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SD III Block 3 > Pharmacology: Asthma > Flashcards

Pharmacology: Asthma Flashcards

1
Q

Classify asthma and COPD into reversible and irreversible bronchospasm.

A

Asthma - reversible

COPD - irreversible

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2
Q

Are bronchodilators considered relievers or controllers?

A

relivers

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3
Q

Are anti-inflammatory considered relievers or controllers?

A

controllers

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4
Q

1st line treatment for asthma?

A

B2 agonists

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5
Q

Symptoms of asthma

A

chest tightness
shortness of breath
coughing and wheezing

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6
Q

Which leukotrienes are of importance in the treatment of asthma?

A

LTC4, LTD4,

LTB4 (attract inflammatory cells to airways)

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7
Q

Understand and explain picture.

A

Immunologic model for the pathogenesis of asthma.
Exposure to antigen causes synthesis of IgE, which binds to and sensitizes mast cells and other inflammatory cells.

When such sensitized cells are challenged with antigen, a variety of mediators are released that can account for most of the signs of the early bronchoconstrictor response in asthma.

LTC4, D4, leukotrienes C4 and D4; ECF-A, eosinophil chemotactic factor-A; PGD2, prostaglandin D2.

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8
Q

What are the 5 goals in the management of asthma?

A

Prevent chronic and troublesome symptoms

Maintain (near) “normal” breathing

Maintain normal activity levels, including exercise

Prevent recurrent asthma flare-ups, and minimize the need for emergency room visits or hospitalizations

Provide optimal medication therapy with no or minimal adverse effects

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9
Q

What are the drugs useful in the treatment of asthma. (in general give classifications not drug names)

A

Bronchodilators
Anti-inflammatory drugs
Leukotriene antagonists play dual role

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10
Q

Reproduce chart so memory of treatment strategies is easy to understand.

A

Reproduce chart.

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11
Q

What are the classes of bronchodilators used in the treatment of asthma?

A

Beta2 agonists, muscarinic antagonists, and theophylline (methylxanthine)

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12
Q

What are the anti-inflammatory agents used in the treatment of asthma (name of class of drugs)?

A

corticosteroids

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13
Q

Leukotriene antagonists have what reliever or controller effects? What are they typically used for?

A

The leukotriene antagonists have effects on both bronchoconstriction and inflammation but are used only for prophylaxis.

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14
Q

Reproduce this chart to understand drugs used in asthma.

A

Reproduce chart.

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15
Q

Bronchodilators can relax airway smooth muscles but cannot treat what other symptoms of asthma?

A

mucosal edema, cellular infiltration, or mucus formation

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16
Q

What are the SABA?

A

Albuterol

levalbuterol

turbutaline

metaproteronol

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17
Q

What are the LABA?

A

Salmeterol, formoterol

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18
Q

Name the sympathomimetics that can be used?

A

epinephrine, ephedrine A,B agonists

isoproteronol B agonists

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19
Q

What are the methylxanthines that can be used in asthma patients

A

theophylline

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20
Q

List the muscarinic antagonists that can be used in the treatment of asthma.

A

ipratropium, tiotropium

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21
Q

List the glucocorticoids that can be used in the treatment of asthma.

A

all the asones

beclomethasone

fluticasone

mometasone

dexamethasone

budesonide

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22
Q

Name the leukotriene antagonists drugs used in the treatment of asthma.

A

montelukast, zafirlukast, zileuton

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23
Q

Name the anti-IgE antibody drugs that can be used in the treatment of asthma.

A

omalizumab

24
Q

What is mepolizumab?

A

IL-5 antagonist monoclonal antibodies

25
Q

Name the drugs that are used to prevent mast cell degranulation

A

cromolyn sodium

nedocromil sodium

26
Q

What should drugs to prevent mast cell degranulation be used for

A

prophylaxis

27
Q

What are some important combination of inhaled steroids and long-acting bronchodilators that are becoming widespread in use?

A

fluticasone/salmeterol (Advair)

budexonide/formetorol (Symbicort)

28
Q

Explain what this chart is trying to say and draw out.

A

Bronchodilation is promoted by cAMP which can be increased by:

β2-adrenergic agonists that increase its synthesis by adenylyl cyclase

Phosphodiesterase (PDE) inhibitors that slow its degradation

Bronchoconstriction can be inhibited by: muscarinic or adenosine antagonists

29
Q

What class of B2 adrenergic agonists are used for acute asthmatic attacks?

A

SABA

30
Q

How long to long acting LABA’s drugs take to act?

A

12 hours

31
Q

Can LABAs used alone increase asthma mortality?

A

yes

32
Q

Common adverse effects of B2 adrenergic agonists.

A

skeletal muscle tremor, tachycardia, hypokalemia, nervousness and occasional weakness

33
Q

What is the benefit of using levalbuterol?

A

Inhalant which is claimed to have fewer central nervous system (CNS) and cardiac adverse effects

34
Q

Which class of bronchodilators are considered purine derivatives?

A

methylxanthines

35
Q

MOA of methylxnthines.

A

It produces bronchodilation by inhibiting the enzyme cyclic nucleotide phosphodiesterase. Increased levels of cAMP results, which explains the cardiac stimulation and smooth muscle relaxation produced by these drugs.

It blocks adenosine receptors. Adenosine acts as a local mediator contracting smooth muscles, so the blockage of receptors produces opposite response.

36
Q

What is pentoxifylline’s drug class and benefit?

A

Another methylxanthine derivative, pentoxifylline, is promoted as a remedy for intermittent claudication; this effect is said to result from decreased viscosity of the blood.

37
Q

What are some adverse effects of using methylxanthines?

A 
cardiac stimulation
CNS excitation
tremors and 
insomnia
etc
Therefore cardiac arrhythmias, and seizures may result from overdosage.
38
Q

MOA of anticholinergics for treatment of asthma?

A

agents reverse vagally mediated bronchospasm.

Also decrease mucus gland hyper secretion seen in asthma

39
Q

Between iprtropium bromide and tiotropium, which drug has a longer duration of action and is used for COPD?

A

Tiotropium

40
Q

How can anticholinergics be given in the treatment of asthma?

A

given by aerosol or nasal spray

41
Q

When are systemic (oral) corticosteroids used in the treatment of asthma?

A

systemic (oral) corticosteroids are used chronically only when other therapies are unsuccessful.

42
Q

What is the common first-line therapy for inidividuals with moderate to severe asthma?

A

corticosteriods

43
Q

What are some toxicities of corticosteroids?

A

oropharyngeal candidiasis or hoarseness from vocal cord irritation .

When used long term > Cushing’s effects

44
Q

MOA leukotriene modulators.

A

Leukotriene receptor antagonists. (CysT1 receptors)

Leukotriene syntheses inhibitors
block 5-lipoxygenase activity

45
Q

What are 2 leukotriene drugs now available as oral tablets?

A

montelukast and zafirlukast

46
Q

MOA of Omalizumab

A

anti-IgE monoclonal antibody

reduces bronchospastic antigen responses (reduction in frequency and severity of asthma exacerbations)

47
Q

Who is Omalizumab prescribed for?

A

mainly prescribed for patients with with moderate to severe persistent asthma who have a positive skin test or in vitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids.

48
Q

MOA of Mepolizumab?

A

IL5 antagonist

49
Q

What is Mepolizumab used for?

A

indicated for add-on maintenance treatment of patients with severe asthma aged 12 years and older, and with an eosinophilic phenotype

50
Q

What is the MOA of the mast cell stabilizers? Use?

A

These drugs are thought to act by inhibiting mast cell degranulation and, as such, have no direct bronchodilator action, but inhibit both antigen- and exercise-induced bronchospasm in asthmatic patients.

51
Q

MOA of chromones?

A

Mechanism not clearly known.

Combination of various effects.
Stabilize mast cells thereby preventing mediator release.
Inhibition of irritant receptors, nerves, plasma exudation and inflammatory cells.

52
Q

Most important use for cromolyn and nedocromil?

A

astma (especially in children)

53
Q

ROA of chromes.

A

nasal or eye drop

54
Q

Loxamide. ROA and use?

A

formulated as an ophthalmic solution to treat ocular allergies, including vernal keratitis and vernal conjunctivitis

55
Q

Treatment of status asthmaticus.

A

Humidified Oxygen

Terbutaline

Hydrocortisone

Nebulized Albuterol/terbutaline + ipratropium bromide intermittent inhalation.

Antibiotics for chest infections

Correct dehydration and acidosis

56
Q

Treatment of COPD in acute symptoms.

A

Acute symptoms: inhalation of a short-acting β agonist (eg, albuterol) with or without anticholinergic drug (eg, ipratropium bromide).

57
Q

Treatment of COPD in persistent symptoms.

A

Persistent symptoms (exertional dyspnea and limitation of activities): regular use of an LABA or a long-acting anticholinergic, or the two together, is indicated.

SD III Block 3 (14 decks)

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