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Respiratory 2 > Pharm of Asthma - Fitzpatrick > Flashcards

Pharm of Asthma - Fitzpatrick Flashcards

1
Q

Immune players in asthma (4)

A

Mast cells, dendritic cells, eosinophils, Th2 cells

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2
Q

Smooth muscle constriction of bronchioles

Airway inflammation, mucus, pulmonary edema

A

Asthma

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3
Q

Asthma drug type used ONLY acutely/urgently to relieve symptoms

A

Short-acting Beta-2 agonists (SABAs) - usually inhaled

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4
Q

2 classes of asthma CONTROLLER drugs (daily use)

A
  • Anti-inflammatory

- Bronchodilators

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5
Q

3 classes of anti-inflammatory agents for asthma prevention

A
  • Corticosteroids
  • LT modifiers
  • Anti-IgE antibody
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6
Q

2 classes of bronchodilator agents for asthma prevention

A
  • Long acting beta-2 agonists

- Anti-cholinergic agents

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7
Q

When to start using a daily controller drug for asthma

What drug type?

A

> 2 attacks per week

Low dose inhaled corticosteroid (ICS)

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8
Q

If DAILY asthma attacks…treat with what controllers daily?

A

Medium dose ICS + long-acting beta-2 agonist (LABA)

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9
Q

Should SABAs and controller drugs be used together?

A

YES - always use a SABA to relieve a current attack even if already on a controller drug

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10
Q

If a trigger of asthma symptoms can be predicted, when should the patient take the SABA?

A

10 minutes prior to symptom onset

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11
Q

Should epinephrine be used for asthma attacks?

A

NO - don’t want the beta-1 effects on the cardiac muscle

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12
Q

5 SABAs (relievers)

A
  • Albuterol
  • Levalbuterol
  • Pirbuterol
  • Metaproterenol
  • Terbutaline
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13
Q

2 LABAs (controllers)

A
  • Salmeterol

- Formoterol

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14
Q

Drugs contraindicated in asthma patients

A

Beta-2 antagonists (propranolol, nadolol, timolol, pindolol)

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15
Q

If you are using more than _____ SABA per month, your asthma is not adequately controlled, and you should consider a controller drug

A

1 canister

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16
Q

5 ICS drugs (controllers)

A
  • Beclomethasone
  • Triamcinolonoe
  • Flunisolide
  • Budesonide
  • Fluticasone
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17
Q

Function of corticosteroids (molecular/cellular)

A

Receptors dimerize –> become Txn factor –> express anti-inflammatory genes and suppres inflammatory genes

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18
Q

ICS time of onset

A

Several hours to days (must wait for gene Txn)

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19
Q

Benefits of ICS use

A
  • Fewer symptoms, exacerbations
  • Less use of SABAs
  • Improved lung function (FEV1)
  • Reduced airway inflammation
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20
Q

Inhaled ICSs are designed to minimize _____

A

Systemic exposure, unwanted side effects

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21
Q

Adverse effect of ICS use in children

A

Growth impairment

22
Q

Adverse effect of ICS use in adults

A

Oral candidiasis (opportunistic infections)

23
Q

Adverse effect of ICS use in older women

A

Osteoporosis aggravation

24
Q

3 glucocorticoids for asthma

A
  • Prednisone
  • Prednisolone
  • Dexamethasone
25
Q

Use of systemic glucocorticoids in asthma

Must do what?

A

Getting control of severe attacks, chronic bad attacks

Taper off after control is established

26
Q

Adverse effects of systemic glucocorticoids

A
  • Impaired wound healing
  • Psychosis
  • Osteoporosis
  • HTN
  • Glaucoma
27
Q

Moderate persistent asthma = ___ attacks

A

DAILY

28
Q

Mild persistent asthma = ____ attacks + _____

A

> 2 per week

FEV1 = 60-80% of normal

29
Q

2 good drug combos for moderate persistent and severe persistent asthma

A

ICS + LABA…

Budesonide + formoterol
Fluticasone + salmeterol

30
Q

The use of ICS-LABA drug combos is indicated when ____

A

FEV1 shows appreciable deterioration of lung function

31
Q

LABA drugs are ONLY used WITH what else?

LABA drugs are NOT a replacement for what else?

A

ICS

ICS

32
Q

____ is reserved for patients not controlled with medium dose ICS + rescue inhaler

A

Salmeterol (LABA)

33
Q

Cells rich in COX enzyme

A

Platelets, endothelial cells, fibroblasts, SM cells, PMN inflammatory cells

34
Q

Cells rich in 5-lipoxygenase enzyme

A

PMN inflammatory cells ONLY

35
Q

Cell type that has COX-1 but not COX-2

A

Platelets

36
Q

Function of LTB4

Function of LTC4 and LTD4

A

B4 = chemotactic

C4, D4 = promote inflammation, edema, bronchospasm

37
Q

5-LO enzyme function

A

Convert AA into LTA4 (to be converted further)

38
Q

Zileuton - MoA

Used in who?

A

Inhibits 5-LO (thus LT biosynthesis)

Those > 12 y/o

39
Q

Zafirlukast - MoA

Used in who?

A

LTC4/LTD4 receptor antagonist (Cysteinyl LT1, LT2)

Those > 5 y/o

40
Q

Montelukast - MoA

Used in who?

A

LTC4/LTD4 receptor antagonist (Cysteinyl LT1, LT2)

Those > 1 y/o

41
Q

Uses of LT receptor antagonists

A

Mild Persistent Asthma - INSTEAD OF ICS

Moderate Persistent Asthma - I.O. or WITH ICS

42
Q

Use of 5-LO inhibitor

A

Moderate Persistent Asthma - I.O or WITH ICS

43
Q

Shown benefit of LT modifier vs. ICS

A

Better adherence to 1x daily LT modifier

44
Q

Generally, LT modifiers are used when?

A

Those who won’t or can’t take an ICS

45
Q

Adverse effects of Zileuton (5-LO inhibitor) (2)

A
  • Liver toxicity (elevated ALT)

- Flu-like symptoms

46
Q

Adverse effects of LT receptor antagonists (4)

A
  • Infection (elderly)
  • Liver toxicity (Zafirlukast)
  • Hypersensitivity (angioedema, rash)
  • Eosinophilia
47
Q

Asthma provoked by environmental or occupational allergens…treat with what?

A

Anti-IgE monoclonal antibody (Omalizumab)

48
Q

MoA of Omalizumab

A

Bind IgE, thus it can’t bind and activate mast cells

49
Q

You want to give Omalizumab to a patient with allergen-induced asthma. What must you be careful of?

A

ANAPHYLAXIS - serious potential side effect

50
Q

Uses of Theophylline in asthma (4)

A
  • Not controlled by normal combos
  • Adherence only to oral, and Montelukast is ineffective
  • Inhalation is difficult, and Montelukast is ineffective
  • Additive acute therapy for patients in ICU not responding to other measures
51
Q

Theophylline - MoA

Adverse effects?

A

PDE inhibitor –> more cAMP –> adenosine receptor inhibition –> less bronchoconstriction

  • CNS stimulation, nervousness, restlessness, insomnia, tremors, etc.

Respiratory 2 (15 decks)

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