terol”
-lipid soluble, so stays in cell membrane of lung tissue longer and have lasting effects
MOA
-produces bronchodilation
-stimulates beta-2 receptors in bronchiolar smooth muscle
-blocks bronchoconstriction caused by histamine, methacholine, and exercise
-long acting due to binding properties
ADE
-HA, tremor, URT infx, pharyngitis, cough, tachycardia/palpations, hyperglycemia, hypokalemia
-black box warning! increased risk of severe asthma exacerbations and asthma-related deaths due to down regulation of B-2 receptors. (TOLERANCE)

Question 1

Albuterol

Answer 1

asthma
-Beta-2 agonist (short acting) SABA
-“-sterol”
-water soluble
MOA
-produces bronchodilation
-stimulates beta-2 receptors in bronchiolar smooth muscle
-blocks bronchoconstriction caused by histamine, methacholine, and exercise
ADE
-HA, tremor, URT infx, pharyingits, cough, tachycardia/palpitations, hyperglycemia, hypokalemia

Question 2

Tiotropium (long acting)

Ipratropium (short acting)

Answer 2

COPD
-anticholinergic
MOA
-produces bronchodilation
-blocks Ach stimulation of muscarinic receptors in bronchial smooth muscle which produces bronchoconstriction and mucous secretion
ADE
-blurred vision (cararacts)
-xerostomia
-constipation, HA, pharyngitis, laryngitis, sinusitis, URT infx
-epistaxis
-angina, atrial fib.
-"CAN'T SEE, CAN'T PEE, CAN'T SPIT, CAN'T SHT"

Question 3

Fluticasone
Flunisolide
Ciclesonide
Mometasone
Budesonide
Beclomethasone

Answer 3

asthma
-inhaled corticosteroids
-"-asone, -sonide"
-DO NOT have bronchodilator effects = *only for anti-inflammatory effects
-used in conjx w/ bronchodilator
-reduces progression of asthma and airway remodeling
MOA
-DEC respiratory inflammation to facilitate breathing
-inhibits the release of pro-inflammatory mediators from cells (histamine, leukotrienes, cytokines, prostaglandins, bradykinin)
ADE
-*oral thrush (candidiasis)
-HA
-Infx (URT, LRT)
-pharyngitis
-*adrenal suppression/growth inhibition
-*DEC bone mineral density
-glaucoma or cataracts

Question 4

Montelukast

Zafirlukast

Answer 4

asthma
-leukotriene receptor antagonist (leuk modifier)
-“-lukast”
MOA
-prevents leuk mediated smooth muscle contraction and inflammation
-binds to luek D4 receptor
Cyclooxygenase/lipoxygenase pathway
-if COX-2 inhibitor is used, then all arachadonic acid will be funneld into producing COX-2 (increase thrombosis) and leuks (bronchocontrx)

Question 5

Methylxanthines

theophylline, aminophylline

Answer 5

asthma
MOA
-causes moderate bronchodilation and mildly inhibits inflammation
-non-selectie inhibitor of phosphodiesterase.  this INC cAMP and cGMP
ADE
-*narrow therapeutic index (unpredictable pharmacokinetics, drug interx)
-*usually monitor drug levels
-nausea/vomiting
-jitteriness/insomina
-HA
-tach/arrhythmias
-seizures

Question 6

Mast cell stabilizers

cromolyn, nedocromil

Answer 6

asthma
MOA
-prevent bronchoconstriction (*do not bronchodilate)
-prevents mast cell release of Leuks and histamines by inhibiting degranulation after antigen exposure
ADE
-*bad taste (*nedocromil>cromolyn)
-HA
-cough
-wheeze