Pharmaology - Asthma

Question 1

Class: Albuterol

Answer 1

short-acting beta-2 agonist (4-6 hours)
bronchodilator
inhaled

Question 2

Class: Terbutaline

Answer 2

short-acting beta-2 agonist (4-6 hours)
bronchodilator
inhaled, can also be subQ

Question 3

Class: Metoproterenol

Answer 3

short-acting beta-2 agonist (4-6 hours)

bronchodilator

Question 4

Class: Pirbutol

Answer 4

short-acting beta-2 agonist (4-6 hours)

bronchodilator

Question 5

What is a major effect of beta 2 agonists?

Answer 5

Reduction in cholinergic transmission

***increase in intracellular cAMP –> bronchodilation

Question 6

Use:
Albuterol
Metoproterenol
Pirbutol
Terbutaline

Answer 6

Acute exacerbations;

Exercise-induced or mild asthma

Question 7

Class: Salmeterol

Answer 7

bronchodilator

long-acting beta-2 agonist (partial agonist)

Question 8

Class: Formoterol

Answer 8

bronchodilator

long-acting beta-2 agonist (full agonist)

Question 9

Class: Indicaterol/Vilanterol

Answer 9

bronchodilator

long-acting beta-2 agonist

Question 10

What long-acting beta-2 agonists are only indicated for use in COPD?

Answer 10

Indicaterol

Vilanterol

Question 11

Long-acting beta-2 agonists are always used in combination with what in the treatment of asthma?

Answer 11

Corticosteroids

Question 12

T/F: Beta-2 agonists are less effective in treating COPD

Answer 12

True

Question 13

Side effects: Beta-2 agonists

Answer 13

Tremor (beta-2 receptors in muscles);
Tachycardia;
Prolongation of QTc - dose dependent –> can lead to fatal v-tach;
Hypokalemia;
V/Q mismatch –> hypoxia;
tolerance with chronic use (short-acting);
overuse associated with respiratory mornidity (long-acting)

Question 14

Class: Ipratroprium

Answer 14

Antimuscarinic - bronchodilator

Question 15

Class: Tiotroprium

Answer 15

Antimuscarinic - bronchodilator

**longest half life at M3 receptor

Question 16

Class: Atropine

Answer 16

Antimuscarinic - bronchodilator

**most systemic side effects

Question 17

Class: Acidlinium

Answer 17

Antimuscarinic - bronchodilator
newer formulation of tiotroprium, shorter *circulation half-life
less side effects (systemic, CNS)

Question 18

What antimuscarinic is long-acting for use in COPD?

Answer 18

Tiotroprium

Question 19

What antimuscarinic is short-acting for use in COPD?

Answer 19

Ipratroprium

Question 20

What is a secondary effect of tiotroprium as an antimuscarinic in the treatment of COPD?

Answer 20

Anti-inflammatory effects - reduces neutrophil migration;
reduces airway remodeling;
decreased mucus production

Question 21

Side effects: Antimuscarinic agents (COPD)

Answer 21

urinary retention;
acute angle glaucoma;
dry mouth

Question 22

T/F: Better M3 selectivity confers better side effect profile in antimuscarinic agents (ie triotroprium) used for COPD.

Answer 22

True

Question 23

Why are methylxanthines used in the treatment of COPD if they are only weak bronchodilators?

Answer 23

They reverse diaphragmatic fatigue and have anti-inflammatory effects, restores sensitivity to corticosteroids

Examples: Theophylline, Theobromine, Caffeine, Roflumilast

**narrow therapeutic window - not really used anymore, as well as MULTIPLE drug interactions bc of cytochrome P450

Question 24

Roflumilast is unique among the methylxanthines (treatment of COPD) in that:

Answer 24

It produces the most anti-inflammatory effect;

Selective PDE4 inhibitor

Question 25

Corticosteroids increase the responsiveness of the lungs to beta-2 agonists.

Answer 25

True

Question 26

Class: Budesonide

Answer 26

Inhaled corticosteroid

Question 27

Class: Fluticasone

Answer 27

Inhaled corticosteroid

Question 28

Class: Beclamethasone

Answer 28

Inhaled corticosteroid

Question 29

Oral thrush is a side effect of what drugs?

Answer 29

Inhaled corticosteroids
ie Budesonide
Fluticasone
Beclamethasone

Question 30

What is the first-line therapy for persistent asthma?

Answer 30

Inhaled corticosteroids
ie Budesonide
Fluticasone
Beclamethasone

use before adding in long-acting beta-2 agonists

Question 31

How is Ciclesonide different from other inhaled corticosteroids such as fluticasone?

Answer 31

Ciclesonide is a prodrug that is only activated in the airway by an esterase, which results in less systemic absorption and side effects

Question 32

Class: Ciclesonide

Answer 32

Inhaled corticosteroid

Prodrug**

Question 33

Class: Omalizumab

Answer 33

IgE inhibitor

mAB

Question 34

Use: Omalizumab

Answer 34

Asthma patients who are refractory to other medications ie corticosteroids