E2: Asthma Flashcards
What innervation constricts and relaxes the lungs?
-Bronchioles are constricted by cholinergic innervation and relaxed b beta 2 innervation
What happens in emphysema?
- Wall of the alveoli break down, so the few alveoli left become larger. Less surface area of gas exchange
- Fibrosis and loss of elasticity makes it difficult to breath
How do Beta2 agonists help treat asthma?
- Most widely used treatment for asthma
- B2 receptors increased cAMP, which relaxes airway smooth muscle and inhibits histamine release from mast cells
What are the B2 agonists used as rescue inhalers (SABA)?
- Albuterol, levabuterol
- These act immediately to stop an attack in progress and last 4-6 hours
What kind of drug is Salmeterol?
Long acting B2 agonist for prevention and prophylaxis
What should LABAs always be combined with?
A steroid (advair)
What are the common side effects of B2 agonists?
-Tachycardia, nervousness, dizziness, tremor
What is the black box warning of LABAs?
May increase risk of asthma related death
What kind of drug is Ipratropium?
Muscarinic antagonist
What are the indicated for Ipratropium?
- Useful for patients intolerant of B2 agonists
- Used on COPD
- Combined with albuterol
What is the MOA of Theophylline?
- Increases cAMP, phosphodiesterase inhibitor
- Blocks adenosine receptors
- Results in relaxation of smooth muscle and stimulates CNS and heart
What are the side effects of theophylline?
- Low therapeutic index
- drug interaction with cimetidine
- Nervousness, insomnia, anxiety, and tremor
- Tachycardia and arrhythmias
- Decreases diaphragm fatigue, increases contraction
- Weak diuretic
What are the anti-inflammatory drugs used in asthma?
- Corticosteroids
- Leukotrienes inhibitors
- Cromolyn sodium
How do corticosteroids treat asthma?
- They decrease inflammation, reduce bronchial reactivity, improve response to beta agonist.
- Inhaled steroids are becoming first line treatment
What are the side effects of inhaled or oral steroids?
-Oral candidiasis
-Hoarseness
-osteoporosis
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What kind of drugs are Zileuton, Zafirlukast, and Monkelukast?
Leukotriene receptor antagonists
Which LTA inhibits 5-lipoxgenase?
Zileuton
What are the side effects of LTAs?
- Upper respiratory infections, sore throat, headache, abdominal pain, sleepiness
- No effect on attack in progress
- may allow decreased steroid dose
What kind of drug is Omalizumab?
Monoclonal antibody receptor that may decrease the need for steroids and reduce asthma exacerbation
What is the MOA of omalizumab?
-Monoclonal antibody to IgEs, high affinity Fc receptor, prevents binding of IgE to cells associated with allergic response and lowers free serum IgE concentrations
What is the use of Omalizumab in asthmatics?
Moderate to severe allergic asthma
What are the side effects of omalizumab?
Rash, injection site reactions, small decrease in platelets
What is the MOA of Cromolyn sodium?
-Inhibit release of histamine from mast cells, not bronchodilators
What are the 3 types of LABAs?
- Salmeterol (Salmeterol/fluticasone)
- Formoterol/mometasone or Formeterol/budesonide
- Vilanterol/fluticasone
What kind of drugs are ipratropuim and tiotropium?
Muscarinic antagonists
-Quaternary compounds widely used to treat COPD
What drugs increase the clearance of theophylline?
Phenytoin, smoking, Rifampin, and oral contraceptives
What drugs decrease the clearance of Theophylline?
Cimetidine
What happens in Theophyline OD?
- May be fatal due to arrhythmia
- moderate toxicity has headache, palpitations, dizziness, hypotension
What ar the 5 ICS?
Beclomethasone, flunisolide, triamcinolone, fluticasone, and Budesonide
What are the two oral steroids used for asthma?
Methylprednisolone and prednisone
What are the common side effects of the inhaled corticosteroids?
Thrush, hoarseness, decreased bone density
Can leukotriene inhibitors stop and asthma attack?
No, an inhaled B agonist would still be required
When is benralizumab indicated for asthma?
For severe asthma with eosinophilic phenotype
What are the common side effects of leukotriene inhibitors?
Headache, abdominal pain, slight increase in URIs, sore throat, sleepiness
-Possible psychiatric reactions like agitation, aggression, hallucinations, and nightmares
What is the used of Leukotriene inhibitors in asthma?
-Inhibit early response to allergen, decrease asthmatic response to exercise or cold air, and decrease the need for steroids
