Asthma&COPD

Question 1

sympathomimetics - B agonists
non-specific: Epinephrine, Ephedrine, Isoproterenol
B2, quick: Albuterol, Terbutaline
B2, slow (use with steroids): Salmeterol, Formoterol

Answer 1

MOA: bronchodilators by increasing levels of cAMP
AE: fall in BP, reflex increase in HR, cardiac arrhythmias, hypokalemia, QT prolongation, CNS agitation (tremors)

LABA - BBW: use with steroids or increase mortality

Question 2

Atropine Sulfate

Ipratropium [Atrovent]

Answer 2

MOA: competitive Ach-muscarinic receptor blockade
- reduce airway SM contraction
- decrease in mucus secretion
- enhance B2-mediated bronchodilation
AE: pupillary dilation, loss of accommodation of eyes (no systemic effects)

Question 3

Tiotropium [Spiriva]

Answer 3

MOA: competitive Ach-muscarinic receptor blockade (M3-Gq for bronchoconstriction)
- long acting
- Use with steroids to reduce severe exacerbations in poorly controlled asthmatics
AE: pupillary dilation, loss of accommodation of eyes (no systemic effects)

Question 4

Combivent

Answer 4

combine B agonist with anti-cholinergic for COPD pts

ex. ipratropium and albuterol

Question 5

methylxanthines (-phylline)
Aminophylline
Theophylline
Dyphylline
Oxtriphylline

Answer 5

MOA: increase levels of cAMP -> bronchodilation, decrease release of mediators, anti-inflammatory effects
AE: “similar to caffeine”
- increase CNS activity
- increase gastric acid secretion
- diuretic
- hyperventilation
*dose too high will cause: tachycardia, arrhythmias, tremors, seizures

Question 6

Cromolyn Sodium [Intal]

Answer 6

MOA: inhibit degranulation of mast cells in lungs, inhibit inflammatory response by eosinophil, inhibit cough
- reduce bronchial hyperactivity during exercise or antigen-inhaled asthma
AE: CP, hypoTN, arrhythmias, CNS depression, seizures

Question 7

Glucosteroids (-sone or -nide)

Answer 7

MOA: decrease production of inflammatory cytokines, reduce mucus secretion, reduce bronchial hyperactivity, enhance effect of B-2 agonist

• reduces GATA-3 phosphorylation by P38 MAP kinase, preventing entry of this gene into nucleus to be expressed (usu. makes IL-4, IL-5, IL-13 = inflammatory mediators)
• enters nucleus via importin-alpha, 13 in place of GATA-3
• makes lipocortin to inhibit prod of phospholipase A

AE: inhaled-thrush, decrease bone density in premenopausal women, decrease growth in children
oral-Cushing’s syndrome (wt. gain, moon face, buffalo hump, neck skin darkening (acanthosis)

Question 8

Zafirlukast [Accolate]

Answer 8

MOA: blocks LTD4 receptors, decrease bronchial reactivity, decrease mucus secretion, decrease airway inflammation
AE: elevation of liver enzymes

Question 9

Monteleukast [Singular]

Answer 9

used more often
MOA: blocks LTD4 receptors, decrease bronchial reactivity, decrease mucus secretion, decrease airway inflammation
AE: URT-itis, possible suicidal idealation

Question 10

Zileuton [Zyflo]

Answer 10

MOA: inhibit LT formation, decrease SM contraction and leukocyte migration to damaged area
AE: liver enzyme elevation

Question 11

Omalizumab [Xolair]

Answer 11

MOA: binds to IgE and prevents IgE-stimulated release of inflammatory mediators -> decrease allergic response
*USE WITH STEROID
AE: allergic rxn, CV complications (MI, CAD, arrhythmias)

Question 12

Doxapram [Dopram]

Answer 12

MOA: activates peripheral carotid receptors
*short-acting, IV, narrow margin of safety
Uses:
after anesthesia, drug overdose, acute hypercapnia in COPD
AE: increase BP, HR, arrhythmias