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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
Use of systemic glucocorticoids in asthma Must do what?
Getting control of severe attacks, chronic bad attacks Taper off after control is established
26
Adverse effects of systemic glucocorticoids
- Impaired wound healing - Psychosis - Osteoporosis - HTN - Glaucoma
27
Moderate persistent asthma = ___ attacks
DAILY
28
Mild persistent asthma = ____ attacks + _____
> 2 per week | FEV1 = 60-80% of normal
29
2 good drug combos for moderate persistent and severe persistent asthma
ICS + LABA... Budesonide + formoterol Fluticasone + salmeterol
30
The use of ICS-LABA drug combos is indicated when ____
FEV1 shows appreciable deterioration of lung function
31
LABA drugs are ONLY used WITH what else? LABA drugs are NOT a replacement for what else?
ICS ICS
32
____ is reserved for patients not controlled with medium dose ICS + rescue inhaler
Salmeterol (LABA)
33
Cells rich in COX enzyme
Platelets, endothelial cells, fibroblasts, SM cells, PMN inflammatory cells
34
Cells rich in 5-lipoxygenase enzyme
PMN inflammatory cells ONLY
35
Cell type that has COX-1 but not COX-2
Platelets
36
Function of LTB4 Function of LTC4 and LTD4
B4 = chemotactic C4, D4 = promote inflammation, edema, bronchospasm
37
5-LO enzyme function
Convert AA into LTA4 (to be converted further)
38
Zileuton - MoA Used in who?
Inhibits 5-LO (thus LT biosynthesis) Those > 12 y/o
39
Zafirlukast - MoA Used in who?
LTC4/LTD4 receptor antagonist (Cysteinyl LT1, LT2) Those > 5 y/o
40
Montelukast - MoA Used in who?
LTC4/LTD4 receptor antagonist (Cysteinyl LT1, LT2) Those > 1 y/o
41
Uses of LT receptor antagonists
Mild Persistent Asthma - INSTEAD OF ICS | Moderate Persistent Asthma - I.O. or WITH ICS
42
Use of 5-LO inhibitor
Moderate Persistent Asthma - I.O or WITH ICS
43
Shown benefit of LT modifier vs. ICS
Better adherence to 1x daily LT modifier
44
Generally, LT modifiers are used when?
Those who won't or can't take an ICS
45
Adverse effects of Zileuton (5-LO inhibitor) (2)
- Liver toxicity (elevated ALT) | - Flu-like symptoms
46
Adverse effects of LT receptor antagonists (4)
- Infection (elderly) - Liver toxicity (Zafirlukast) - Hypersensitivity (angioedema, rash) - Eosinophilia
47
Asthma provoked by environmental or occupational allergens...treat with what?
Anti-IgE monoclonal antibody (Omalizumab)
48
MoA of Omalizumab
Bind IgE, thus it can't bind and activate mast cells
49
You want to give Omalizumab to a patient with allergen-induced asthma. What must you be careful of?
ANAPHYLAXIS - serious potential side effect
50
Uses of Theophylline in asthma (4)
- 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
Theophylline - MoA Adverse effects?
PDE inhibitor --> more cAMP --> adenosine receptor inhibition --> less bronchoconstriction - CNS stimulation, nervousness, restlessness, insomnia, tremors, etc.

Respiratory 2 (15 decks)

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