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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
Q

Drug to avoid PO administration

A

B2 agonists

26
Q

Drugs (2) w/ concerns for tachyphylaxis & what they should NOT be administered w/o…

A

Long acting B2 agonists: Salmeterol/Formoterol

Should NOT be administered w/o inhaled steroids in asthma

27
Q

AE of B2 adrenergic agonists

A

Tachycardia, tremor, nervousness
Not entirely selective
B2 receptors also found on heart

28
Q

MOA of corticosteroids

A

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
Q

Effects of glucocorticoids

A

↓ lymphocytes & macrophages; ↓ cytokine release
↓ endothelial cell adhesion molecules (ICAM-1)
↓ prostaglandin & leukotriene C4
↓ fibroblast proliferation
Eosinophil apoptosis

30
Q

AE of Glucocorticoids

A

Immunosuppression, Gastric Ulcers, Osteoporosis, Muscle Wasting, Cataracts

31
Q

Do inhaled corticosteroids offer immediate bronchorelaxation?

A

NO

32
Q

What are the side effects of inhaled steroids & what can be done to avoid them?

A

Dysphonia (hoarseness), Thrush
Pneumonia (mild risk) in COPD patients

Rinse mouth, use spacer device

33
Q

What are the short and long term effects of oral corticosteroids?

A

Short: VERY effective, preferred to increasing dose of inhaled steroid; initiate Tx early in exacerbation

Long: for asthma & COPD-associated w/ sig toxicity

34
Q

Where are the anticholinergics or muscarinic receptors found?

A

Heart, CNS, GI, sweat glands, GU, eye

35
Q

What are the anticholinergics w/ systemic & non-systemic effects?

A

Atropine: systemic effects

Ipratroprium bromide: ‘quaternary ammonium’ not systemically absorbed

36
Q

Side effect of inhaled anticholinergic

A

Dry mouth

37
Q

Synergistic combination of muscarinic antagonist & B2 agonist

A

Ipratropium; albuterol

38
Q

Effects of leukotrienes in asthma

A 
Potent effectors of airway obstruction
Bronchial constriction
Vasodilation
Edema
Leukocyte chemotaxis
39
Q

In addition to inhaled corticosteroid, what is the other add-on controller agent in asthma?

A

Leukotriene modifiers

40
Q

Which leukotriene is good to add for allergic rhinitis?

A

Montelukast

41
Q

Adenosine receptor antagonist that can mediate bronchospasm & Histone deacetylase modulator (HDAC)

A

Theophylline

42
Q

AE of Theophylline within therapeutic range (a)? dose dependent toxicity (b)?

A

a) Nervousness, insomnia, dyspepsia

b) Nausea, emesis, tachyarrhythmias, seizures

43
Q

What is the 3rd line agent in asthma?

A

Theophylline

44
Q

What is the phosphodiesterase-4 isotope specific methylxanthine?

A

Roflumilast, w/ a better side effect profile than Theophylline although (-) GI effects & weight loss

45
Q

What is the FDA approved methylxanthine for SEVERE copd?

A

Roflumilast, ↓ exacerbation rates but not for acute bronchorelaxation

46
Q

Characteristics of mab’s

A

highly specific, long T1/2, subQ admin, $

47
Q

What is the drug used in Tx-resistant asthma?

A

Omalizumab

48
Q

What are anti IL-5 mab’s? (2)

A

Mepolizumab, Reslizumab

49
Q

Role of lL-5

A

cytokine for growth, differentiation, recruitment, activation and survival; may impair response to helminth infection & zoster

50
Q

What are the 2 drugs used as add-on Tx for severe disease w/ eosinophilic phenotype?

A

Mepolizumab & Reslizumab

51
Q

What are adjunct Tx for asthma?

A 
Vaccination vs. pneumococcus/influenza
Allergen immunotherapy
Smoking cessation
Control allergic rhinitis
Mg
52
Q

Describe the pyramid levels of Asthma Tx

A

Oral Steroids (long term)

Theophylline, Leukotriene modifiers, Tiotropium, Long acting B2 agonists

ICS

SABA

53
Q

What are the advantages and limitations of inhaled corticosteroids?

A

↓ exacerbations but do NOT change FEV1 or parenchymal destruction

54
Q

Uses of mast cell stabilizer

A

Prophylaxis of mild to moderate persistent asthma & exercise induced asthma

55
Q

What is the effect of Theophylline on endogenous B2 adrenergic receptors?

A

Enhance activity of endogenous Beta2 adrenergic receptors

56
Q

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

A

Inhaled muscarinic receptor antagonists

57
Q

How do inhaled corticosteroids work synergistically w/ B2 agonists?

A

Inhaled corticosteroids up regulate B receptors to enhance responsiveness to B agonists

Block 3b1 PHM (5 decks)

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