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BLOCK B - RESPIRATION > Pharmacology - Drugs for Asthma and COPD > Flashcards

Pharmacology - Drugs for Asthma and COPD Flashcards

1
Q

What are the most prevalent pulmonary diseases in the world?

A

Asthma and COPD

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2
Q

How many individuals are currently suffering from asthma?

A

262 million people in 2019 (this number continues to grow)

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3
Q

How many individuals are currently suffering from COPD?

A

15.7 million adults in 2014
COPD is the 3rd leading cause of death worldwide, causing 3.23 million deaths in 2019.

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4
Q

What causes asthma?

A

We don’t really know…

There are some correlations with
- Smoking and antibiotic use during pregnancy
- Obesity
- Environmental factors (esp. air pollution, hence why asthma is becoming more common)
- Genetic factors (eg. mutations in cytokines like IL-1, IL-33, IL-17)
- Food allergies
- Antibiotic use and microbiome

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5
Q

Why is asthma more commonly seen in children?

A

Because they are still developing their immunity…

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6
Q

Describe the two types of asthma

A

Extrinsic asthma - triggered by allergic reaction (characterized by higher levels of IgE in blood test)

Intrinsic asthma - triggered by non-allergic factors (e.g. stress, cold air, smoke, anxiety, viruses, infections)

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7
Q

Why do asthamatics have thickened parenchyma and abnormal airways?

A
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8
Q

Describe the process by which an allergen triggers inflammation in asthma.

A
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9
Q

Monoclonal antibody treatment of asthma targets different pathways in the inflammatory response

A
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10
Q

How are asthma and COPD diagnosed?

A

Using spirometry
Both diseases are characterized by decreased FEV1 relative to their FVC, which can be reversed after inhaling a short-acting bronchodilator.

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11
Q

What are the 3 main therapeutic benefits of drugs for asthma treatment?

A
  1. Decreased inflammation
  2. Bronchodilation
  3. Decreased inflammation and bronchodilation (i.e. both)
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12
Q

What are the 5 main drug classes for treating asthma?

A

Corticosteroids
Antileukotrienes
Beta 2 adrenergic receptor agonists
Muscarinic receptor antagonists

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13
Q

What are the 3 types of inhaled drug delivery?

A
  1. Metered dose inhalers (with and without spacers)
  2. Dry powder inhalers
  3. Nebulizers (less specific)
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14
Q

Glucocorticoids

A

Can block ALL inflammation (stop transcription of important inflammatory mediators)
Bind to glucocorticoid receptors

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15
Q

Anti-inflammatory actions of glucorticoids

A

1.
2.

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16
Q

Leukotrienes

A

Leukotrienes are bronchoconstrictors and vasoactive lipid mediators. They are mainly produced by immune cells.

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17
Q

Why would we target leukotrienes?

A
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18
Q

What are adrenergic receptors?

A

A class of G-protein receptors
Targets of many catecholamines

Activators don’t affect inflammation. Drugs targeting these receptors are used to relieve bronchoconstriction

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19
Q

What are SABAs?

A

Short acting beta2 adrenergic receptor agonists

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20
Q

What are LABAs?

A

Long acting beta2 adrenergic receptor agonists

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21
Q

How do beta 2 agonists affect adrenergic receptors? How do M3 muscarinic antagonists affect muscarinic receptors?

A

Agonists: turn on receptors in SNS
Anatgonist: turn off receptors

22
Q

What are LAMAs and SAMAs

A
23
Q

What are methyxanthines?

A

Act as bronchodilators AND anti-inflammatory dugs.

24
Q

Name an example of methyxanthine

A

Theophylline

25
Q

What is the major drug type administered to asthmatics?

A

Inhaled corticosteroids

26
Q

What type of drug is a reliever of asthmatic symptoms?

A

SABAs and LAMAs

27
Q

What therapy is prescribed to individuals with severe asthma?

A

Oral corticosteroids and monoclonal therapy (antibody therapy)

28
Q

Why must monoclonal antibodies be administered in the clinic?

A

These drugs are not prescribed, because they must be delivered intravenously.

29
Q

Monoclonal antibodies are directed toward…

A

Interleukin-5
IgE

30
Q

What are two types of monoclonal antibodies used for asthma treatment

A

Omalizumab
Mepolizumab/reslizumab

31
Q

Which drugs need to be inhaled? Which do not?

A
32
Q

What are some adverse effects of glucocorticoids?

A

Infection of tongue and mouth
- dysphonia and thrush

33
Q

What are some adverse effects of leukotrienes?

A

Oral glucocorticoids+ antileukotrienes can result in eosinophilic granulomatosis (Churg-Strauss)

34
Q

What are some adverse effects of beta 2 adrenergic receptor agonists?

A

These drugs work so well at relieving symptoms, that many patients would only take this without their anti-inflammatory medications. Thus, symptoms are relieved but cause is not being treated (bad compliance).

35
Q

What are some adverse side effects of monoclonal antibodies (theophylline)?

A
36
Q

What are some adverse side effects of muscarinic receptor agonists?

A

Mostly very well tolerated, very few side effects.
However can have small side effects in GI tract.

37
Q

If a patient responds well to a higher level of asthma therapy (good symptom control, no exacerbations for 3 months, what should the clinician recommend in terms of subsequent treatment

A

Step down…

38
Q

What is the main issue in patients with COPD?

A

Airways obstruction
Emphysema: destruction of alveoli
Bronchitis: bronchi

39
Q

What is the main cause of COPD?

A

Smoking

40
Q

Is it possible to develop COPD if you are not a smoker?

A

Yes!

41
Q

What are causes of COPD other than smoking?

A

Environmental factors
Age
Alpha-1 trypsin deficiency

42
Q

The same exact drugs used for asthma are used to treat COPD!

A
43
Q

How is COPD diagnosed?

A

Combination of spirometry and medical history, including symptom history and presence of risk factors

FEV1/FVC ratio less than 0.7 (confirms obstructive disease)

GOLD classification (?)

44
Q

COPD Assessment Test (CAT)

A

Missing images in slides!!
Did not understand how this whole thing works

45
Q

What is the most effective treatment for COPD?

A

Bronchodilators (LABAs)!

Corticosteroid treatment is of minimal benefit

46
Q

What are COPD exacerbations?

A

Exacerbations of COPD are acute episodes of worsening respiratory symptoms (dyspnea, cough, sputum volume, purulence) that require a change in treatment.

47
Q

How do we control COPD exacerbations?

A
48
Q

What is the leading symptom for hospital admissions in COPD? What is the trigger for most COPD exacerbations?

A

Dyspnea = leading symptom

Most events are triggered by viral or bacterial respiratory tract infections.

49
Q

Is there a cure for COPD?

A

No, there is no cure.

50
Q

Smoking is becoming significantly less prevalent, especially in younger populations. So what is the future of COPD?

A

E-cigarettes (vaping) are becoming significantly more prevalent among children and teenagers.

Vaping was found to cause severe lung injury in children due to vitamin E acetate

51
Q

What is EVALI?

A
52
Q

What is an effective treatment for EVALI?

A

Corticosteroids might be helpful, but this has not been studied and this treatment should be used with caution!

BLOCK B - RESPIRATION (31 decks)

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