Exam 5- Respiratory Pharm

Question 1

classic asthma progression

Answer 1

allergen -> IgE secretion -> mast cell activation => histamines and leukotrienes

• most occurrences ave a viral trigger
• allergens are not a good predictor of attacks even in allergic patients
• other non allergic stimuli cause attacks (exercise ect…)

Question 2

B2 agonist effects and side effects

Answer 2

=relaxation of smooth muscle

=glucose mobilization

=relaxation of arterial smooth muscle side effects

= increased blood glucose mild hypotension

Question 3

albuterol

Answer 3

=ß2 adrenergic receptor agonist

=decreases myosin phosphorylation =BRONCHODILATION

Question 4

Short acting B2 adrenergic receptor agonist

Answer 4

=albuterol -reverses bronchoconstriction during an asthmatic attack

-3-4hr effects

=”rescue” inhaler

-excessive use = arrhythmias and increased heart rate

Question 5

long acting B2 adrenergic receptor agonist

Answer 5

=”controllers”

=salmeterol

• prophylacticly controls asthma
• effects can last >12hrs
• not mono therapy
• with chronic use you get down regulation of B2-receptor expression

Question 6

glucocorticoids for asthma treatment target ___

Answer 6

inflammation (-) inhibit leukotriene synthesis (main effect)

• regulate anti- and pro-invlammatory mediators
• regulate NE and histamine

Question 7

glucocorticoids MOA on leukotriene synth

Answer 7

Question 8

glucocorticoid MOA on NE and Histamine system

Answer 8

= decreased extracellular NE and B2 ag. clearance

= decreased histamine release

Question 9

inhaled glucocorticoids

Answer 9

fluticasone -improves lung function

• decreases airway hyper responsiveness
• decreases inflammation 10-20% delivery of a metered
• dose is absorbed
• very safe bc 90% is eliminated by first pass and it’s actions are local

Question 10

systemic glucocorticoids

Answer 10

prednisone

• only used for short term control of acute or chronic severe asthma
• because its systemic there are lots of adverse side effects

Question 11

leukotriene blockers

Answer 11

=asthma “controller”

1. zileuton leukotriene synthesis inhibitor (-) lipoxygenase
2. zafirlukast leukortiene receptor antagonist

Question 12

NSAIDS an asthma

Answer 12

• can exacerbate asthma in 3-5%
• they (-) COX ∴ more arachidonic acid is available to make leukotrienes

Question 13

theophylline

Answer 13

=a methylxanthine

• inhibits phosphodiesterase
• prescribed as an “overnight controller”
• messy drug -> arrhythmia, headache, nausea, seizure, dizziness, hypotension

Question 14

omalizumab

Answer 14

=an anti-IgE ∴ mast cells can’t be activated to release leukotrienes and histamine

=a “controller” won’t reverse acute bronchoconstriction

-for moderate-severe asthma

Question 15

cromolyn

Answer 15

=a mast cell stabilizer

-inhibits release of histamine and leukotrienes when activated by an allergen

=a “controller” won’t reverse acute bronchoconstriction

-for mild persistant asthma or exercise induced asthma

Question 16

ipratropium

Answer 16

• use when B agonist is contraindicated (MAOI use/arrhythmia)
• often prescribed for COPD
• competitive antagonist to ACh at muscarinic receptor
• used with beta agonist as rescue therapy