Lecture 12 - Asthma Drugs

Question 1

Serum ____ levels are predictive of development of asthma.

Answer 1

IgE

Question 2

Beta-2 Adrenergic Agonists are most effective bronchodilators without ______ side effects. They are effectively administered ____ or _____. They stimulate ____ ____ and increase _____, favoring bronchodilation.

Answer 2

Cardiovascular side effects

Orally

Inhaled

Adenylyl Cyclase

cAMP

Question 3

Albuterol’s effects take place in about ____min and can last several hours.

Answer 3

30 mins

Question 4

LABAs should be taken as 2 puffs/day for ____ weeks for maximum effectiveness. What MUST also be administered with LABAs for Asthma patients but NOT for COPD patients?

Answer 4

2 weeks

ICS should also be administered with LABAs for asthma patients, but the same is not true for COPD patients.

Question 5

_________ is a non-selective Beta-adrenergic agonist that can be inhaled. It is very potent and fast acting, so it’s good for severe episodes of bronchoconstriction. Because it is non-selective, it WILL have side effects, including cardiac ______.

Answer 5

Isoproterenol

Cardiac arrythmias

Question 6

Muscarinic antagonists are used to treat non-______ bronchoconstriction.

Answer 6

Non-antigenic

Question 7

______ bromide is a short acting muscarinic antagonist (SAMA). It is administered as an _____ and it’s effects peak about 2-3hrs after administration. Thus it should NOT be used as a rescue inhaler.

_________ bromide is a LAMA, and it is typically used in patients who have poorly controlled asthma with ICS.

Answer 7

Ipratropium bromide

Inhaler

Tiotropium bromide

Question 8

Caffeine, Theobromine, and Theophylline all belong to the drug group ________. They act by inhibiting ______, which effectively increases ______, favoring bronchodilation.

Keep in mind Theophylline has a very narrow therapeutic range, between ___ and ___micrograms/mL. It is given ____.

Answer 8

Methylxanthines

Phosphodiesterase

cAMP

5 and 15 micrograms/mL

Orally

Question 9

Theophylline is metabolized by ______ in the liver, so it has many drug-drug interactions. One of the contraindications for Theophylline administration is _____ illness.

Answer 9

CYP450

Febrile

Question 10

How do the oral bioavailabilities compare between Fluticasone and Flunisolide? Which has a greater lung retention time? Which has a greater potency (receptor binding affinity)?

Keep in mind these are both _____ corticosteroids.

Answer 10

Fluticasone has lower Oral bioavailability (which is good bc we want it to act in the lungs). It has greater lung retention AND greater receptor binding affinity.

Inhaled corticosteroids (ICS)

Question 11

Predinsone is administered _____, and it is used for severe ______ episodes only.

Answer 11

Orally

Acute

Question 12

Corticosteroids act by controlling ______, reducing ______ edema, they potentiate the effects of ________ agonists, and they inhibit transcription of _______ agents.

Answer 12

Eosinophils

Mucosal edema

Beta-adrenergic agonists

Inflammatory agents

Question 13

Orally administered corticosteroids have serious side effects including Hypertension, Diabetes, ______ Cushings, ______ suppression, and _____ ulcers.

Answer 13

Iatrogenic Cushings

Adrenal Suppression

Peptic Ulcers

Question 14

Leukotrienes ____ and ____ are known as the Slow reacting substance of anaphylaxis.

Zileutin (which should never be given with ______) inhibits 5-_______ (no conversion of Arachidonic acid to Lekotrienes).

Zafirlukast and Montelukast are both _____ receptor ______.

All of these Leukotriene inhibitors are given ______.

Answer 14

LTC4 and LTD4

Theophylline

Inhibits 5-Lipoxygenase

LT receptor Antagonists

Orally

Question 15

Erythromycin decreases the effectiveness of ________.

Answer 15

Zafirlukast

Question 16

Anti-LTs decrease _____ clearance, so they increase Prothrombin time, and they also increase _________ levels.

Answer 16

Warfarin

Theophylline

Question 17

Keep in mind Anti-LTs are NOT effective in everyone. They are used specifically to DECREASE the dose of ______ patients receive. They are also good for ______ and _____ - induced asthma.

Answer 17

ICS

Exercise and Aspirin-induced asthma

Question 18

_______ and Nedrocromil inhibit the release of mediators from mast cells, neutrophils, and eosinophils. They do so by causing an interaction between the secretory vesicles and cytoskeleton in these cells, inhibiting _______.

Answer 18

Cromolyn and Nedrocromil

Exocytosis

Question 19

Cromolyn and Nedrocromil are good for early and late response, but are less effective than _____. They CANNOT reverse ______ bronchospasm. They are given as _____ prophylactically.

Answer 19

ICS

Acute

Inhalers

Question 20

________ is an anti IgE that is used for asthma patients ___years or older who have tested positive on skin test or in vitro reactivity to allergens and whose asthma is poorly controlled with ____.

It is administered via ______ injection every ___-___ weeks. The goal is to decrease serum IgE levels to < ______ IU/mL.

Answer 20

Omalizumab

6 years or older

ICS

SubQ injection

2-4 weeks

<10IU/mL

Question 21

Reslizumab is an anti-_______ 5 monoclonal Ab that reduces _______ proliferation and differentiation. So it should obviously be used to treat what type of asthma?

Answer 21

Anti-Interleukin 5

Eosinophil

Eosinophilic asthma

Question 22

Reslizumab should be used in patients ____ years or older, and its given monthly via _____.

Answer 22

18 years or older

IV