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Pharm 2024 > PPT 16: Asthma > Flashcards

PPT 16: Asthma Flashcards

Exam 3

1
Q

Airway diameter (resistance) is determined by what 3 things?

A
  • Contraction and relaxation of smooth muscles
  • ANS input
  • Greatest resistance is in medium bronchi
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2
Q

What is the patho behind asthma?

A

Airway inflammation Mucosal thickening, plugs
Contraction of airway smooth muscle

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3
Q

What are the suspected reasons behind increased asthma prevalence?

A
  • Infant second-hand smoke
  • Worsening air quality
  • Hygiene hypothesis
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4
Q

What are the symptoms of asthma?

A
  • Wheezing, breathlessness, chest tightness, coughing
  • ↑ at night, early morning
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5
Q

What are the measurements for asthma testing?

A

FEV1
PEF

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6
Q

What is PEF testing?

A
  • Peak expiratory flow
  • Maximum flow of forced expiration
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7
Q

What is FEV1 testing?

A
  • Bronchial hyperreactivity testing
  • Fall in forced expiratory volume in 1 second provoked by inhaling increasing concentrations of histamine or methacholine
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8
Q

What are the treatment modalities for asthma?

A

Contraction of smooth muscle
- Beta adrenergic agonists
Edema and cellular infiltration
- Anti-inflammatory agents

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9
Q

Extrinsic or atopic asthma is also known as _______

A

Type 1 Hypersensitivity Reactions

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10
Q

What are the mediators responsible for in the early asthma reaction?

A
  • Diffuse throughout airway wall
  • Cause muscular contraction and vascular leakage
  • Immediate bronchoconstriction
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11
Q

What are the 3 mediators in the early asthma response?

A

Histamine, PGs, and leukotrienes

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12
Q

What are the mediators responsible for in the late asthma reaction?

A

Occurs 2-8 hours after immediate effects
- Sustained bronchoconstriction
- Cellular infiltration
- Mucous hypersecretion

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13
Q

The early asthma reaction is mediated by ____ cells, while the late reaction is mediated by ______

A

early: mast cells
late: WBCs

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14
Q

What kind of cells is mucus produced by?

A

Produced by goblet and epithelial cells

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15
Q

Mucus is composed of?

A
  • 95% water
  • 5% glycoproteins
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16
Q

Mucus is has increased ____ in asthma

A

viscosity

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17
Q

What is the role of mucus?

A

Defense against irritants and microorganisms

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18
Q

Describe the type 1 hypersensitivity reaction in detail

A

1st exposure:
1. dendritic cell on mucosa processes allergen, then turns into an antigen presenting cell → MHCII receptor presented on antigen presenting cell surface to activate immune response → migrates to regional lymph node and presents to T cell
2. T cell releases IL4 → activates B cells → B cells turn into plasma cells (antibody producing factories) and produce IgE or the B cells turn into B memory cells
- Dupixent (monocloncal antibody) - blocks IL4
3. IgE binds to surface of mast cells → sensitization of mast cells and basophils

2nd exposure: allergic reaction
1. Allergen binds to IgE antibodies on mast cells → Degranulation
2. Histamines and leukotrienes are released
3. Allergy symptoms

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19
Q

The difference between a type 1 hypersensitivity reaction in allergies and asthmatics is that asthma has less _______

A

histamine - more leukotriene and PG

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20
Q

Differentiate between PANS and SANS airway control

A

PANS - vagus nerve, contracts bronchiolar SM (M3)
SANS - relaxes bronchiolar SM (B2), circulating catecholamines

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21
Q

Asthma attack causes (7)

A
  • Allergens
  • Respiratory infections (viral or bacterial)
  • Irritants
  • Certain medications
  • Exercise
  • GERD
  • Anxiety/Stress
22
Q

Croup is also known as _____

A

Acute laryngotracheobronchitis

23
Q

What is the age range for croup?

A

6 months to 5 years

24
Q

What is the main symptom of croup?

A

Causes seal-like barking cough

25
Q

In severe cases, croup can be treated with ______

A

nebulized epinephrine

26
Q

COPD includes what 2 things?

A

chronic bronchitis and emphysema

27
Q

Define chronic bronchitis

A
  • Hypersecretion of mucus and chronic productive cough that lasts for at least 3 months of the year and for at least 2 consecutive years
  • Inspired irritants increase mucus production and the size and number of mucous glands
  • The mucus is thicker than normal
28
Q

Define emphysema

A
  • Abnormal permanent enlargement of the gas-exchange airways accompanied by destruction of alveolar walls without obvious fibrosis
  • Loss of elastic recoil
29
Q

What are the two treatment categories for asthma?

A
  • Short-term relievers (bronchodilators)
  • Long-term controllers (anti-inflammatory and leukotriene antagonists)
30
Q

What are the effects of B2 agonists on obstructive airway diseases?

A
  • Relax airway smooth muscle
  • Inhibit some of substances from mast cells
  • Inhibit microvascular leakage
  • Increase mucociliary transport
31
Q

The toxic effect of sympathomimetics is ______

A

skeletal muscle tremor

32
Q

What are the 2 drugs that are non-selective sympathomimetics used to treat asthma? What is an adverse effect?

A

Epinephrine and isoproterenol - arrythmogenic

33
Q

What are the 3 B2 selective sympathomimetics used to treat asthma?

A

Terbutaline, formoterol, salmeterol, albuterol

34
Q

Only 10-20% of aerosol drugs are delivered to the lungs due to _____

A

Particle size
Pattern of breathing
Geometry of airways

35
Q

What are the proposed MOA of methylxanthines on asthma?

A
  • Inhibits phosphodiesterase
  • Inhibits adenosine receptors
  • Anti-inflammatory action
36
Q

What are the examples of methylxanthines?

A

Theophylline and caffeine

37
Q

Why is theophilline given in tea form?

A

too strong in pure form - toxic effects (N/V, arrythmias), narrow TI, positive chronotrope and inotrope

38
Q

How are muscarinic antagonists useful in treating airway obstructive disorders? What are the drugs?

A
  • Effective bronchodilators - Block contraction of airway smooth muscle, mucus secretion
  • Parasympathetic blockade
    Drugs:
  • Parenteral atropine
  • Inhaled ipratropium bromide, tiotripium (COPD)
39
Q

What are the positive effects of chronic corticosteroid use?

A
  • Reduce bronchial activity
  • Increase airway caliber
  • Reduce frequency of asthmatic exacerbations
  • Improve quality of life
40
Q

What are the negative effects of chronic corticosteroid use?

A
  • Increase in osteoporosis
  • Slow the rate of growth in children
  • Oropharyngeal candidiasis
41
Q

What are the corticosteroids used as long-term controllers in obstructive airway diseases?

A

Prednisone, Fluticasone

42
Q

What is the MOA of Leukotriene Pathway Inhibitors?

A
  1. Inhibit 5-lipoxygenase - Zileuton
  2. Inhibit receptor binding – Montelukast
43
Q

Leukotriene Pathway Inhibitors improve ______ induced asthma

A

aspirin

44
Q

______ is a monoclonal antibody drug that targets ___ on Mast Cells

A

Omalizumab, IgE

45
Q

What are the 3 classes of short-term relievers in obstructive airway diseases?

A
  1. B2 agonists
  2. Methylxanthines
  3. M3 antagonists
46
Q

What are the 3 classes of long-term relievers in obstructive airway diseases?

A
  1. Corticosteroids
    1. Leukotriene Pathway Inhibitors
  3. Monoclonal antibodies
47
Q

What drugs are used for COPD, but not asthma?

A

SAMA and LAMA - muscarinic antagonists
- atropine, ipratropium bromide, tiotropium (longest acting)

48
Q

COPD is _____ responsive to corticosteroids than asthma

A

less

49
Q

What drugs are used in asthma but not COPD?

A
  • Leukotriene receptor antagonists (Montelukast)
    and LOX inhibitor (Zileuton)
  • Mast cell stabilizer/ monoclonal antibodies (Omalizumab)
50
Q

What is the treatment standard for COPD?

A

LABA and LAMA

51
Q

What are the meds given for asthma progression?

A

Mild - SABA
Moderate - ICS or LTRA
- ICS for relief
Severe - oral corticosteroids, anti-IgE antibody

Pharm 2024 (28 decks)

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