Asthma + COPD Flashcards
Systemic corticosteroids
Methylprednisolone
Aerosol corticosteriods
Fluticason
B2 adrenergic Ags
SABA = albuterol LABA = Salmeterol
Muscarinic blockers
- ipratropium bromide
* tiotropium
Phosphodiesterase blocker
Theophylline
Leukotriene pathway blocker
Montelukast
IgE inhbitors
Omalizumab
Asthma airway resistance
Reversible!
Hallmark of asthma
Early rxn = mast cell + t lymp
Late rxn = Neutrophil/eosinophil release in late rxn,
Maintenance therapy Rx
goal
- Prevent attack
* Affect airway responsiveness/reactivity
Quick relief Meds
Goals
Relieve bronchospasm in attack
*affect airway resistance
Topical delivery of aerosolized Rx
T.I. Effect?
UPs T.I.
Methylxanthines target
Cholinergic
ICS
- target + suppress inflammatory
- NOT cure
- anti-inflammatory (hours) –> maximal benefit (weeks)
- can add long acting B2 agonist
Topical activity of ICS UPed by
17a sub
Effect corticosteriods on Airway cells
*DOWN cytokines
No effect on mediater release
*UP B2 receptors
ICS
S.E
- oropharyngeal candidiasis/dysphonia
- Hypothalamic pituitary axis (HIGH dose/systemic)
- COPD = only if FEV1 <50%
B2 Ags
Effects
- relax airway
* inhibit release of mast cell mediators (less microvascular leakage)
Rescue tx
SABA
LABA used
Maintenance
ONLY w/ ICS
LABAs alnoe w/ COPD
Most asthma controlled w/
ICS + b2 ag
Albuterol
Time
- Short acting 3-5 min
- Peak 30-60 mins
- Duration 3-6 hours
Salmeterol
Time
Long-acting
>12 hrs
B2 ags
S.E.
*uncommon w/ short-acting b2
Tremor/tac/hypokalemia
Muscarinic cholinergic antagonists
Effects
Block Ach from vagus to M3
- down mucus
- down secretion
- NO anti-inflammatory
- Limited unless B2 ag intolerant (Can do 2 together)
*COPD effective in some
Ipatroprium vs Tiotropium
Time
Ipratropium = Short acting
Tiotropium = long acting
Antichol
Why effective in COPD?
Vagal tone the only thing left to control
Natural trippy atropine version
Datura stramonium
Antichol
Adverse effects
- Few systemic = poorly absorbed
- NO prostatic hyperplasia
- Dry mouth
Methylxanthine Rx = Theophylline
Effects
- Block cAMP phosphodiesterase = UP cAMP
- oral
- COPD = up diagragm muscle contractility, up ventilatory function
Methylxanthine Rx = theophylline
- narrow T.I. = monitor plasma
- cardio = tac, vasodilation, arrythmia
- CNS = nervousness
- GI = N/V
Leukotriene pathway inhbitor
- GOOD in aspirin sensitive
- inhibit bronchoconstriction
- add-on
- NO COPD
Anti-IgE
Mech
Binds Fc IgE, can’t bind to mast cell
No allergen induced activation of mast cells
New drugs
IL=5
Mepolizumab
Reslizumab
COPD = LABAs superior to anticholinergics?
Don’t know
They help improve lung function and quality of life
Deposition of inhaled Rx
80-90% swallowed
Blood stream –> systemic effects + inactive metabolites
Cortiocosteroids inhibit inflammation how?
- Stop gene transcription
* Stop acetylation of DNA so strand doesn’t open
Systemic glucocorticoid use
Asthma exacerbation
SHORT TERM
Methylprendisolone 3-10 days
Withdraw over 2 weeks
Status Asthmaticus? IV
B2 agonists
Mech
Through cAMP/PKA –> down Ca2+ influx into bronchial smooth muscle
Montelukast blocks
Leukotriene receptor (CysLT1) = block:
- plasma exudation
- Mucus secretion
- Bronchoconstriction
- Eosinophil recruitment
Omalizumab
Mech
- anti-IgE antibody
- binds Fc portion IgE, prevents Fc receptor binding to mast cells
*use less steroid + prevent allergic reactions
