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Block 3b1 PHM > Obstructive Lung Disease > Flashcards

Obstructive Lung Disease Flashcards

1
Q

Short acting B2 Agonist

A

Albuterol

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2
Q

Tx for acute asthma exacerbation

A

Albuterol

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3
Q

Long acting agents (2) for prophylaxis

A

Salmeterol/Formoterol

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4
Q

AE: Tremor/Arrhythmia

A

Salmeterol/Formoterol

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5
Q

Inhaled Corticosteroids (2)

A

Fluticasone/Budesonide

Others: ‘sone’ & ‘ide’
Beclomethasone, Mometasone, Ciclesonide

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6
Q

MOA of inhaled corticosteroids (i.e.: Fluticasone/Budesonide)

A

Inhibits cytokine synthesis; Inactivates NF-KB, transcription factor that induces production of TNF alpha and other inflammatory agents

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7
Q

1st line therapy for chronic asthma (2)

A

Fluticasone/Budesonide

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8
Q

AE: oral thrush (2)

A

Fluticasone/Budesonide

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9
Q

Muscarinic Antagonists (2)

A

Tiotropium/Ipratroprium

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10
Q

MOA of muscarinic antagonists (i.e.: Tiotropium/Ipratroprium)

A

Competitively block muscarinic receptors, preventing bronchoconstriction T

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11
Q

Long acting muscarinic antagonists (2)

A

Tiotropium; Aclidinium

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12
Q

Antileukotrienes (2)

A

Montelukast/Zafirlukast

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13
Q

MOA of antileukotrienes (i.e.: Montelukast/Zafirlukast)

A

block leukotriene receptors (CysLT1)

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14
Q

5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes

A

Zileuton, antileukotriene

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15
Q

Anti-IgE monoclonal antibody

A

Omalizumab

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16
Q

MOA of Omalizumab

A

binds unbound serum IgE & blocks FCERI binding

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17
Q

Tx for allergic asthma w/ increased IgE levels

A

Omalizumab

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18
Q

Methylxanthines (2)

A

Theophylline, Roflumilast

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19
Q

MOA of Theophylline

A

Blocks action of adenosine
Metabolized by cytochrome P-450
↑cAMP due to ↓cAMP hydrolysis

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20
Q

Methylxanthine w/ limited use bc of narrow TI

A

Theophylline

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21
Q

non-specific muscarinic receptor M3 agonist to diagnose asthma

A

Methalcholine

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22
Q

MOA of Cromolyn

A

“mast cell stabilizer”
Inhibits mediator release from mast cells
↓ chemotaxis
sensory nerve effects (↓ cough, neuropeptide release)

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23
Q

Clinical Roles of B2 Agonism (2)

A

Acute relief: min tachyphylaxis

Bronchoprotection: known triggers (cold air/allergens); attenuates w/ repeated use

24
Q

Drug w/o anti-inflammatory properties

A

B2 agonists

25
Drug to avoid PO administration
B2 agonists
26
Drugs (2) w/ concerns for tachyphylaxis & what they should NOT be administered w/o...
Long acting B2 agonists: Salmeterol/Formoterol | Should NOT be administered w/o inhaled steroids in asthma
27
AE of B2 adrenergic agonists
Tachycardia, tremor, nervousness Not entirely selective B2 receptors also found on heart
28
MOA of corticosteroids
Bind cytoplasmic receptor assoc w/ HSP 70, 90 and immunophilin (target of cyclosporine) Translocation to nucleus, acts as transcription factor w/ widespread cellular effects Modulate production of anti-inflammatory proteins modifying histones & their transcription
29
Effects of glucocorticoids
↓ lymphocytes & macrophages; ↓ cytokine release ↓ endothelial cell adhesion molecules (ICAM-1) ↓ prostaglandin & leukotriene C4 ↓ fibroblast proliferation Eosinophil apoptosis
30
AE of Glucocorticoids
Immunosuppression, Gastric Ulcers, Osteoporosis, Muscle Wasting, Cataracts
31
Do inhaled corticosteroids offer immediate bronchorelaxation?
NO
32
What are the side effects of inhaled steroids & what can be done to avoid them?
Dysphonia (hoarseness), Thrush Pneumonia (mild risk) in COPD patients Rinse mouth, use spacer device
33
What are the short and long term effects of oral corticosteroids?
Short: VERY effective, preferred to increasing dose of inhaled steroid; initiate Tx early in exacerbation Long: for asthma & COPD-associated w/ sig toxicity
34
Where are the anticholinergics or muscarinic receptors found?
Heart, CNS, GI, sweat glands, GU, eye
35
What are the anticholinergics w/ systemic & non-systemic effects?
Atropine: systemic effects Ipratroprium bromide: 'quaternary ammonium' not systemically absorbed
36
Side effect of inhaled anticholinergic
Dry mouth
37
Synergistic combination of muscarinic antagonist & B2 agonist
Ipratropium; albuterol
38
Effects of leukotrienes in asthma
``` Potent effectors of airway obstruction Bronchial constriction Vasodilation Edema Leukocyte chemotaxis ```
39
In addition to inhaled corticosteroid, what is the other add-on controller agent in asthma?
Leukotriene modifiers
40
Which leukotriene is good to add for allergic rhinitis?
Montelukast
41
Adenosine receptor antagonist that can mediate bronchospasm & Histone deacetylase modulator (HDAC)
Theophylline
42
AE of Theophylline within therapeutic range (a)? dose dependent toxicity (b)?
a) Nervousness, insomnia, dyspepsia | b) Nausea, emesis, tachyarrhythmias, seizures
43
What is the 3rd line agent in asthma?
Theophylline
44
What is the phosphodiesterase-4 isotope specific methylxanthine?
Roflumilast, w/ a better side effect profile than Theophylline although (-) GI effects & weight loss
45
What is the FDA approved methylxanthine for SEVERE copd?
Roflumilast, ↓ exacerbation rates but not for acute bronchorelaxation
46
Characteristics of mab's
highly specific, long T1/2, subQ admin, $
47
What is the drug used in Tx-resistant asthma?
Omalizumab
48
What are anti IL-5 mab's? (2)
Mepolizumab, Reslizumab
49
Role of lL-5
cytokine for growth, differentiation, recruitment, activation and survival; may impair response to helminth infection & zoster
50
What are the 2 drugs used as add-on Tx for severe disease w/ eosinophilic phenotype?
Mepolizumab & Reslizumab
51
What are adjunct Tx for asthma?
``` Vaccination vs. pneumococcus/influenza Allergen immunotherapy Smoking cessation Control allergic rhinitis Mg ```
52
Describe the pyramid levels of Asthma Tx
Oral Steroids (long term) Theophylline, Leukotriene modifiers, Tiotropium, Long acting B2 agonists ICS SABA
53
What are the advantages and limitations of inhaled corticosteroids?
↓ exacerbations but do NOT change FEV1 or parenchymal destruction
54
Uses of mast cell stabilizer
Prophylaxis of mild to moderate persistent asthma & exercise induced asthma
55
What is the effect of Theophylline on endogenous B2 adrenergic receptors?
Enhance activity of endogenous Beta2 adrenergic receptors
56
All of the following are asthma controller medications, which affect the underlying causes of the disease EXCEPT: Inhaled Corticosteroids Inhaled muscarinic receptor antagonists Leukotriene receptor antagonists Mast cell stabilizers
Inhaled muscarinic receptor antagonists
57
How do inhaled corticosteroids work synergistically w/ B2 agonists?
Inhaled corticosteroids up regulate B receptors to enhance responsiveness to B agonists

Block 3b1 PHM (5 decks)

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