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Pulm > Pharm - Asthma and COPD > Flashcards

Pharm - Asthma and COPD Flashcards

1
Q

Structure vs. function of sweat glands

A 
Anatomically SNS (long postganglionic fiber)
Functionally PNS (releases ACh)
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2
Q

Non-specific beta agonists

A

Epi, ephedrine, isoproterenol

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3
Q

Fast acting, short lived beta 2 agonists

A

Albuterol, levalbuterol, terbutaline

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4
Q

LABAs

A

Salmeterol, formoterol

used with steroid

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5
Q

Antiinflammatory meds

A

Steroids
Cromolyn
Leukotriene inhibitors

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6
Q

Leukotriene receptor blockers

A

Montelukast, zafirlukast

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7
Q

Leukotriene synthesis blocker

A

Zileuton

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8
Q

IgE mab

A

Omalizumab

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9
Q

What has highest density of B2R?

A

Bronchial smooth muscle cells

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10
Q

Bronchial SMCs don’t have ___ innv, while blood vessels don’t have ___ innv

A

Symp

Parasymp

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11
Q

What is unique about the adrenergic receptors in bronchial SMCs?

A

Epinephrine is their endogenous ligand rather than NE like other adrenergic receptors

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12
Q

What type of cholinergic receptors are present on bronchial SMCs?

A

M2 and M3

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13
Q

M2R responsible for ___ using what G protein?

A

Decreased ACh release (M2R is autoreceptor)

Gi

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14
Q

M3R responsible for ___ using what G protein?

A

Bronchoconstriction

Gq –> increased Ca2+

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15
Q

Relationship between eosinophils and asthma/COPD

A

Major basic protein of eo’s causes bronchoconstriction by inhibiting M2R (so increasing ACh)

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16
Q

When would an M2R AGONIST cause bronchoconstriction?

A

In presence of a B2R agonist which would increase levels of cAMP and cause relaxation; by working through Gi, an M2R agonist would inhibit this effect and cause constriction.

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17
Q

How do B2 agonists cause bronchial SMC relaxation?

A

Increase cAMP –> PKA –> phosphorylation of MLCK –> relaxation

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18
Q

Which nerve is stimulated in asthma pts? Effect?

A

Vagal afferents –> sends messages to vagal afferents –> release ACh (parasymp) –> constriction of bronchial SMC

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19
Q

Affinity of epi vs. ephedrine vs. isproterenol

A

Epi - B1, B2, alpha
Ephedrine - B1, B2, some alpha
Isoproterenol - B1, B2

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20
Q

4 MOA beta agonists

A
  1. Increase cAMP –> relaxation
  2. Increase mucociliary transport
  3. Decrease mast cell release of mediators
  4. Decrease microvascular permeability
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21
Q

How do LABAs cause increased mortality?

A

Through Gq –> PLC –> inflammation

(beta2 agonists do NOT treat inflammation of asthma/COPD; they might exacerbate it

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22
Q

AE of sympathomimetics

A

N/V, HA, hypotension, arrhythmias, agitation, coma, convulsions, respiratory and vasomotor collapse

23
Q

Density of B2R vs. muscarinic receptors

A

B2R - bronchioles

MR - lower airways

24
Q

2 antimuscarinics

A

Atropine

Ipratropium

25
Q

2 MOA antimuscarinics

A
  1. COMPETITIVE muscarinic block –> SMC relaxation

2. Decrease mucus secretion

26
Q

AE atropine

A

Pupil dilation

Cycloplegia (paralysis of ciliary muscle causing loss of accommodation = blurry near vision)

27
Q

Combo beta2 agonist and antimuscarinic indicated for:

28
Q

List the methylxanthines

A

Theophylline
Aminophylline
Dyphylline
Oxtriphylline

29
Q

Actions of methylxanthines

A
  1. Increase cAMP –> SMC relaxation
  2. Inhibit adenosine –> antiinflammatory
  3. Weak diuretic
  4. Increase skeletal muscle (diaphragm) strength
  5. Positive inotropic and chronotropic effects
  6. Increase gastric acid secretions
  7. Decrease release of mediators
30
Q

Unique AE of methylxanthines

A

Hypokalemia
Hyperglycemia
Neuromuscular irritability

31
Q

Indications for cromolyn

A

Exercise or allergen induced asthma

32
Q

Actions of cromolyn

A
  1. Inhibit mast cell degranulation*******
  2. Inhibit Cl- channels
  3. Inhibit eosinophilic inflammatory pathway
  4. Reduce cough by action on airway nerves
  5. Reduce bronchial hyperactivity
33
Q

AE cromolyn

A
  1. Bad tase
  2. Cough and bronchospasms after inhalations
  3. CNS depression
  4. Anorexia
34
Q

MOA of glucocorticoids

A

Cause dissociation of HSO90 –> recruitment of HDAC:

  1. Decreased synthesis of pro-inflammatory cytokines
  2. TRANSACTIVATION of anti-inflammatory cytokines
  3. Recruitment of TTP, which decreases stability of mRNA of pro-inflammatory cytokines
35
Q

Overall effects of glucocorticoids

A
  1. Reduce bronchial hyperactivity
  2. Reduce mucus secretion
  3. Reduce pro-inflammatory cytokines
  4. Synergism with beta 2 agonists
36
Q

Which GC’s are oral? IV?

A

PO - dexamethasone, prednisone
IV - dexamethasone
(rest are inhaled)

37
Q

AE of GC’s

A 
Cushingoid syndrome
Bone demineralization
Retarded growth in children
Oral candidiasis/immunosuppression
Weight gain
Glucose intolerance
HTN
Cataracts
38
Q

Indication for leukotriene antagonists

A

Aspirin-induced asthma

39
Q

What does LTB4 do? LTC4 and D4?

A 
LTB4 = neutrophil chemoattractant
LTC4/D4 = mimic asthma; mucus secretion, bronchoconstriction, bronchial hyper-reactivity, edema
40
Q

MOA zileuton vs. montelukast/zafirlukast

A 
ZiLeuton = Lipoxygenase inhibitor
ZafiRlukast/montelukast = LTD4 receptor antagonist
41
Q

Which leukotriene inhibitor prevents neutrophil recruitment?

A

Zileuton = inhibits LTB4

42
Q

AE zafirlukast

A

Hepatic enzyme elevation

Bladder, liver, histocytic cancer

43
Q

AE montelukast

A

Infections

Suicidal ideations

44
Q

AE zileuton

A

Increase liver enzymes

Inhibit CYP1A2

45
Q

Which other asthma drug may interact with zileuton?

A

Theophylline (levels would increase if also taking zileuton)

46
Q

Name the IgE mab

A

Omalizumab

47
Q

Indication for omalizumab

A

ABPA (IgE > 700)

48
Q

AE of omalizumab

A

Severe allergic reaction (SOB, closing of throat, swelling of face, lips, tongue, hives)

49
Q

6 steps of therapy for asthma

A
  1. SABA PRN
  2. Low-dose ICS
  3. Low-dose ICS + LABA or medium-dose ICS
  4. Medium-dose ICS + LABA
  5. High-dose ICS +LABA
  6. High-dose ICS + LABA + PO CS
50
Q

Are steroids helpful in COPD?

A

Not really; poor response

51
Q

CI in COPD

A 
Sedatives
Beta blockers
ACE inhibitors
ASA/cox inhibitors
Local anesthetics with epi
52
Q

MOA doxapram

A

Stimulate peripheral carotid receptors –> respiratory stimulant

53
Q

Indications for doxapram

A

COPD exacerbation

Post-anesthesia or drug-induced respiratory depression

Pulm (33 decks)

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