objective 2.3 (2)

Question 1

 A sudden and dramatic onset is referred to as an asthma attack.
 Prolonged asthma attack that does not respond to typical drug therapy is
known as status asthmaticus

Answer 1

asthma

Question 2

 Recurrent and reversible shortness of breath
 The airways of the lungs become narrow as a result of:
 Bronchospasms, Inflammation and edema of the bronchial mucosa,Production of viscous
mucus
 The alveolar ducts and alveoli remain open, but airflow to them is obstructed

Answer 2

bronchial asthma

Question 3

Progressive respiratory disorder
Characterized by chronic airflow limitation, systematic
manifestations, and significant comorbidities

Answer 3

chronic obstructive pulmonary disease

Question 4

Presence of cough and sputum for at least 3 months in each of 2
consecutive years
Separate disease from chronic obstructive pulmonary disease

Answer 4

chronic bronchitis

Question 5

Relax bronchial smooth muscle, which causes dilation of the
bronchi and bronchioles that are narrowed as a result of the
disease process

Answer 5

bronchodilators

Question 6

what three classes of bronchodilators?

Answer 6

 β-adrenergic agonists,
 anticholinergics, and
 xanthine derivatives

Question 7

what are short acting B agonist inhalers?

Answer 7

salbutamol (Ventolin®)
Terbutaline sulphate (Bricanyl®)

Question 8

what are long acting B agonist inhalers?

Answer 8

formoterol (Foradil®, Oxeze®)
salmeterol (Serevent®)

Question 9

what are the long acting B agonist and glucocorticoid steroid combo inhaler?

Answer 9

budesonide/formoterol fumarate dihydrate (Symbicort®)
Use as a reliever or rescue treatment for moderate to severe asthma when
symptoms worsen

Question 10

what are the 3 subtypes of B-adrenergic agonists?

Answer 10

nonselective adrenergic
nonselective B-adrenergic
selective B2 drugs

Question 11

Stimulate ß-, ß1- (cardiac), and ß2- (respiratory) receptors
Example: epinephrine (EpiPen®)

Answer 11

nonselective adrenergic

Question 12

Stimulate both ß1- and ß2-receptors
Example: isoproterenol hydrochloride

Answer 12

nonselective B-adrenergic

Question 13

Stimulate only ß2-receptors
Example: salbutamol (Ventolin®)

Answer 13

selective B2 drugs

Question 14

what is the MOA of B-adrenergic agonists?

Answer 14

 Used during acute phase of asthmatic attacks
 Quickly reduce airway constriction and restore normal airflow
 Agonists, or stimulators, of the adrenergic receptors in the sympathetic
nervous system
 Sympathomimetics bronchodilators– relax smooth muscle and inhibit inflammatory
response.

Question 15

what are the indications of B-adrenergic agonists

Answer 15

 Relief of bronchospasm (asthma, chronic obstructive pulmonary disease
(COPD), and other pulmonary diseases)
 Treatment and prevention of acute attacks

Question 16

what are the contraindications of B-adrenergic agonists?

Answer 16

Known drug allergy
Uncontrolled cardiac dysrhythmias
High risk of hypertension/ stroke

Question 17

what are the AE of B-adrenergic agonists?

Answer 17

α and ß (epinephrine): Insomnia, Restlessness, Anorexia, Vascular headache,
Hyperglycemia, Tremor, Cardiac stimulation
 ß1 and ß2 : Cardiac stimulation, tachycardia, Tremor, Anginal pain, Vascular headache
 ß2 (salbutamol): Hypotension or hypertension, Vascular headache, Tremor

Question 18

what are the interactions of B-adrenergic agonists?

Answer 18

Diminished bronchodilation when nonselective ß-blockers are used
with the ß-agonist bronchodilators
Monoamine oxidase inhibitors
Sympathomimetics
Monitor patients with diabetes; an increase in blood glucose levels
can occur.

Question 19

 Short-acting ß2-specific bronchodilating ß-agonist
 Most commonly used drug in this class
 Don’t exceed max. daily dosage.
 Oral, parenteral, and inhalational use
 Inhalational dosage forms include metered-dose inhalers as well as solutions for
inhalation (aerosol nebulizers)

Answer 19

salbutamol sulphate

Question 20

 Long-acting ß2-agonist bronchodilator
 Never to be used alone but in combination with an inhaled glucocorticoid steroid
 Used for the maintenance treatment of asthma and COPD; salmeterol maximum daily
dose (one puff twice daily) should not be exceeded.

Answer 20

salmeterol

Question 21

what is the MOA of anticholinergics?

Answer 21

Acetylcholine (ACh) causes bronchial constriction and narrowing of the
airways.
Anticholinergics bind to the ACh receptors, preventing ACh from binding.
Result: bronchoconstriction is prevented, airways dilate

Question 22

what are the AE of anticholinergics?

Answer 22

Dry mouth or throat, Nasal congestion, Heart palpitations, Gastrointestinal
distress, Urinary retention, Increased intraocular pressure, Headache,
Coughing, Anxiety

Question 23

 Oldest and most commonly used anticholinergic bronchodilator
 Available both as a liquid aerosol for inhalation and as a multidose inhaler
 Usually dose 2 puffs tid-qid
 Child (5-12 years)125-250mcg /puff
 Adult: 250-500mcg/ puff

Answer 23

ipratropium bromide

Question 24

 Indirectly cause airway relaxation and dilation
 Help reduce secretions in COPD patients
 Indications: prevention of the bronchospasm associated with COPD; not for the
management of acute symptoms

Answer 24

ipratropium, tiotropium bromide monohydrate

Question 25

theophylline and caffeine are currently used clinically

Answer 25

plant alkaloids

Question 26

what is action of xanthine derivatives?

Answer 26

smooth muscle relaxation, bronchodilation, and increased
airflow

Question 27

what are the indications of xanthine derivatives?

Answer 27

Dilation of airways in asthmas and COPD
Mild to moderate cases of acute asthma
Not for management of acute asthma attack
Adjunct drug in the management of COPD
Not used as frequently because of potential for drug interactions and
variables related to drug levels in the blood

Question 28

what are the contraindications of xanthine derivatives?

Answer 28

Known drug allergy, Uncontrolled cardiac dysthymias, Seizure
disorders, Hyperthyroidism, Peptic ulcers

Question 29

what are the AE of xanthine derivatives?

Answer 29

Nausea, vomiting, anorexia
Gastroesophageal reflux during sleep
Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
Transient increased urination
Hyperglycemia

Question 30

 Most commonly used xanthine derivative
 Oral and injectable (as aminophylline) dosage forms
 Aminophylline: intravenous (IV) treatment of patients with status asthmaticus
who have not responded to fast-acting ß-agonists such as epinephrine
Body weight is used to calculate dosage

Answer 30

theophylline

Question 31

 Used without prescription as a central nervous system stimulant or analeptic to
promote alertness (e.g., for long-duration driving or studying)
 Cardiac stimulant in infants with bradycardia
 Enhancement of respiratory drive in infants in NICUs

Answer 31

caffeine

Question 32

 Newer class of asthma medications
 Nonbronchodilating
 Currently available drugs: montelukast (Singulair®), zafirlukast (Accolate®)

Answer 32

leukotriene receptor antagonists

Question 33

what is the MOA of leukotriene receptor antagonists?

Answer 33

 Leukotrienes are substances released when a trigger, such as cat hair or
dust, starts a series of chemical reactions in the body and cause
inflammation, bronchoconstriction, and mucus production.
 Result: coughing, wheezing, shortness of breath
 Leukotriene receptor antagonists prevent leukotrienes from attaching to
receptors on cells in the lungs and in circulation.
 Inflammation in the lungs is blocked, and asthma symptoms are relieved.

Question 34

what are the indications of leukotriene receptor antagonists?

Answer 34

 Prophylaxis and long-term treatment and prevention of asthma in adults and children
 Montelukast safe in children 2 years of age and older; Zafirlukast safe in children 12 years of age and
older
 Not meant for management of acute asthmatic attacks
 Montelukast is also approved for treatment of allergic rhinitis
 Improvement with their use is typically seen in about 1 week

Question 35

what are the contraindications of leukotriene receptor antagonists?

Answer 35

 Known drug allergy, Previous adverse drug reaction
 Allergy to povidone, lactose, titanium dioxide, or cellulose derivatives—important to note
because these are inactive ingredients in these drugs
 Usage may lead to liver dysfunction.

Question 36

 Anti-inflammatory properties, Used in treatment of pulmonary diseases
 Oral or inhaled forms, may be administered intravenously
 Inhaled forms reduce systemic effects.
 May take several weeks before full effects are seen

Answer 36

corticosteroids

Question 37

what is the MOA of corticosteroids?

Answer 37

 Stabilize membranes of cells that release harmful broncho constricting
substances
 These cells are called leukocytes (white blood cells).
 Increase responsiveness of bronchial smooth muscle to ß-adrenergic
stimulation
 Dual effect of both reducing inflammation and enhancing the activity of ß-
agonists

Question 38

what are the indications of inhaled corticosteroids?

Answer 38

Primary treatment of bronchospastic disorders to control the
inflammatory responses that are believed to be the cause of these
disorders
Persistent asthma
Often used concurrently with the ß-adrenergic agonists
Systemic corticosteroids are generally used only to treat acute
exacerbations or severe asthma.
IV corticosteroids: acute exacerbation of asthma or other COPD

Question 39

what are the contraindications of inhaled corticosteroids?

Answer 39

Drug allergy, Not intended as sole therapy for acute asthma attacks, Hypersensitivity to
glucocorticoids, Patients whose sputum tests are positive for Candida organisms ,
Patients with systemic fungal infection

Question 40

what are the AE of inhaled corticosteroids?

Answer 40

 Pharyngeal irritation, Coughing, Dry mouth, Oral fungal infections
 Systemic effects are rare because low doses are used for inhalation therapy

Question 41

what are the interactions of inhaled corticosteroids?

Answer 41

 Drug interactions are more likely to occur with systemic (versus inhaled) corticosteroids.
 May increase serum glucose levels, possibly requiring adjustments in dosages of antidiabetic drugs
 May raise the blood levels of the immunosuppressants cyclosporine and tacrolimus; itraconazole may
reduce clearance of the steroids
 phenytoin, phenobarbital, and rifampin
 Greater risk of hypokalemia with concurrent diuretic use (e.g., furosemide, hydrochlorothiazide)