L4- Respiratory Pharmacology Flashcards
list the 3 main characteristics of Asthma
- chronic inflammation of the airways
- bronchial hyper-responsiveness
- airflow obstruction
in asthma, inflammation of the airway leads to the following 4 changes, (1), which will all lead to (2)
- bronchial smooth muscle spasm
- airway hyper-responsiveness
- airway edema
- inc mucus secretion
all => Airflow Obstruction
list and define the classifications of Asthma (hint- 4)
Intermittent:
- <2 Sxs per wk
- <2 nighttime awakenings/mo
Mild Persistent:
- > 2 Sxs but not daily
- 3-4 awakenings/mo
Moderate Persistent:
- daily Sxs
- > 1 awakening/wk
Severe Persistent:
- Sxs throughout the day
- 4-7 awakenings/wk
describe the MOA of inhaled β-agonists
1) binds β2 receptors (Gs) on airway smooth muscle cells
2) stimulation of adenylyl cyclase –> inc cAMP
3) cAMP activates protein kinase A –> phosphorylates / inactivates MLCK (myosin light chain kinase)
4) => relaxation of SM cells => bronchodilation
SABAs are the drug of choice for…..
- relief of acute asthma symptoms
- prevent exercise induced asthma (use before exercise)
LABAs are used for (1) therapy. They are almost always used with (2) because monotherapy with LABAs may cause (3). LABAs are also never used for (4).
1- long-term asthma therapy for moderate to severe asthma
2- ICS (inhaled corticosteroid)
3- inc risk of serious asthma-related events
4- acute Sxs or exacerbation
The main adverse effects of SABAs and LABAs is (1). There is really only one contraindication for LABAs, which is (2).
1- tachycardia, tremor, hypokalemia
2- monotherapy: inc risk for serious asthma-related events
describe the MOA of inhaled anticholinergics
1) blocks muscarinic (M3- Gq) receptors
2) dec IP3 and intracellular Ca++
3a) => bronchodilation
3b) => dec respiratory secretions
(SABAs/SAMAs) are more efficacious
SABAs are more efficacious
The main use of Ipratropium is (1). It is the drug of choice for (2).
The main use of tiotropium is (3).
(SAMA)
1- in adjunct with SABAs for moderate to severe asthma exacerbations
2- β-blocker induced bronchospasm
(LAMA)
3- adjunct with ICS for long-term control of severe persistent asthma
SAMAs and LAMAs are compounds in the (1) form, therefore their adverse effects are limited to (2). The common adverse effects are (3). It is also pertinent that SAMAs are used over SABAs in (4) situations.
1- quaternary ammonium (lipophobic)
2- systemic circulation
3- xerostomia (mild anticholinergic effects)
4- Pts with CVD, SAMAs are safer than SABAs
The main methylxanthine is (1), which functions to inhibit (2) in order to increase (3) levels intracellularly and induce (4).
1- theophylline
2- phosphodiesterase (normal function is cAMP –> AMP)
3- cAMP
4- bronchodilation
Theophylline is administered in (1) fashion and is only used for (2) situations because of (3).
1- oral, IV
2- alternate therapy for persistent asthma
3- β2 agonists and corticosteroids are safer: theophylline has narrower therapeutic window, more AEs and drug interactions
The most common adverse effects of theophylline is (1). At high concentrations, (2) are critical side effects that can occur.
1- HA, n/v, abdominal discomfort, restlessness
2- cardiac arrhythmias, seizures
Glucocorticoids function to inhibit (1) and (2) in order to reduce (3). This is most effective for (4) while used in adjunct with SABAs.
1- phospholipase A2
2- COX2
3- LT and PG formation
4- prevents or reverses β2 desensitization with prolonged use of SABAs
The most effective long-term control medication for persistent asthma is (1). (2) maybe added to (1) in (3) or used alone adjunct to other medications in (4) situations.
1- ICS
2- oral/systemic corticosteroid
3- long-term control of severe persistent asthma
4- short course for moderate to severe acute (=> speedy recovery and to prevent recurrence of exacerbation)
(ICS/systemic) corticosteroids have more adverse effects.
- local AEs for ICS are (2)
- long-term AEs for ICS are (3)
- long-term AEs for systemic corticosteroids are (4)
1- systemic (ICS has less F)
2- oropharyngeal candidiasis, dysphonia, reflex cough, bronchospasm
3- osteoporosis, cataracts (+ deceleration of vertical growth in children)
4- hypercortisolism / Cushing’s syndrome
Cromolyn and Nedocromil function to inhibit (1) in order to prevent (2) and (3) in asthmatic patients. They are not as useful for (4) in asthmatics.
1- mast cell degranulation
2- Ag induced bronchospasm
3- exercise induced bronchospasm
4- acute asthma attacks (b/c not bronchodilators)
Cromolyn and Nedocromil are mainly used for (1) and (2)
1- alternative for mild persistent asthma
2- prevent exercise induced bronchospasm
Note- once widely used, now replaced by other therapies
Cromolyn and Nedocromil:
- (1) common AEs
- (2) rare AEs
- (3) rare side effect syndromes
1- throat irritation, cough, mouth dryness
2- chest tightness, wheezing
3- reversible dermatitis, myositis, gastroenteritis, pulmonary infiltration with eosinophilia / anaphylaxis
(1) is the main immunomodulator used for asthmatics. It is described as a (2) structure, used in order to bind (3) to prevent (4).
1- omalizumab
2- monoclonal Ab
3- IgE
4- binding / activation / degranulation of basophils and mast cells
Omalizumab is mainly used for….
management of severe persistent asthma with evidence of allergy
the main AE for omalizumab is (1), therefore it is only used in (2)
anaphylaxis- only administered in hospitals
LTMAs, aka (1), function to interfere with (2), in order to reduce release from (3).
1- leukotriene modifying agents
2- pathway of leukotriene mediators
3- mast cells, eosinophils, basophils
LTMAs are mostly used in (1) fashion. They are also used to prevent (2) and manage (3- a drug induced side-effect).
1- alternative therapy for asthmatics
2- exercise induced bronchospasm
3- NSAID exacerbated respiratory disease (NERD)
describe the pathogenesis of NERD
(NSAID exacerbated respiratory disease)
1) NSAIDs inhibit COX1/2
2a) dec PG, TX synthesis
2b) inc LT synthesis
3) LTs => asthma-like Sxs and persistent bronchoconstriction
Montelukast has the following AEs….
insomnia
anxiety
depression
suicidal thinking
Zileuton has the following AEs….
hepatotoxicity
COPD is a (acute/chronic) (sporadic/progressive) (ir-/reversible) obstruction of airflow. (4) is the main important risk factor. The three cardinal symptoms of COPD are (5).
1/2/3- chronic, progressive, irreversible obstruction to airflow
4- smoking
5- dyspnea, chronic cough, sputum production
Oxygen therapy is indicated for COPD in……
- Pts w/ severe hypoxemia, O2 therapy will inc survival
- key component of hospital Tx for COPD exacerbation
LAMAs and or LABAs are recommended to be used in (1) patients in order to improve (2) and reduce (3).
1- Pts with moderate to severe dyspnea (COPD)
2- lung function
3- COPD Sxs and exacerbation rates
what is the key difference in LABA therapy for Asthmatics and COPD patients
Asthma: contraindicated to be used in monotherapy b/c of inc risk of asthma related death
COPD: no such evidence, monotherapy is appropriate
SAMAs and SABAs are used in COPD for….
- Sx relief
- management of acute exacerbations
ICS are used (more/less) in COPD patients than in asthmatics. This is because of (2), therefore it is appropriate to use ICS is (3) fashion.
1- less
2- ICS doesn’t slow COPD progression or reduce mortality + LABAs are more effective (therefore not used in monotherapy)
3- adjunct with LABA to improve lung function and reduce exacerbations
the main mucolytic agent is (1), which functions to (2) and is used in treatment of (3)
1- N-acetlycysteine
2- breaks disulfide linkages in mucus => dec viscosity
3- COPD
(1) are often used in COPD patients because exacerbations commonly involve (2). (2) is usually indicated by (3) and (4) changes, and therefore (1) therapy is usually prescribed.
1- antibiotics
2- bacterial infections in lower airways
3- increasing dyspnea
4- change in phlegm quantity or color
Allergic rhinitis is the result of (1) due to various allergens. (1) will induce (2) symptoms. Treatment for allergic rhinitis consists of (3) and (4).
1- inflammation nasal mucosa
2- nasal pruritus, sneezing, rhinorrhea, nasal congestion
3- allergen avoidance
4- pharmacotherapy
_____ is the first line treatment for allergic rhinitis
glucocorticoid nasal sprays
list the AEs for glucocorticoid sprays
- local irritation of nasal mucosa
- nosebleed
- nasal septal perforation
- nasopharyngeal candidiasis
compare the AEs for 1st and 2nd generation oral antihistamines
1st (diphenhydramine, chlorpheniramine): lipophilic –> sedation central effect
- anticholinergic effects
- orthostatic hypotension (α blocker)
2nd (loratadine, fexofenadine, cetirizine): hydrophilic –> no central effects
- minor anticholinergic effects
- little or no orthostatic hypotension (less likely to block α-receptors)
(1) and (2) are the major nasal decongestants that work on (3) receptors in order to induce (4). (5) is the main risk of (1) and (2) if used in (6) fashion.
1/2- phenylephrine, pseudoephedrine 3- α-receptors 4- vasoconstriction of arterioles in nasal mucosa 5- rebound nasal congestion 6- longer than 3 days
(1) and (2) are the main cough suppressors by directly acting on (3). (1/2) is preferred because of (4). (5) are the main adverse effects for (1) and (2).
1- codeine
2- dextromethorphan** (preferred b/c safer and lower abuse potential)
3- cough center in medulla –> suppress cough reflex
4- constipation, drowsiness
