Drugs inflammatory and related disorder_ drugs used in Rx of Asthma Flashcards
_____ is an inflammatory disease associated with bronchial hyperactivity (BHR), bronchospasm, increase mucous secretion, edema, and cellular infiltration
Asthma
___________ is lasting from 30-60 minutes, are associated with bronchospasm from the actions of released histamine and LTs
Early asthmatic response (EAR)
________ involve infiltration of eosinophils and lymphocytes into airways —-> bronchoconstriction and inflammation with mucous plugging
Late asthmatic response (LAR)
Management of asthma includes:
bronchodilators to provide short-term relief and anti-infalmmatroy agents that reduce bronchial hyperactivity and protect against cellular infiltration
______ that inhibits acetylcholine
Ipratropium (relaxes bronchial smooth muscle)
Muscarnic receptor: vagal stimulation —->Ach =>bronchoconstriction which is blocked by muscarnic antagonists
ipratropium and tiotropium are
muscarnic-receptor blockers
_________ are choice in bronchospasm caused by beta-blockers
ipratropium ; tiotropium
there are minor atropine-like effect in
ipratropium; tiotropium
ipratropium and tiotropium are used via __________ which causes _________?
inhalation; bronchodilation in acute asthma, esp. COPD patients and may be safer than B-agonist in patients with cardiovascular disease
safer than B-agonist in patients with cardiovascular disease
ipratropium; tiotropium
Beta-receptors agonist also used in
Asthma patients
which beta-agonists drugs are widely used in Rx of acute bronchoconstriction and prophylaxis of exercise-induced asthma
Beta-2 selective
beta-2 selective drugs are
albuterol (short acting); metaproterenol; terbutaline
longer acting beta-2 selective agonist
salmeterol
_________ may decrease nighttime attacks (propylaxis only) and permit dosage reduction of other agents
Salmeterol; formerterol
***not used as monotherapy, always give with corticosteriods
what is a long acting muscarnic blocker
tiotropium
side effects of long acting beta-receptor agonists
HTN; arryhthymia; tremors
aerosolic forms of asthma have ________ potential for systemic toxicity but may cause anxiety, muscle tremors and cardiovascular toxicity with overdose
Low (Beta-receptors agonist)
_______ bronchodilates via inhibition of phosphodiesterase (PDE) —> increase cAMP due to decrease cAMP hydrolysis and also by antagonism of adenosine (bronchoconstrictor)
theophylline
antagonism of adenosine causes
bronchoconstriction
methylxanthines are
theophylline
usage of _______ is limited b/c of its narrow therapeutic index (cardiotoxicity and neurotoxicity)
Theophylline
Mainly adunctive; regular use may decrease symptoms but narrow therapeutic window
theophylline
Many drug interactions; toxicity increases by erythromycin, cimetidine, and fluroquinolones
theophylline
___________ sometimes used in bronchospasm and status asthmaticus
aminophylline IV
Cromolyn and Nedocromil
prevents degranulation of pulmonary mast cells and decrease release of histamine, PAF and LTC4 from inflammatory cells
prevents degranulation of pulmonary mast cells and decrease release of histamine, PAF and LTC4 from inflammatory cells
Cromolyn (inhaler. nebulizer); Nedocromil
prophylactic use of Cromolyn and Nedocromil
decrease symptoms and bronchial hyperactivity (BHR), esp. responses to allergens
has minimal systemic toxicity but may cause throat irritation and cough
Cromolyn and Nedocromil
Relieved by beta-2 agonists
Cromolyn and Nedocromil
__________ block mediator release and decrease BHR via decrease expression PGS, LTs and inflammatory ILs, TNF-gamma/alpha/Gm-CSF resulting in increase immunosuppression
Glucocorticoids
__________ are a surface-active drugs used via inhalation for both acute attacks and for prophylaxis
Budesonide; Flunisolide
***are glucocorticoid groups
_______ can cause oropharyngeal candidiasis which can be prevented via spacers and gargling
glucocorticoids
_______ low dose may prevent desensitization of beta-receptors that can occur with overuse of beta-2 agonist
Glucocorticoids
__________ (oral) and IV __________ generally reserved for severe acute attacks
Prednisone; Steroids (methylprednisone aka: solumedrol)
All asthmatic need a ________________ for acute attacks ; for Prophylaxis _____________ are most often used
short-acting beta-2 agonist; Glucocorticoids
For COPD (emphysema, chronic bronchitis), multiple ____________ are used including ___________ and ______ blockers
Bronchodilators; beta-2 agonists; M
_____________ and ____________ are antagonists at LTD4 receptors with slow onset of action used prophylactically for many forms of asthma, including antigen, exercise or drug-induced (ASA)
Zafirlukast; Monetlukast
__________ is selective inhibitor of lipoxygenases (LOX), decrease formation of all LTs from arachdonic acid
Zileuton
__________ has more rapid onset (1-3 hrs) and is adjunctive to steroids
Zileuton
side effects of Zileuton
Hepatotoxicity
