Asthma & COPD pharm Flashcards
What is the hygiene hypothesis?
The immune system of the newborn infant is skewed toward Th2 cells and needs timely and appropriate environmental stimuli to create a balanced immune response
What are the preformed mast cell mediators?
Histamine, TNF-alpha and proteases
What are the Lipid-derived mast cell mediators?
LTC-4 (leukotrieneC-4) and LTD-4- bronchoconstriction, vasoconstriction
• LTB-4-leukocyte chemotaxis
• PGD-2 (prostaglandinD-2)-vasodilation, bronchoconstriction, mucus secretion, vasopermeability
• PAF (platelet activating factor)- bronchoconstriction, leukocyte chemotaxis
What are the cytokine mast cell mediators?
IL-l (Interleukin-l)-broad promotion of inflammation
• IL-3-mast cell division
• IL-5-eosinophil differentiation and chemotaxis
• IL-6-lymphocyte growth and differentiation
• IL 4 and 13-activation of Th2 pathway activation
• GM-CSF stimulates PMNs, eosinophils and macrophages
What are some extrinsic precipitants of asthma
Aspirin, NSAIDs, Beta blockers, cholinesterase inhibitors,
What are the 10 approaches to treating asthma?
- Increase cyclic AMP—Beta2 agonists
- Block adenosine receptors—theophylline
- Decrease cGMP—tiotropium
- Prevent mediator release—beta2 agonists
- Block mediator effects—antihistamines, LT receptor antagonists
- Inhibit mediator synthesis—lipoxygenase inhibitors
- Inhibit phosphodiesterase4 –roflumilast
- Bind serum free lgE–omalizumab
- Multiple antiinflammatory mechanisms of corticosteroids
- Bind interleukin-5 –mepolizumab
Name 3 beta agonists
Albuterol (short acting), Salmeterol (long acting), Levalbuterol
Discuss the PKs of albuterol and salmeterol
Albuterol Onset-5 min; peak at 30-60 min; duration 4-6 h
Salmeterol • Onset-15-20 min; peak at 3-4 h; duration 12 h
What are the side effects of beta agonists
Skeletal muscle tremor • Anxiety • Restlessness • Tachycardia and palpitations • Hypokalemia
Discuss the Leukotriene receptor antagonists
Montelukast; Competitive antagonists of leukotrienes
- Prevent but NOT reverse bronchorestriction
- Used for exercise induced bronchorestriction
- Not as effective as steriods
Discuss the Cholinergic Muscarinic Antagonists
Tiotropium; Ipratropium is short acting
- Given as a dry powder
- Dry mouth is the SE
- Used for COPD
- Combined with albuterol as Combivent
How does corticosteroids help with asthma?
- Up-regulate beta-adrenergic receptors
- Decrease vascular permeability
- Decrease leukotriene synthesis
- Decrease late-phase inflammatory response
SEs of inhaled corticosteroids
- Dysphonia
- Candidasis (thrush)
- Cataracts
Discuss Theophylline
- alpha blocker in bronchial smooth muscle
2. Treats COPD
MOA of Theophylline
- Relaxes bronchial smooth muscle and increases mucociliary clearance
- Increases diaphragmatic contractility and decreases its fatigue
- Dilates arterioles and venules and increases CO
- Increases GFR and diuresis
- Increases gastric acid secretion
- Decreases lower esophageal sphincter tone
