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Pharmacology > Asthma Medications COPIED > Flashcards

Asthma Medications COPIED Flashcards

1
Q

What is the problem with B-adrenoceptor agonists and diabetes?

A

They stimulate glycogenolysis and thus can cause hyperglycaemia.

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2
Q

Why are the anticholinergics Ipratropium and tiotropium used in COPD?

A

the bronchodilating effects of ipratropium is slower to develop than that of a B2-agonist, but it lasts longer.

Improves quality of life in patients with moderate-severe COPD.

Tiotropium; first-line treatment for patients with mild to severe COPD.

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3
Q

What kind of drug is Salbutamol?

A

Acts on the Beta 2 adrenergic receptors in the smooth muscle. It is a Beta 2 agonist drug.

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4
Q

Why would you add a LABA?

A

If inhaled corticosteroid therapy is insufficient.

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5
Q

What drugs can trigger an asthma attack?

A

B-Blockers

NSAIDS

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6
Q

Theophyline fo asthma?

A

Usage is declining. Use if other drugs not working.

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7
Q

What do B1 agonists do?

A

stimulate cardiac muscle;

increasing rate (chronotropic)

and strength (inotropic),

and

conductivity (dromotropic)

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8
Q

How do Salmeterol and Formoterol work?

A

They inhibit the late phase of allergen-induced bronchoconstriction.

(occurs after the bronchodilating effects of shorter-acting drugs have dissipated).

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9
Q

Which drugs can inact with > therapeutic range of theophylline

A

Cimetidine

erthromycin

fluoroquinolone, isoniazid and verapamil.

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10
Q
A
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11
Q

What other drug (not salbutamol) is commonly used to treat asthma?

A

Ipratropium Bromide

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12
Q

What is a side effect of tiotropium and ipratropium?

A

dry mouth

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13
Q
A
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14
Q

What is theophylline used for?

A

COPD (20%> in FEV1)

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15
Q

When are muscarinic antagonists indicated?

A

for COPD patients more than asthma patients.

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16
Q

If usual meds are ineffective for acute asthma attack, what is worth trying?

A

magnesium sulphate

2g over 20 minutes via 200ml saline (mark saline bag with time)

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17
Q

Indications fo theophylline

A

Long term use is associated with 20% increase in FEV1.

Reduces dyspnea, increases diaphragmatic contractility.

Increases central respiratory drive.

Increases muociliary clearance, reduces inflammation.

Used to treat COPD that isn’t controlled by B2 agonist and tiotropium.

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18
Q

What are the three groups of bronchodilators?

A

selective B2-adrenoceptor agonists

muscarinic receptor antagonists

theophylline

  • all relax bronchial smooth muscle, but only B2 agonists are used in acute asthmatic attacks.
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19
Q

Whats the MOA for theophylline?

A

acts at CNS and cellular level. Multiple actions on cell types and receptors.

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20
Q

What group of drugs do respiratory consultants use for the management of asthma (2)?

Name two.

A

Xanthines

  • aminophylline
  • theophyline

Corticosteroids

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21
Q

What is Formoterol?

A

Long-acting B2​-receptor agonist

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22
Q

What is symbicort?

A

Symbicort: Budesonide and Formoterol

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23
Q

Why would you use Ipratropium or Tiotropium in the management of COPD? (chronic bronchitis + emphysema)

A

Bronchodilating effect of ipratroprium is slower to develop than that of a B2-agonist, but it lasts longer.

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24
Q

What is Advair?

A

Fluticasone and Salmeterol

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25
Q

What is Combivent?

A

Albuterol and ipratropium

(used to treat COPD).

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26
Q

What’s the management for mild, persistent asthma?

A

Corticosteroid inhaler

(may be fluticasone or budesonide)

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27
Q

Indications of Cromolyn Sodium

A

Prophylactic use.

Indicated for exercise-induced asthma.

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28
Q

How are corticosteroids used to manage asthma?

A

Used on a long-term basis to prevent asthmatic attacks, rather than to treat acute bronchospasm.

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30
Q

What are the potential side effects of all B2-agonists?

A

tachycardia

tremor

nervousness

31
Q

What is Advair (brand)?

A

Fluticasone (corticosteroid)

Salmeterol (long-acting B2-receptor agonist)

32
Q

When are theophyllines used?

A

long-term basis to prevent bronchoconstriction (with asthma or emphysema)

33
Q

MOA of theophylline

A

Acts at the CNS level

Also cellular level; blocks adenosine receptors, etc.

Drug is bronchodilating, anti-inflammatory, and immunosuppressant.

34
Q

What kind of drug is Ipratropium Bromide?

A

anti cholinergic bronchodilator

35
Q

Drug interactions of theophylline

A

Cimetidine and erythromycin inhibit CYPP1A2 and increase theophylline plasma concentrations.

Significant when drug is high in therapeutic range.

Also fluoroquinolone, isoniazid and verapamil.

36
Q

What is Symbicort?

A

Budesonide (corticosteroid)

Formoterol ( long acting B2 receptor agonist)

37
Q

What is Omalizumab?

A

IgE antagonist given subcutaneously every 2-4 weeks in combination with inhaled corticosteroid therapy.

(however this drug can cause allergic reactions)

38
Q

What could you mix with Salbutamol for an acute asthma attack (and dose)?

A

ipratropium bromide 500ug (micrograms)

39
Q

Two examples of LABA

A

salmeterol

and

formoterol

40
Q

How do the anticholinergic muscarinic receptor antagonists work?

(tiotropium and ipratropium)

A

They block the bronchoconstricting effect of the vagal nerve (parasympathetic)

41
Q

What are the adverse effects of

Leukotriene receptor antagonists

(eg. Montelukast)

A

Small number of patients can get hypersensitivity reactions.

Rare cases of liver injury.

NB> this group of drugs is highly bound to plasma proteins (>99%) and are extensively metabolized by hepatic cytochrome P450 enzymes.

42
Q

theophylline helps with COPD; in which ways?

A

>20% FEV1

> diaphragmatic contactility

> central respiratory drive

> mucociliary clearance

< inflammation

(used when COPD not controlled)

43
Q

Why is it not advisable to give steroid inhalers to children?

A

Possibly suppress growth.

(another possible side effect; oral thrush from excessive steroid deposition in the mouth)

44
Q

What is Salmeterol?

A

Long-acting B2-receptor agonist

45
Q

Side effects of B2 agonists

A

Tachycardia, tremor, nervousness

46
Q

What the the LABAs Salmeterol and Formoterol good for treating?

A

Late phase of allergen-induced bronchoconstriction, therefore useful at preventing nocturnal asthmatic attacks.

47
Q

What type of drugs are Ipratropium and Tiotropium?

A

Muscarinic receptor antagonists

(NB. Ipratroprium is a derivative of atropine).

48
Q

What is Montelukast an example of, and what is its mechanism?

A

Leukotriene receptor antagonist

They have a structure similar to cysteinyl leukotrienes, and they compete with these substances for the CysLT1 receptor.

49
Q

What is albuterol?

A

Short acting inhaled B2 -agonist

(also levalbuterol)

50
Q

What is Symbicort?

A

Budesonide and Formoterol

51
Q

What is an adrenergic agonist?

A

An adrenergic agonist is a drug that stimulates a response from the adrenergic receptors.

52
Q

What is Advair?

A

Advair: Fluticasone and Salmeterol

53
Q

Some examples of steroid inhalers (4)

A

Beclomethasone

Budesonide

Fluticasone

Triamcinolone

55
Q

What is the clinical use of Montelukast and Zafirlukast?

A

Effective with patients with allergic asthma, including aspirin-sensitive asthma, and they maybe used to prevent exercised-induced asthma when taken at least two hours before the event.

Effects of this drug are accumulative.

Benefit children more than adults.

56
Q

What are Salmeterol and Formoterol examples of, and when would they be prescribed?

A

Long-acting B2-receptor agonists (LABA), given twice daily by inhalation for the long-term treatment of asthma and emphysema.

Particularly useful in preventing nocturnal asthmatic attacks.

57
Q

What kind of neb would you use for an acute asthma attack (and dose)

A

5mg Salbutamol via O2 driven Nebuliser

58
Q

What category are ipratropium and tiotropium and what are they primarily used for?

A

Muscarinic receptor antagonists

Primarily used to treat COPD

59
Q

How quickly does Salbutamol act, and how long does it last for?

A

2-5 mins

about two hours

60
Q

What’s the use of LABAs?

A

Long-term treatment of asthma and emphysema. Particularly useful for preventing nocturnal asthmatic attacks.

Salmeterol and Formoterol inhibit the late phase of allergen-induced bronchoconstriction.

61
Q

Ipratropium is typically a less effective B2-agonist in asthmatic patients, so why is it used in moderate to severe asthma?

A

Because it has a greater bronchodilating effect when used synergically with another B2 agonist in moderate to severe asthmatics.

62
Q

What is Montelukast?

A

Leukotriene receptor antagonist (they compete for the same leukotriene receptors)

63
Q

Indications of Montelukast?

A

Allergic asthma (including aspirin-sensitive asthma)

Prevention of exercise-induced asthma (take two hours before)

Accumulative effect. Benefits children more and adults.

Alternative for those not wishing to take steroids (although not so effective).

Not as effective as LABA as add-on to corticosteroids, but may be safer.

64
Q

If serum level of theophylline is too high, then….

A
  • 25mg/L ; seizures and serious arrhythmias.
65
Q

MOA of Cromolyn Sodium

A

Stabilize the plasma membrane of mast cells and eosinophils

  • mast cell stabilizer
66
Q

Which drug lasts for 24 hours and is first -line treatment for COPD?

A

Tiotropium

67
Q

A common side effect from Salbutamol

A

tachycardia

68
Q

What is Cromolyn sodium and how does it work?

A

Mast cell stabilizer

Stabilizes the plasma membrane of mast cells and eosinophils to prevent the release of histamine, leukotrienes, and other inflammatory mediators.

(works by blocking flux of Calcium into the cells).

69
Q

What’s the advantage of B2 -agonists over nonselective B-receptor agonists?

A

They relax bronchial smooth muscle without producing so much tachycardia.

HOWEVER; higher doses can activate cardiac B1-receptors and cause tachycardia.

70
Q

What’s the typical dose of prednisolone for an acute asthma attack?

A

40-60mg orally

or

IV hydrocortisone 100mg if oral tablets not tolerated.

71
Q

Montelukast adverse effects?

A

use P450 pathway

Occasionally hypersensitivity reactions.

Rare – liver injury.

Pharmacology (13 decks)

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