Exam I - Asthma and COPD

Question 1

Drug List

Systemic

Answer 1

Methylprednisolone

Question 2

Drug List

Aerosol Corticosteroids

Answer 2

Fluticasone

Question 3

Drug List

SABA

Answer 3

Albuterol

Question 4

Drug List

LABA

Answer 4

Salmeterol

Question 5

Drug List

SA Muscarinic Antags

Answer 5

Ipratropium

Question 6

Drug List

LA Muscarinic Antags

Answer 6

Tiotropium

Question 7

Drug List
Phosphodiesterase Inhibitors
Non-selective

Answer 7

Theophylline

Question 8

Drug List

Leukotriene Inhibitors

Answer 8

Montelukast

Question 9

IgE Inhibitors

Answer 9

Omalizumab

Question 10

Acute Asthma

Stimuli

Answer 10

• Allergens
• Viral Inxns
• Pollutants
• Cold Air
• Exercise
• Stress

Question 11

Asthma
Immunopathogenesis
Early Phase

Answer 11

• sharp decline FEV1
• IgE/mast cell/histamine mediated
• T-cell participation
• Also: Tryptase, PGD, LTC, PAF
• bronchodilator drugs

Question 12

Asthma
Immunopathogenesis
Late Phase

Answer 12

• Eosinophil -> ECP, MBP
• Neutrophil -> Proteases, PAF
• anti-inflammatory drugs

Question 13

Maintenance Drugs

Answer 13

• ICS

- anti-inflammatory

Question 14

Maintenance Drugs

Effect

Answer 14

-airway responsiveness

Question 15

Quick Relief

Drugs

Answer 15

• SABA

- IV/oral CS

Question 16

Quick Relief

Effect

Answer 16

-airway resistance

Question 17

Therapeutic Index

Equation

Answer 17

TD50/ED50

Question 18

Asthma Inhaler

Types

Answer 18

• MDI w/ or w/o Spacer (+mask PRN)
• DPI (really effective and easy for kids!)
• Nebulizer w/ face mask

Question 19

Deposition of

Inhaled Drugs

Answer 19

• 10-20% inhaled
• 80-90% swallowed + first pass
• side effects from circulation

Question 20

Attack Prevention

Drug Targets

Answer 20

• Immune cells: CS, leukotrienes, IgE
• Muscarinic cholinergic antagonists
• B2 adrenergic agonists

Question 21

Most Effective Tx

Answer 21

-inhaled glucocorticoids (ICS)

Question 22

ICS

mechanism

Answer 22

-Suppress inflammation
(inflamm gene transcr.)
-direct inhibition of CBP/HAT gene transcr.
(acetylation of enzyme)
-indirect inhibition of HDAC2 gen transcr.
(deacetylation of DNA)

Question 23

ICS

Effects on Inflamm Cells

Answer 23

• incr. B2 receptors on smooth musc
• decr. Eosins, macs, dendritics
• decr. cytokines on T cells
• decr. T cell activation of mast/eosin

Question 24

ICS

Not mechanism

Answer 24

• effect on mediator release

- effect on early response

Question 25

ICS | TX Timeline

Answer 25

-weeks/mos/long-term

Question 26

ICS Not working well enough? What to do?

Answer 26

-Add LABA before increasing ICS

Question 27

ICS | Adverse

Answer 27

-oral candidiasis, dysphonia -suppress hypothal/pit axis (bone resporption, skin thinning, growth retardation)

Question 28

ICS | COPD indications

Answer 28

-only if FEV1<50%

Question 29

Systemic Glucocorticoids | Indications

Answer 29

- acute asthma exacerbation - may need to use IV - 3-10 day short-course - replace with ICS upon conclusion

Question 30

Systemic Glucocorticoids | Adverse

Answer 30

-Same as ICS

Question 31

SABA/LABA | mechanism

Answer 31

- Relax smooth muscle/bronchodilator - pos reg of adenylate cyclase-> cAMP - inhibits methylxanthines - Inhibit mast cells - inhibit vasc leakage - stimulate glucocorticoid receptor translocation - incr. mucociliary transport

Question 32

SABA Indication Duration/Impact

Answer 32

- Rescue - effects in 3-5 min - peak 30-60 min - duration 3-6 hours

Question 33

LABA Indication Duration/Impact

Answer 33

- adjunct to ICS - duration > 12h - COPD monotherapy

Question 34

SABA/LABA | Adverse

Answer 34

-muscle tremor, tachycardia, hypokalemia -no LABA w/o concurrent ICS (use combo inhaler)

Question 35

Muscarinic Cholingergic Antags | Mechanism

Answer 35

- block vagus ACh on M3 - inhib sm musc contraction - additive effect w/ B2 agonists - no anti-inflammatory action

Question 36

Muscarinic Cholingergic Antags | Indication

Answer 36

- B2 agonist intolerance | - more effective in COPD

Question 37

Muscarinic Antags | Durations

Answer 37

- Ipratropium: SA, 15 min to 4 hours | - Tiotropium: LA, >24 hrs

Question 38

Muscarinic Antags | Adverse

Answer 38

- few systemic (poor absorption) | - dry mouth

Question 39

Methylxanthines | Mechanism

Answer 39

-oral! -inhibs cAMP phosphodiesterase (incr cAMP) -blocks adenosine receptors on sm musc, mast cells (reduce constriction, reduce histamine) -deactylates histones -decr. cytokine release

Question 40

Methylxanthines | and COPD

Answer 40

- increases diaphragm contractility | - may increase ICS effects

Question 41

Methylxanthines | Adverse

Answer 41

- Nausea/vomit - CNS stim: anxiety, tremor, convulsions - CV: tachycardia, arrhythmias, vasodilation - narrow tx window!

Question 42

Leukotriene Pathway Inhibs | Mechanism

Answer 42

-Oral -inhibit bronchoconstriction (blocks receptor for cysteinyl leukotrienes in COX)

Question 43

Leukotriene Pathway Inhibs | Indications

Answer 43

- aspirin-sensitive asthmatics - additive for poorly controlled mild/mod asthma - NO ROLE IN COPD

Question 44

Leukotriene Pathway Inhibs | Adverse

Answer 44

- rare hepatic dysfx'n | - reversible on discontinuation

Question 45

Anti-IgE | Mechanism

Answer 45

- injected Ab - binds Fc portion of IgE - prevents IgE from binding

Question 46

Anti-IgE | Adverse

Answer 46

- $$$$$$$$$$$ - rare anaphylaxis - rare increase in malignancies

Question 47

COPD | best cure

Answer 47

stop smoking, beez

Question 48

Asthmatic Sx following URI | TX

Answer 48

- no official recommendations | - can use SABA or SA anti-chol or LABA