Asthma/COPD Drugs

Question 1

Decreases bronchial reactivity & eliminates need for oral corticosteroids
MOA: inhibition of phospholipase A2 and reduction in COX expression
Use in patients who require more than occasional beta agonist to relieve symptoms
Taper oral steroid therapy to avoid adrenal insufficiency
with chronic use PFTs improve and symptoms are reduced
Adverse: oral Candidiasis, hoarseness from inhalation directly on vocal cords, may slow growth rate in children, cause cataracts or osteoporosis if used long-term

Answer 1

Beclomethasone
Budesonide
Ciclesonide
Flunisolide
Fluticasone
Mometasone
Triamcinolone

Question 2

LTD4 receptor antagonist (LTD4 is released by the mast cell and causes bronchoconstriction, increased bronchial reactivity, mucosal edema & mucus hypersecretion)

Answer 2

montelukast

zafirlukast

Question 3

methylxanthine that inhibits lymphocyte function & reduces airway mucosal inflammation, as well as produces bronchodilation
narrow therapeutic index
thought to inhibit phosphodiesterase resulting in cAMP: smooth muscle relaxation
blocks adenosine receptor
Adverse: insomnia, tremor, anorexia, seizures, arrhythmias

Answer 3

theophylline
Aminophylline is the preparation that is used

Advantage in COPD because it can improve diaphragmatic contractility & reverse fatigue

Question 4

partial beta-2 agonist (long-acting)

Answer 4

salmeterol

Question 5

full beta-2 agonist (long-acting)

Answer 5

formoterol

Question 6

beta-2 selective drugs used for bronchodilation (relaxation of bronchial smooth muscle)
adverse: tremor, tachycardia

Answer 6

albuterol
terbutaline
metaproterenol
pirbuterol

Question 7

nonselective beta agonist that was once used for asthma but is associated with excess sympathomimetic effect

Answer 7

isoproterenol

Question 8

muscarinic antagonists, preventing vagally-mediated bronchoconstriction, used for asthma & COPD
Adverse: dry mouth & cough

Answer 8

ipratroprium
tiotropium (long-acting)

Question 9

inhibits 5-lipoxygenase, reducing the synthesis of leukotrienes
Use: aspirin allergy, exercise and antigen induced bronchospasm
Adverse: elevates liver enzymes

Answer 9

zileuton

Question 10

parenteral corticosteroid for status asthmaticus

inhibits phospholipase A2

Answer 10

prednisolone

This is the active metabolite of prednisone

Question 11

oral corticosteroid added to asthma medications if FEV1 < 50%

Answer 11

prednisone

Question 12

When should inhaled corticosteroids be used in asthma?

Answer 12

FEV1 < 80% , nocturnal wakenings are more than twice per month or rescue therapy is needed more than twice per week

Question 13

reduces release of inflammatory and bronchoconstrictor mediators from sensitized mast cells

Answer 13

cromolyn
nedocromil

Cromolyn inhibits early response to antigen challenge
Nedocromil inhibits airway nerves, inhibiting late response

Question 14

monoclonal antibody that binds IgE on mast cells and reduces interaction with inhaled antigen used for severe asthma refractory to other medications
Adverse: extremely expensive

Answer 14

omalizumab

Question 15

What does bradykinin do?

Answer 15

causes heat, redness, swelling, and pain in inflammation = vasodilation
B2 receptor activates phopholipase A2
Kininase II hydrolyzes bradykinin as it passes through the pulmonary vascular bed
Kininase is identical to ACE
Icatibant = B2 blocker used to treat bradykinin-mediated angioedema of the airways