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Pulmonary > Lower Respiratory Pharmacology Dr. Roane > Flashcards

Lower Respiratory Pharmacology Dr. Roane Flashcards

1
Q

What are the two most common conditions associated with the Lower Respiratory diseases?

A

Obstructive:

Asthma and COPD

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2
Q

What are Obstructive and Restrictive conditions referred to?

A

Obstructive means reduced FEV1 (forced expiratory volume of 1 second)

Restrictive means reduced Vital Capacity (all the volume that can be breathed in

FVC (forced vital capacity): maximum that can be breathed in -> maximum that can breathed out (residual volume will stay)

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3
Q

How much air should be exhaled in a normal FEV1?

A

70-80%
slightly less with >65 of age

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4
Q

What is the function of the smooth muscles wrapped around the bronchiole?

A

they regulate how much air can be moved (Bronchodilation, Bronchoconstriction)

with increased force, there is lower surface pressure

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5
Q

What is Asthma?

A

-disease of diffuse airway inflammation, extra excreted mucus, bronchoconstriction

-caused by a variety of triggering stimuli
-resulting in partially or completely reversible bronchoconstriction

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6
Q

Symptoms of Asthma

A

-Dyspnea (difficulty breathing)
-chest tightness
-cough
-wheezing
-possible anxiety

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7
Q

Treatment of Asthma

A

-inhaled beta-2 agonists (short-term)
-muscarinic blockers
-inhaled corticosteroids (long-term treatment)

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8
Q

Epidemiology

A

-Asthma is more common in African American and Puerto Ricans
-some genetics suspected to be involved
ORMDL3 and many genes coding for cytokines

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9
Q

How do allergens involved in asthma attacks affect the airways?

A

Allergens -> cause Inflammatory mediator secretion
-bronchoconstriction (muscarinic effect)
-vasodilation
-mucus hypersecretion
-plasma exudation, edema
-activation of sensory nerves

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10
Q

Consequences of chronic inflammation of the airways due to asthma?

A

-structural changes
-subepithelial fibrosis (the membrane will be less elastic)
-smooth muscle hypotrophy (bigger) and hyperplasia (more cells)

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11
Q

What happens in an asthma attack?

A

-Bronchoconstriction: smooth muscle contraction + Tissue inflammation
-Mucus secretion/edema
-Mismatch between ventilation and pulmonary blood flow

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12
Q

What happens when the ventilation and perfusion don’t match?

A

-Normally, pulmonary blood flow goes to highly ventilated regions
-in asthma, constricted airflow cause a mismatch in ventilation and perfusion (passage of blood) -> dysfunction in gas exchange

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13
Q

If the airways are blocked what happens to pO2 and pCO2?

A

pO2 goes down
pCO2 goes up

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14
Q

What is the status asthmaticus?

A

-Non-reversible asthma attack
-can be fatal

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15
Q

COPD

A

-persistent airflow limitation from the consequences of chronic inflammation from smoking (can also affect people with air pollution)

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16
Q

Subtypes of COPD

A

-chronic bronchitis
-Emphesyma (damage of lung tissue - air sacs)
-small airway disease: small bronchioles are narrowed and reduced in number

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17
Q

Drugs that are used in COPD and asthma

A

-Bronchodilators
>Beta-2 adrenergic receptor agonists
>Anticholinergics (Muscarinic antagonists)
>Methylxanthines

-Corticosteroids
-Leukotriene modifiers
-Mast cell stabilizers
-Immunomodulators

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18
Q

What are the ß-agonists used for Asthma/COPD?

A

-SABA (short-acting): Albuterol, Terbutaline, levalbuterol (Xopenex), metaproterenol (Alupent),
and pirbuterol (Maxair)

-LABA (long-acting): Salmeterol, Formoterol, Vilanterol and Olodaterol

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19
Q

Adverse effects ß2 Agonists

A

due to partial ß1 activity
-cardiac arrhythmia (faster heart rate)
-decrease in plasma K+
-reduce insulin secretion -> increase in blood glucose

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20
Q

Which drug class is associated with increased mortality in patients having asthma?

A

LABA (Long-acting ß agonists)
-Salmeterol, Formoterol, Vilanterol and Olodaterol

-indicated for COPD - not asthma

21
Q

Which enzymes regulate the contraction and relaxation of smooth muscles in the airway?

A

-Myosin light chain kinase: phosphorylates the myosin light chain -> interact with actin-fiber-> CONTRACTION

-Myosin light-chain phosphatase removes Phosphate from the myosin light chain -> RELAXATION

(Relaxation can also occur when Ca entry is stopped)

22
Q

MOA for ß2-Agonists

A

-binds to ß2-receptor
-activates adenylate cyclase -> producing cAMP
-cAMP turns on protein kinase A (PKA)
-PKA inhibits MLCK -> RELAXATION of smooth muscles -> BRONCHODILATION

23
Q

Why are some ß-agonists short-acting?

A

Because cyclic AMP (activating PKA -> PKA inhibiting MLCK -> RELAXATION) has a short halflife
-cAMP gets metabolized by Phosphodiesterase (PDE)

24
Q

What is the final effect of Phosphodiester inhibitors (PDE-inhibitor)?

A

PDE4 metabolizes cAMP to AMP
-cAMP is needed to activate PKA -> PKA deactivates MLCK causing BRONCHODILATION

-PDE inhibitor inhibits PDE4 so there is more cAMP to activate PKA

-relaxes smooth muscles
-inhibit inflammatory cells

25
Q

What are the Phosphodiester inhibitors (PDE -inhibitor)?

A

-Methylxanthines
Theophylline
Aminophylline

-Selective PDE4 blocker (better against COPD) !!
Romflumilast (Daliresp)

26
Q

What is an unwanted effect of PDE inhibitors (Methylxanthines)?

A

-adenosine on adenosine receptor causes slower HR
-blocking adenosine receptors and increasing heart rate

27
Q

If muscarinic receptors are blocked to achieve Bronchodilation or constriction?

A

-Muscarinic causes Bronchodilation

28
Q

Which nerve is responsible for stimulating smooth muscles around the airways?

A

Vagus nerve

29
Q

What are the muscarinic blockers?

A

-Ipratropium
-Tiotropium
-Glycopyrrolate
-Umeclidinium
-Aclidinium

-all are atropine-like drugs

30
Q

What are the drug classes of the following combination product: albuterol/ipratropium

A

Albuterol: Short acting ß agonist (SABA)

Ipratropium: short-acting muscarinic antagonist (SAMA)

31
Q

What are the drug classes of the following combination product: indacaterol/glycopyrrolate

A

Indacaterol: long-acting ß-agonist (LABA)

Glycopyrrolate: long-acting muscarinic antagonist (LAMA)

32
Q

What are the drug classes of the following combination product: vilanterol/umeclidinium

A

ANORA ELLIPTA
Vilanterol: long-acting ß agonist (LABA)

umeclidinium: long-acting muscarinic antagonist (LAMA)

33
Q

Drug classes in BREO ELLIPTA

A

BREO ELLIPTA (Vilanterol and Fluticasone)
-> LABA and Inhaled Corticosteroid

34
Q

Direction for long-acting ß agonists

A

-often once daily
-longer onset, longer duration
-CAUTION when used in asthma patients

35
Q

Examples of Inhaled Corticosteroids

A

-Fluticasone (OTC)

-Prodrugs (activated in the lungs)
Beclomethasone dipropionate (BDP)
Ciclesonide

-with first-pass effect
Budesonide
Fluticasone
Mometasone

36
Q

Side effects associated with Glucosteroids

A

-Raise blood glucose
-alter fat metabolism
-increased appetite
-may affect skin health (weak)
-capillary fragility (small blood vessels)
-gastric ulcers
-reduce bone metabolism (fragile bones)
-immunosuppressive (can’t fight infections well)

-seen in large doses, long-term use

37
Q

What are the important Cysteinyl-leukotrienes?

A

-LTC4
-LTD4
-LTE4

38
Q

What are the effects of Leukotrienes when binding on Leukotrienes receptors?

A

-Plasma exudation
-Musus secretion
-Bronchoconstriction
-Eosinophiles recrution

39
Q

How are Cysteinyl-leukotrienes synthesized and blocked?

A

-Derived from Arachidonic acid and converted to Cysteinyl-leukotrienes

-by the enzyme: 5-lipoxygenase

40
Q

Which drug inhibits Dysteinyl-leukotrienes synthesis?

A

5-lipoxygenase inhibitor

Zileuton (Zyflo)

41
Q

How do LT antagonists work?

A

Block Leukotriene receptor 1 (specifically)
LT1 receptor mediates the effects of Bronchoconstriction, Mucus secretion, Plasma exodus, Eosinophil recrution

-patients will have fewer asthma attacks and less severe -> prophylactic-like effect

-Montelukast
-Pranlukast
-Zafirlukast

42
Q
A
43
Q

MOA of Omalizumab

A

IgE binds to receptors on mast cells -> release of Histamine, leukotrienes, prostaglandin

IgE binds to receptors on immune cells -> Chronic inflammation

-Omalizumab (Xolair): Antibody blocking IgE

44
Q

What is the role of IL-5 in allergic reactions?

A

-stimulation of eosinophilic inflammation

45
Q

Which drug inhibits IL-5?

A

Mepolizumab (Nucala) and Reslizumab (Dupixent)

46
Q

Which drug blocks IL-5 receptors on eosinophiles?

A

Benralizumab (Fasenra)

47
Q

Which drug is considered a mast cell stabilizer?

A

Cromolyn sodium

48
Q

Which drugs are used for allergic conjunctivitis?

A

OTC: mast stabilizer
Nasalcrom
Gastrocrom

Pulmonary (13 decks)

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