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Block 9 Week 4 > Singer > Bronchodilators > Flashcards

Singer > Bronchodilators Flashcards

1
Q

what is asthma?

A

inflammatory dz w/ airway smooth muscle changes

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2
Q

what are the 4 main pathophys mechanisms of asthma?

A
  1. narrowed airway
  2. tightened muscles > constrict airway
  3. inflamed/thick airway wall
  4. mucus
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3
Q

what cell types do allergens stimulate in asthma?

A

dendritic cells & mast cells

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4
Q

what cells are activated downstream in asthma?

A

eosinophils
TH2
neutrophils

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5
Q

what happens to airway smooth muscle in asthma?

A

hyperplasia

hypertrophy

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6
Q

what does vagal stimulation cause in asthmatics?

A

bronchoconstriction d/t ACh

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7
Q

what specific receptors are in airway smooth muscle cells?

A

IgE receptors

they secrete cyto & chemokines to either exacerbate or downplay an inflammatory response

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8
Q

T/F: FEV1 decreases in mild, moderate, and severe asthma

A

FALSE
INCREASES in mild!
decreases in mod & severe

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9
Q

T/F: COPD & asthma both have an inflammatory component

A

FALSE
asthma does
COPD does NOT

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10
Q

can you treat COPD w/ steroids?

A

NOPE

it’s not inflammatory! steroids won’t do anything

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11
Q

what types of cells contribute to COPD?

A 
epithelial cells
macrophages
FIBROBLASTS
TH1 & TC1
neutrophil
monos
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12
Q

what are the 3 results of the cellular processes in COPD?

A
  1. fibrosis
  2. alveolar wall destruction
  3. mucus hypersecretion
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13
Q

what causes alveolar wall destruction & mucus hypersecretion in COPD?

A

proteases (from macs & neutrophils)

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14
Q

what are the 3 epigenetic mechanisms that might contribute to asthma?

A
  1. DNA methylation
  2. histone mods
  3. microRNA
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15
Q

is IgE involved in COPD?

A

NOPE

only asthma!

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16
Q

what % of inhaled drugs are swallowed?

A

80-90%

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17
Q

what causes systemic side FX d/t inhaled drugs?

A

absorption from GI tract mostly, but also systemic spread from lungs

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18
Q

what happens to an inhaled drug if you swallow it?

A

absorption from GI tract > subject to 1st pass metabolism in liver > systemic circulation (possibly side FX)

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19
Q

what are the 2 main goals of asthma therapy?

A
  1. decrease impairment (improve QoL)

2. reduce risk (reduce exacerbation & minimize drug tox)

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20
Q

what are the 5 main classes of drugs used to treat asthma?

A
  1. bronchodilators
  2. ICS
  3. leukotriene antagonists
  4. cromolyn & nedocromil
  5. immunomodulatory therapy
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21
Q

what is the goal of using a beta 2 adrenergic agonist?

A

lower intracellular calcium

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22
Q

what 2 things do beta 2 adrenergic agonists PREVENT (in a good way)?

A
  1. mediator release from mast cells

2. microvascular leakage & edema

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23
Q

what do beta 2 adrenergic agonists increase as a happy side effect?

A

mucus secretion & ion transport across airway epithelium

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24
Q

how do beta 2 adrenergic agonists affect ACh release?

A

reduce NT in human airway cholinergic nerves by acting at presynaptic B2 receptors > INHIBIT ACh release

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25
Q

which drug is a SABA?

A

albuterol

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26
Q

which drugs are LABAs?

A

formoterol

salmeterol

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27
Q

what is the duration of action of albuterol?

A

3-4 hours

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28
Q

how many times a day do pts use albuterol?

A

4-6x/day

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29
Q

what is the drug of choice for acute asthma attacks?

A

albuterol

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30
Q

what is the duration of action of salmeterol/formoterol?

A

> 12 hours

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31
Q

how many times a day to pts use salmeterol/formoterol?

A

BID

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32
Q

in ASTHMA, do you prescribe a LABA alone?

A

NO NEVER EVER!!!!!

always RX w/ an ICS!!!

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33
Q

in COPD, do you prescribe a LABA alone?

A

you can
or in combo w/ ICS
or in combo w/ anticholinergics

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34
Q

what are the 6 side FX of beta 2 agonists?

A
  1. muscle tremor
  2. tachycardia
  3. hypokalemia
  4. restlessness
  5. hypoxemia
  6. inc mortality w/ LABA
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35
Q

what is the main side effect of theophylline?

A

seizures

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36
Q

what class of drug is theophylline?

A

methylxanthine

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37
Q

what is the mechanism of action of methylxanthines?

A

inhibit PDE so that cAMP cannot go to 5’ AMP

38
Q

in order to think through the effects of methylxanthines, think of THIS

39
Q

what can methylxanthines do to your CNS?

A 
(think about coffee)
inc alertness
dec fatigue
tremor
insomnia
anxiety
40
Q

what can methylxanthines do to your CVS?

A

(think about coffee)
inc cardiac contractility
dec peripheral vascular resistance

41
Q

what can methylxanthines do to your metabolism?

A

(think about coffee)
diuresis
inc basal metabolic rate

42
Q

when should you use methylxanthines?

A

in pts w/ more severe sx

43
Q

how do you administer theophylline?

A

oral or IV

44
Q

what can INCREASE clearance of theophylline?

A

being a kid
smoking pot
(d/t induction of CYP12)

45
Q

what does theophylline do in COPD pts?

A

reverses corticosteroid resistance as an HDAC activator

46
Q

what can REDUCE clearance of theophylline?

A

liver dz
heart failure
pneumonia
co-admin of erythromycin, cipro, cimetidine

47
Q

what are the side fx of theophylline?

A 
N/V
HA
gastric discomfort
diuresis
behavioral issues
cardiac arrhythmias
SEIZURES
48
Q

where are M1, M2, & M3 receptors in the airway?

A 
M1 = ganglionic
M2 = neuronal & muscle
M3 = muscle
49
Q

what does M1 do?

A

facilitates neurotransmission

ganglionic

50
Q

what does M2 do?

A

limits further ACh release (neuronal)

couteracts airway muscle relaxation (muscle)

51
Q

what does M3 do?

A

contraction of airway smooth muscle (muscle)

52
Q

what 3 drugs are anticholinergics?

A
  1. atropine
  2. ipratropium
  3. tiotropium

The TROPS

53
Q

which drug is the prototypical nonselective anticholinergic?

54
Q

what anticholinergic drug is most specific?

A

tiotropium

55
Q

which anticholinergic drugs are nonselective?

A

atropine

ipratropium

56
Q

what can you combine ipratropium w/?

57
Q

what receptors does tiotropium act at?

A

inhibits M1, M2, & M3
dissociates quickly from M2
(so it acts less at neuron, more at muscle & ganglion)

58
Q

which 2 anticholinergics are QUATERNARY ammonium derivatives?

A

the tropiums

59
Q

which anticholinergic is a TERTIARY ammonium derivative?

60
Q

can you give anticholinergics for COPD?

61
Q

how does an anticholinergic work for a COPD pt (mechanism)?

A

causes LESS airway constriction via inhibiting ACh (I think)

62
Q

what are the 2 side effects of ipratropium?

A

bitter taste

glaucoma if nebulized w/ a face mask

63
Q

what are all ICS derivatives of?

A

hydrocortisone

64
Q

what is the mechanism of action of ICS?

A

Activates ligand-activated transcription factors bc they’re LIPOPHILIC (recruit HDACs to decrease inflammation)

65
Q

which drugs are ICS?

A

beclomethasone
budesonide
fluticasone

66
Q

why should you combine an ICS w/ a beta agonist?

A

over time, ICS increase B2 receptors so eventually you’ll get a better B2 response

67
Q

how often are ICS used per day?

68
Q

which ICS is a prodrug?

A

beclomethasone diproprionate

prodrug cleaved by esterases in lung to active steroid

69
Q

which ICS have greater first pass metabolism?

A

fluticasone & budesonide

70
Q

which ICS have less systemic & side FX?

A

fluticasone & budesonide

71
Q

what is in advair?

A

fluticasone

salmeterol

72
Q

what is in symbicort?

A

budesonide

formoterol

73
Q

what are the 3 local side fx of ICS?

A
  1. dysphonia
  2. cough
  3. oropharyngeal candidiasis
74
Q

what are the 9 systemic side fx of ICS?

A
  1. osteoporosis
  2. bruising
  3. adrenal suppression/insuff
  4. growth suppression
  5. cataracts
  6. glaucoma
  7. metabolic issues
  8. psych issues
  9. pneumonia
75
Q

which drug is a leukotriene antagonist?

A

montelukast

76
Q

how do you administer montelukast?

77
Q

what is good about montelukast clinically?

A

avoids “steroid phobia” & is widely used for kids

78
Q

what does montelukast improve?

A

mild-moderate asthma & aspirin-sensitive asthma

79
Q

what can you do for pts who are not responding to an ICS?

A

add Montelukast

80
Q

what are the 2 rare side fx of montelukast?

A
  1. hepatic dysfxn

2. Churg-Strauss

81
Q

how does omalizumab work?

A

anti-IgE

binds up anything bound to IgE (macs, lymphs, mast cells) to decrease chronic inflammation

82
Q

when should you prescribe omalizumab?

A

severe asthma not responding to ICS/LABA

83
Q

what is the route of omalizumab & how often do you take it?

A

subQ every 2-4 wks

84
Q

how do you determine omalizumab dosing?

A

titering IgE ab in pts

85
Q

what is STEP 1 of asthma tx?

86
Q

what is STEP 2 of asthma tx?

A

low-dose ICS

alt = LTRA

87
Q

what is STEP 3 of asthma tx?

A

ICS + LABA

alt = higher dose ICS, ICS + LTRA, or ICS + theophylline

88
Q

what is STEP 4 of asthma tx?

A

high-dose ICS + LABA +/- LTRA or theophylline

alt = omalizumab

89
Q

what is STEP 5 of asthma tx?

A

step 4 + omalizumab &/or long term oral corticosteroid

90
Q

which steps of asthma tx involve referral to a specialist?

Block 9 Week 4 (5 decks)

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