Asthma drugs

Question 1

Asthma drugs

Answer 1

Bronchoconstriction is mediated by

1) inflammatory process
2) parasympathetic tone

Therapy directed at those

Question 2

Beta 2 agonists

Answer 2

Albuterol : acute exacerbation
Salmeterol. formeterol: long acting prophylaxis
(adverse effect: tremor and arrhythmias)

Question 3

Methylxanthines

Answer 3

Theophylline: causes bronchodilation by

1) inhibiting PDE, increasing cAMP.
2) Use limited due to narrow therapeutic index (cardiotoxicity, neurotoxicity),
3) metabolized by P450.
4) Blocks action of adenosine

Question 4

Muscarinic antagonist

Answer 4

Ipratropium: competitive block of muscarinic receptor
Prevents bronchoconstriction

Used for COPD, a sis tiotropium (long acting antagonist)

Question 5

Corticosteroids

Answer 5

Beclemethasone, fluticasone: inhibit synthesis of virtually all cytokines. Inactivate NFkB, which induces production of TNFa.

1st line for chronic asthma

Question 6

Antileukotrienes

Answer 6

Montelukast, zafirlukast:
block leukotriene receptor, esp good for aspirin induced asthma.

Zileuton: 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes.

Question 7

Omalizumab

Answer 7

Monoclonal anti-IgE Ab.
Binds mostly unbound serum IgE.
Used in allergic asthma resistant to inhaled steroid and long acting beta2 agonists.