Asthma/COPD drugs Flashcards

1
Q

Systemic Coriticosteroid

A

Methylpredinsone

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2
Q

Aerosol corticosteroid

A

Fluticasone

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3
Q

B2 Adrenergic agonists

A

Albuterol, Salmetrol

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4
Q

Muscarinic Antagonists

A

Ipratropium Bromide, Tiotropium

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5
Q

Phosphodiesterase Inhibitors

A

Theophylline

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6
Q

Leukotriene Pathway Inhibitors

A

Montelukast

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7
Q

IgE inhibitors

A

Omalizumab

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8
Q

Characteristics of Early Reaction in Asthma

A

Histamine and Tryptase release from mast cells, airway wall smooth muscle contraction

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9
Q

Characteristics of late reaction in asthma

A

Interleukin and TNF release from T-lymphocytes, ECP, MBP release from eosinophils, protease release from neutrophils - cell infiltration.

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10
Q

Maintenance drugs vs quick relief medicines

A

Maintenance drugs affect AIRWAY RESPONSIVENESS/REACTIVITY to PREVENT attacks.

Quick relief medications relieve bronchoconstriction. They affect AIRWAY RESISTANCE and relieve constriction DURING ATTACKS.

There is overlap between the effects.

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11
Q

Deposition of inhaled drugs

A

10-20% inhaled. The rest gets swallowed, causing systemic and side effects.

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12
Q

Pharmacological target of leukotriene inhibitors

A

Neutrophils - IgE antibodies

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13
Q

Pharmacological target of muscarinic antagonists

A

Cholinergic reflex - inhibit bronchoconstriction

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14
Q

Pharmacological target of B2 adrenergic agonists

A

B2 receptors - bronchodilation

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15
Q

Most effective treatment to PREVENT asthma attacks

A

Inhaled glucocorticoids (ICS) - like all steroids they SUPPRESS INFLAMMATION but do not cure.

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16
Q

Chemically speaking, how do you increase the topical activity of a corticosteroid?

A

Substitution at the 17 alpha carbon

17
Q

How do corticosteroids suppress inflammation?

A

They suppress transcription of inflammatory proteins. However, this means they have no effect on the release of pre-formed mediators like histamine.

18
Q

Adverse effects of inhaled steroids

A

Candidiasis, and dysphonia

Suppression of hypothalamic-pituitary axis - leading to bone resorbtion, skin thinning, and growth retardation.

19
Q

When should you use systemic glucocorticoids?

A

3-10 day treatment for severe asthma exacerbations.

20
Q

B2 adrenergic agonists - use and effectiveness

A

Short acting - rescue

long acting - ONLY USED WITH ICS - most asthmatics can be controlled with ICS and an inhaled B2 agonists.

21
Q

Short acting B2 agonist

A

Albuterolol

22
Q

Long acting B2 agonist

A

Salmetrerol

23
Q

Adverse effects of B2 agonists

A

Muscle tremor, tachycardia, hypokalemia - uncommon with short acting B2 agonists.

24
Q

How many times a week should an asthmatic be using a rescue inhaler if the asthma is controlled?

A

1-2 times per week.

25
Q

If you prescribe a long acting B2 agonist, what else are you prescribing?

A

ICS

26
Q

Effects of muscarinic cholinergic antagonists

A

Block the effects of acetylcholine released from the vagus onto M3 receptors - reduce smooth muscle contraction and decrease mucus secretion. Generally not used in asthma unless intolerant of B2 agonists, potentially additive though.

27
Q

Adverse effects of muscarinic antagonists

A

Dry mouth, possible urinary retention in old men with prostatic hypertrophy. Generally well tolerated because they are poorly absorbed.

28
Q

Mechanism of methylxanthine drugs

A

Multiple potential mechanisms - Inhibits cAMP phosphodiesterase in smooth muscle, blocks activation of adenosine receptors on smooth muscle, decreased histamine deacytlation, decreases cytokine release.

Also, may strengthen the diaphragm in COPD.

29
Q

Adverse effects of methyxanthines

A

Narrow therapeutic window - monitor plasma levels.

Nausea, vomiting,CNS stimulation - anxiety, convulsions, Cardiac - tachycardia, arrythmias (messing with adenosine screws up your AV node if I remember right)

30
Q

Leukotriene inhibitors

A

PO, inhibit bronchoconstriction, add-on for mild to moderate asthma. Not helpful in COPD because it is not an inflammatory condition.

31
Q

Adverse effects of leukotriene inhibitors

A

Hepatic dysfunction - rare. Reversible on discontinuation.

32
Q

Anti IgE therapy

A

Reduces allergen-mediated activation of immune cells. Used SC at 2-4 wks, dose depends on Serum IgE. Adverse - $$$$

33
Q

Definition of COPD

A

NON REVERSIBLE airflow limitation with or without symptoms.