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SD III Block 3 > Asthma/COPD Review > Flashcards

Asthma/COPD Review Flashcards

1
Q

What are the class of drugs useful for asthma that are considered bronchodilators?

A

Sympathomimetics, especially β2-selective agonists, muscarinic antagonists, methylxanthines, and leukotriene receptor blockers.

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2
Q

What are the drugs useful in the treatment of asthma that are considered anti-inflammatory classes drugs?

A

include corticosteroids, mast cell stabilizers, and an anti-IgE antibody.

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3
Q

Do leukotriene antagonists act as bronchodilators or as anti-inflammatory drugs?

A

they act as both

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4
Q

Is asthma considered a reversible condition or irreversible?

A

reversible

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5
Q

COPD is considere a reversible or irreversible condition?

A

irreversible

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6
Q

Out of bronchodilators or anti-inflammatory agents, which are considered relievers and which are considered controllers?

A

Anti-inflammatory agents are considered controllers

Bronchodilators are considered relievers

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7
Q

What is the purpose of using prophylactic therapy in the treatment of asthma? (How do they typically act?)

A

acts by preventing mast cell degranulation and prevents future attacks.

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8
Q

Bronchodilators are used in maintenance therapy and are needed to abort acute or long term attacks?

A

needed to abort acute attacks

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9
Q

Anti-inflammatory agents are called controllers as they provide long or short term stabilization of symptoms?

A

long term

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10
Q

Leukotriene antagonist, when used for the treatment of asthma and/or COPD have effects on bronchoconstriction and inflammation but are used only for long or short term treatment?

A

neither; prophylaxis

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11
Q

What is the general reasoning behind using bronchodilators in the treatment of asthma?

A

relax airway smooth muscles

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12
Q

What symptoms can bronchodilators not help that may affect the respiratory system?

A

mucosal edema

cellular infiltration

mucus formation

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13
Q

Name the B2 agonist drugs to treat asthma.

Classify SABA and LABA

A

SABA: albuterol, levalbuterol, terbutaline, metaproterenol

LABA: Salmeterol, formoterol

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14
Q

Name the sympathomimetic drugs used to treat asthma.

Classify as a, B agonists and selective B agonists

A

A, B agonists: epinephrine, ephedrine

B agonists: isoproterenol

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15
Q

Name the methylxanthines used to treat asthma.

A

Aminophylline, theophylline

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16
Q

Name the muscarinic antagonists used to treat asthma.

A

iptratropium, tiotropium

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17
Q

Which class of drugs, bronchodilators or anti-inflammatory drugs, are used to reduce bronchial responsiveness?

A

anti-inflammatory drugs

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18
Q

Which drugs are the prototype glucocorticoids used to treat asthma?

A

Beclomethasone

Budesonide

Dexamethasone

fluticasone

mometasone

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19
Q

What are the Leukotriene antagonist drugs used in the treatment of asthma?

A

montelukast

zafirlukast

zileuton

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20
Q

What are the anti-IgE antibodies used to treat asthma?

A

Omalizumab

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21
Q

What is the name of a interleukin-5 antagonist monoclonal antibody (IgG1 kappa) used to treat asthma?

A

Mepolizumab

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22
Q

What are drugs used to treat mast cell degranulation?

A

Cromolyn sodium

Nedocromil sodium

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23
Q

T/F. Cromolyn sodium and Nedocromil sodium are used for acute asthma attacks?

A

False

Used only for prophylaxis

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24
Q

Give an example of inhaled steroids and long-acting bronchodilators that are becoming more widespread-combination preparations and are used to treat asthma.

A

fluticasone/salmeterol (Advair) andbudesonide/formoterol (Symbicort)

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25
Q

Be able to explain and draw out this picture without looking.

A

Bronchodilation is promoted by cAMP which can be increased by:
β2-adrenergic agonists that increase its synthesis by adenylyl cyclase
Phosphodiesterase (PDE) inhibitors that slow its degradation

Bronchoconstriction can be inhibited by: muscarinic or adenosine antagonists

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26
Q

What class of drugs are considered the drugs of choice for acute asthmatic attacks?

A

B2-adrenergic agonists

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27
Q

Salmetorol and formoterol are longer acting drugs that can act over a period of how long?

A

12 hours

28
Q

To prevent mortality of longer acting B2 adrenergic drugs what should they be used in combination with?

A

They should be used in combination with coritcosteroids

29
Q

What are common adverse effects of B2 agonist drugs?

A

skeletal muscle tremor,

tachycardia

hypokalemia

nervousness

occasional weakness

30
Q

T/F. Loss of responsiveness (tolerance, tachyphylaxis) is an unwanted effect of excessive use of the short-acting sympathomimetics

A

True

31
Q

What is the benefit of using Levalbuterol over other B2- adrenergic receptor agonists?

A

Inhalant which is claimed to have fewer central nervous system (CNS) and cardiac adverse effects

32
Q

What is the MOA of methylxanthines?

A

It produces bronchodilation by inhibiting the enzyme cyclic nucleotide phosphodiesterase. Increased levels of cAMP results, which explains the cardiac stimulation and smooth muscle relaxation produced by these drugs.

It blocks adenosine receptors. Adenosine acts as a local mediator contracting smooth muscles, so the blockage of receptors produces opposite response.

33
Q

What is the benefit of using Pentoxifylline to treat asthma?

A

remedy for intermittent claudication

34
Q

In asthma, what is the most important therapeutic action of Theophylline?

A

bronchodilation

35
Q

What are some other effects of using therapeutic doses of theophylline?

A

Smooth muscle relaxation.
CNS excitation.
Cardiac stimulation.

36
Q

What are some toxicities related to using Theophylline?

A

The common adverse effects of methylxanthines include gastrointestinal distress, tremor, and insomnia.

Severe nausea and vomiting, hypotension, cardiac arrhythmias, and seizures may result from overdosage.

Very large doses have been linked to suicide attempts

37
Q

What is the benefit of using anticholinergics to treat asthma?

A

reverse vagally mediated bronchospasm.

Also decrease mucus gland hyper secretion seen in asthma

38
Q

Why is Ipratropium bromide used instead of atropine to treat asthma?

A

is free of atropine side effects?

39
Q

Which has a longer duration of action? Tiotropium or Ipratropium bromide? How long?

A

Tiotropium (24 hours)

40
Q

When are systemic (oral)corticosteroids used?

A

used chronically only when other therapies are unsuccessful.

41
Q

What are some local aerosol surface-active corticosteroid used in the treatment of asthma? (name the drugs)

A

(eg, beclomethasone, budesonide, dexamethasone, flunisolide, fluticasone, mometasone ) is relatively safe, and inhaled

42
Q

When are corticosteroids first-line therapy in the treatment of asthma?

A

for individuals with moderate to severe asthma

43
Q

What is the most important intravenous corticosteroid for treatment of status asthmaticus?

A

prednisolone and hydrocortisone

44
Q

What is the MOA of corticosteroids?

A

Corticosteroids reduce the synthesis of arachidonic acid by phospholipase A2 and inhibit the expression of COX-2, the inducible form of cyclooxygenase.

45
Q

Do corticosteroids relax smooth muscles directly? (explain)

A

no; act by inhibiting the production of inflammatory cytokines

46
Q

T/F. Corticosteroids decrease responsiveness of adrenoceptors in the airway.

A

False; Increase responsiveness of adrenoreceptors

47
Q

The effect of corticosteroids on airway obstruction is partly due to what factors?

A

potentiation of the effects of β-receptor agonists

48
Q

T/F. Inhaled glucocorticoids are now considered appropriate (even for children) in most cases of moderate asthma that are not fully responsive to aerosol agonists.

A

True

49
Q

It is believed that corticosteroids that are used early may prevent the severe, progressive inflammatory changes characteristic of what type of asthma?

A

long-standing asthma

50
Q

What is the major toxicities associated with use of corticosteroids in treating asthma?

A

Inhaled preparations may cause oropharyngeal candidiasis or hoarseness from vocal cord irritation .

Cushingoid effects

51
Q

What is a Leukotriene synthesis inhibitor?

A

Zileuton

52
Q

What is a leukotriene receptor antagonists?

A

Zafirlukast

Montelukast.

53
Q

MOA of Zafirlukast and Montelukast?

A

CysT1 receptor antagonist

54
Q

What is the MOA of Zileuton?

A

5-LOX inhibitor

55
Q

Which Leukotrienes are mainly targeted in the treatment of asthma?

A

LTC4 and LTD4

56
Q

What asthmatic effects do LTC4 and LTD4 create?

A

mucosal edema, mucus hypersecretion, increased bronchial reactivity, and bronchoconstriction

57
Q

MOA of Omalizumab.

A

Monoclonal antibody that inhibits binding of IgE to mast cells but does not inactivate already bound IgE

Lowers plasma IgE levels and reduces bronchospasm

58
Q

Who is Omalizumab typically prescribed for?

A

Cost is high, hence omalizumab is mainly prescribed for patients with with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a specific allergen and whose symptoms are inadequately controlled with inhaled corticosteroids.

59
Q

MOA mast cell stabilizers? Clinical use?

A

These drugs are thought to act by inhibiting mast cell degranulation and, as such, have no direct bronchodilator action,

inhibit both antigen- and exercise-induced bronchospasm in asthmatic patients.

60
Q

Clinical use of Ketotifen? ROA?

A

administered orally and is a prophylactic drug for allergic and bronchial disorders.

61
Q

MOA of chromones?

A

mechanism not clearly known.

62
Q

What was the most important use for cromolyn and nedocromil?

A

asthma (especially in children)

63
Q

What routes of administration are cromolyn available in? What is it’s clinical use for typically?

A

oral formulation used

for food allergy and hay fever.

64
Q

Are ADR of chromones common?

A

no; they are mild and rare

65
Q

What is the treatment plan for patients with status asthmaticus?

A

Terbutaline

Hydrocortisone

Nebulized Albuterol/terbutaline and ipratropium bromide

antibiotics for chest infections

correct dehydration and acidosis

humidified oxygen

66
Q

What are the treatment options used to treat acute symptoms of COPD?

A

inhalation of a short-acting β agonist (eg, albuterol) with or without anticholinergic drug (eg, ipratropium bromide).

67
Q

What are the treatment options used to treat persistent symptoms of COPD?

A

regular use of an LABA or a long-acting anticholinergic, or the two together, is indicated.

SD III Block 3 (14 decks)

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