pulm pharm Flashcards
What is the mechanism of omalizumab?
anti-IgE monoclonal antibody activates high-affinity receptor on mast cell on other inflammatory cells
What are the therapeutic use of omalizumab?
patients with very severe asthma who are poorly controlled
in patients with very severe concomitant allergic rhinitis
What are the adverse effects of Beta2 selective agonists?
does related pts with cardiopulm disease are at risk for significant reactions muscle tremor tachycardia hypokalemia restlessness hypoxemia
What is the FDA advisory for sameterol, LABA?
should not be first line LABA
not relief medicine
patients at increased risk for asthma attack
Why do some patients have adverse events of beta agonists?
arginine/arginine polymorphism may be a risk factor in regard to beta agonists
importance of polymorphism remains controversial
What is the mechanism of action of methylxanthine?
theophylline – nonselective phosphodiesterase inhibitor;
adenosine receptor antagonism
adenosine constricts airways from asthmatic patients by releasing histamine and leukotrienes
What are the adverse effects of theophylline?
headache palpitation dizziness nausea hypotension tachycardia severe restlessness agitation seizures
What is the mechanism of action of ipratropium bromide?
- relaxes airway smooth muscle
- decreases mucus secretion
What does the effect of ipratropium bromide have on bronchioles, what is it based on?
antagonist of acetycholine binding to muscarinic cholinergic receptors
degree of bronchodilation reflects level of basal parasympathetic tone and any reflex activation of cholinergic pathways
What are the adverse effects of ipratropium bromide?
dry moth constipation blurred vision dyspepsia cognitive impairment
muscarinic blcokade
What is the clinical use of ipratropium bromide?
effective in acute severe asthma but less effective than beta 2 agonists
What is the role of beclomethasone?
most effective and most often prescribed antinflammatory drugs for treatment of chronic inflammation underlying asthma
What do steroids not have an effect on in the airway?
no direct effect on contractile resposne of airway smooth muscle
a single dose of ICS has no effect on the early response to allergen but inhibits the late response and also inhibits the increase in airway hyperresponsiveness
What is the clinical use of inhaled corticosteroids in asthma?
first line therapy for all patients with persistent asthma
started in any patient who needs an inhalerfor symptom control more than twice weekly
What are the clinical treatment for leukotriene antagonists?
mild to moderate asthma
considerably less effective than ICS in the treatment of mild asthma and cannot be considered the treatment of first choice
are indicated as an add on therapy in pts who are not well controlled on steroids
What is the definition of aspirin asthma?
aspirin HSN
a small proportion of asthmatics becomes worse with aspirin and other COX inhibitors
a well defined subtype of asthmati that is usually preceded by perennial rinitis and nasal polyps
What drugs are superior to Beta 2 agonists in clinical COPD?
anticholinergic drugs
What is the mucolytic (inhaled N-acetylcysteine) used for in treatment?
free sulfhydryl group opens up in the disulfide bonds in mucoproteins thus lowering mucous viscosity
best give with a bronchodilator
What is a side effect of N-acetylcysteine?
bronchospasms
What is the mechanism of action of dornase alpha?
infiltrating neutrophils release DNA which has high viscosity
Genetically engineered version of naturally occuring DNAse
