asthma pharmacology Flashcards
what is the first line drug for acute asthma ?
SABA
what is the easy memorize slang of beta 2 adrenoreceptor agonist ?
OL
what are the names of beta 2 adrenoreceptor agonist?
SABA - sabutamol
LABA - salmeterol and formeterol (long and fast)
what is the mechanism for beta 2 adrenoreceptor agonist ?
relaxation of smooth muscle
bronchodilation and opening of airways
imitate the action of adrenaline triggering sympathetic response
what are the extra notes to take for LABA ?
it downregulate the beta 2 receptor
MUST always take with corticosteroid
what are the adverse effect of beta2 adrenoreceptor agonist ?
tremors (most common) muscle cramps peripheral vasodilation (flushing, palpitations,tachycardia) hypokalemia hypertension
what is the route of beta 2 adrenoreceptor agonist ?
usually by inhalation but oral when cannot use inhaler
IV in emergency
for epinephrine : IV/ SC in emergency
what is the second line of drugs for acute asthma?
SAMA, add on if beta 2 agonist is not producing not enough bronchodilation or can completely replace it too if they cannot use beta 2
what is the easy name for muscurinic receptor antagonist ?
tropium
what are the medication names of muscarinic receptor agonist ?
SAMA ipratropium
LAMA tiotropium
what is the mechenism of muscarinic receptor antagonist ?
inhibit ACH from causing vasoconstriction
inhibit m3 mediated bronchoconstriction
what are the adverse effect of muscurinic receptor antagonist ?
unpleasant taste
parasympathetic effect like dry mouth and urinary retention (esp in elderly)
not well absorbed there fore little sideeffects
what are the second class of bronchodilation medication for asthma?
methylxanthines
and leukotriene receptor antagonist , cyslt receptor antagonist (also anti inflammatory)
what is the easy name for methylxanthines ?
phylline
what are the uses of methylxanthines (phyllines) ?
as a add on bronchodilator
less effective than beta 2 agonist
what is the mechanism of methylxanthines ? (phylline)
- inhibit phosphodiesterase (PDE) for cyclic AMP to accumulate and cause bronchodilation
- block adenosine receptor , block bronchodilation)
- increase adrenaline release
has some anti inflammatory effects
what are the adverse effect of methylxanthines ? (phylline)
- narrow theraputic window
- many drug drug interactions
- gi discomfort
- CNS nervousness, tremor anxiety
- cns arrhythmia
what is the easy name for leukotrine receptor antagonist (cyslt reecptor antagonist)
KAST
what are the uses for leukotrine receptor antagonist (cyslt reecptor antagonist)?
add on for mild to moderate asthma weak bronchodilator mild asthma aspirin sensitive asthma exercise induced asthma
what is the mechenism for leukotrine receptor antagonist (cyslt reecptor antagonist)?
prevent the formation of LTE which causes asthma
- decreases frequency of acute asthma
- reduce the need for beta 2 agonist
- decrease peripheral eosinophil level
what is the adverse effect for leukotrine receptor antagonist (cyslt reecptor antagonist)?
upper respiratory infection
what are the anti inflammatory medication used for?
preventer
what is the first line drug for anti inflammatory?
glucocorticoid , corticosteroid
what are the medication for glucocorticoid and corticosteroid?
budesonide
flutasone (can cause the body to stop producing corticosteroid)
ciclesonide (soft steroid,requires esterase actication and only work in the lungs )
what are the mechenism of glucocorticoids ?
prevent asthma and nocturnal asthma
- inhibit many inflammation associated molecules
- anti inflammatory mediators are often upregulated
- activate beta 2 receptors
what are the adverse effect of glucocorticoids?
rare due to limited systemic absorption
- oropharyngeal irritation
- dysphonia (enfeebled voice due to msucle wasting)
- cough
- adrenosupression
- easy bruising
- cataracts
- osteoporosis
what is the route for glucocorticoid ?
via inhalation
due to higher bidning affinity
can be administered IV in acute asthma attack but must be early as onset of action is slow
what are some extra notes of glucocorticoids ?
- do not relax the smooth muscles
- it ddecreases the airway hyper responsiveness in 4-6 weeks od using the drug
- decrease frequency of asthma attacks
- reduce the need for beta 2 agonist
- reduce the death from asthma
- improve lung fucntion
what is the second line of drug for anti inflammatory ?
leukotrience pathway inhibitors
- 5 lox inhibitor (zileuton)
- montelukast ( cyst receptor antagonist), also a weak bronchodilator
what are the uses of the anti inflammaotry drug leukotrine pathway inhibitor ?
second line ADD on if ICS is not enough or can be replaced in children or if asthma is mild can be replaced
for chronic treatment of asthma
aspirin induced asthma
exercise induced asthma
what is the mechanism of leukotrine pathway inihbitor? (anti inflammatory)
- inhibit bronchoconstriction
- decrease frequency of asthma attack
- decrease need for ICS and beta agonsit
- decrease peripheral eosinophil level
what are the adverse effect of leukotrine pathway inhibitors (anti imflammatory)?
churg straus syndrome (rapid withdrawal of glucocorticosteroid)
suicidal thinking
what is the route for leukotrine pathway inhibitors ?
oral only
what medication is good for allergic asthma ?
mast cell stabilizer (cromoglicic acid)
taken before allergic and exercise induced bronchospasm it decreases the need for beta agonist and need for bronchodilator therapy
less effective than glucocorticoid
response varies in patients
what is the mechanism of mast cell stabilizer?
- prevent lge mediated allergic granulation events
- decrease release of histamine
- decrease seecretion of inflammatory mediators
- increase secretion of annexin A1 , anti inflammatory
what are the adverse effect of mast cell stabalizer?
throat and nasal irritation
mouth dryness
cough
unplesant tase
what is the route of mast cell stabalizer
only inhalation
what is the antibody medication used for allergic asthma/
anti -lgE monoclonal antibody
for severe allergic asthma with an elevated LgE level
(s/C route, every 2-4 weeks )
what is the mechenism for anti LgE ?
- decreases the level of LgE in serum
- decreases mast cell degranulation
what are the adverse effect of anti- lgE medication
small increase risk of heart attack
blood clots
body can make antibody against this
expensive
what is the antibody medication for eosinphilic asthma ?
anit iL 5 (reslizumab)
anti iL 4 for mixed asthma (dupilumaab)
what is the use for antiiL 5 drug ?
only for eosinophilic asthma for people above 18
L5 specific
what are the adverse effect of anti iL 5 ?
oropharyngeal pain
potential for anaphylaxis
what is the route for IL5 ?
IV once ever 4 weeks, expensive
for severe acute asthma (emergency) what drug should be used?
magnesium sulfate
(relaxes smooth muscle of the airway
moderate release of acetylcholine and histamine
anti inflammatory effect)
