Asthma/COPD drugs

Question 1

Systemic Coriticosteroid

Answer 1

Methylpredinsone

Question 2

Aerosol corticosteroid

Answer 2

Fluticasone

Question 3

B2 Adrenergic agonists

Answer 3

Albuterol, Salmetrol

Question 4

Muscarinic Antagonists

Answer 4

Ipratropium Bromide, Tiotropium

Question 5

Phosphodiesterase Inhibitors

Answer 5

Theophylline

Question 6

Leukotriene Pathway Inhibitors

Answer 6

Montelukast

Question 7

IgE inhibitors

Answer 7

Omalizumab

Question 8

Characteristics of Early Reaction in Asthma

Answer 8

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

Question 9

Characteristics of late reaction in asthma

Answer 9

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

Question 10

Maintenance drugs vs quick relief medicines

Answer 10

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.

Question 11

Deposition of inhaled drugs

Answer 11

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

Question 12

Pharmacological target of leukotriene inhibitors

Answer 12

Neutrophils - IgE antibodies

Question 13

Pharmacological target of muscarinic antagonists

Answer 13

Cholinergic reflex - inhibit bronchoconstriction

Question 14

Pharmacological target of B2 adrenergic agonists

Answer 14

B2 receptors - bronchodilation

Question 15

Most effective treatment to PREVENT asthma attacks

Answer 15

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

Question 16

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

Answer 16

Substitution at the 17 alpha carbon

Question 17

How do corticosteroids suppress inflammation?

Answer 17

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

Question 18

Adverse effects of inhaled steroids

Answer 18

Candidiasis, and dysphonia

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

Question 19

When should you use systemic glucocorticoids?

Answer 19

3-10 day treatment for severe asthma exacerbations.

Question 20

B2 adrenergic agonists - use and effectiveness

Answer 20

Short acting - rescue

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

Question 21

Short acting B2 agonist

Answer 21

Albuterolol

Question 22

Long acting B2 agonist

Answer 22

Salmetrerol

Question 23

Adverse effects of B2 agonists

Answer 23

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

Question 24

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

Answer 24

1-2 times per week.

Question 25

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

Answer 25

ICS

Question 26

Effects of muscarinic cholinergic antagonists

Answer 26

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.

Question 27

Adverse effects of muscarinic antagonists

Answer 27

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

Question 28

Mechanism of methylxanthine drugs

Answer 28

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.

Question 29

Adverse effects of methyxanthines

Answer 29

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)

Question 30

Leukotriene inhibitors

Answer 30

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

Question 31

Adverse effects of leukotriene inhibitors

Answer 31

Hepatic dysfunction - rare. Reversible on discontinuation.

Question 32

Anti IgE therapy

Answer 32

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

Question 33

Definition of COPD

Answer 33

NON REVERSIBLE airflow limitation with or without symptoms.