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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
which drug is a SABA?
albuterol
26
which drugs are LABAs?
formoterol | salmeterol
27
what is the duration of action of albuterol?
3-4 hours
28
how many times a day do pts use albuterol?
4-6x/day
29
what is the drug of choice for acute asthma attacks?
albuterol
30
what is the duration of action of salmeterol/formoterol?
>12 hours
31
how many times a day to pts use salmeterol/formoterol?
BID
32
in ASTHMA, do you prescribe a LABA alone?
NO NEVER EVER!!!!! | always RX w/ an ICS!!!
33
in COPD, do you prescribe a LABA alone?
you can or in combo w/ ICS or in combo w/ anticholinergics
34
what are the 6 side FX of beta 2 agonists?
1. muscle tremor 2. tachycardia 3. hypokalemia 4. restlessness 5. hypoxemia 6. inc mortality w/ LABA
35
what is the main side effect of theophylline?
seizures
36
what class of drug is theophylline?
methylxanthine
37
what is the mechanism of action of methylxanthines?
inhibit PDE so that cAMP cannot go to 5' AMP
38
in order to think through the effects of methylxanthines, think of THIS
coffee!
39
what can methylxanthines do to your CNS?
``` (think about coffee) inc alertness dec fatigue tremor insomnia anxiety ```
40
what can methylxanthines do to your CVS?
(think about coffee) inc cardiac contractility dec peripheral vascular resistance
41
what can methylxanthines do to your metabolism?
(think about coffee) diuresis inc basal metabolic rate
42
when should you use methylxanthines?
in pts w/ more severe sx
43
how do you administer theophylline?
oral or IV
44
what can INCREASE clearance of theophylline?
being a kid smoking pot (d/t induction of CYP12)
45
what does theophylline do in COPD pts?
reverses corticosteroid resistance as an HDAC activator
46
what can REDUCE clearance of theophylline?
liver dz heart failure pneumonia co-admin of erythromycin, cipro, cimetidine
47
what are the side fx of theophylline?
``` N/V HA gastric discomfort diuresis behavioral issues cardiac arrhythmias SEIZURES ```
48
where are M1, M2, & M3 receptors in the airway?
``` M1 = ganglionic M2 = neuronal & muscle M3 = muscle ```
49
what does M1 do?
facilitates neurotransmission | ganglionic
50
what does M2 do?
limits further ACh release (neuronal) | couteracts airway muscle relaxation (muscle)
51
what does M3 do?
contraction of airway smooth muscle (muscle)
52
what 3 drugs are anticholinergics?
1. atropine 2. ipratropium 3. tiotropium The TROPS
53
which drug is the prototypical nonselective anticholinergic?
atropine
54
what anticholinergic drug is most specific?
tiotropium
55
which anticholinergic drugs are nonselective?
atropine | ipratropium
56
what can you combine ipratropium w/?
albuterol
57
what receptors does tiotropium act at?
inhibits M1, M2, & M3 dissociates quickly from M2 (so it acts less at neuron, more at muscle & ganglion)
58
which 2 anticholinergics are QUATERNARY ammonium derivatives?
the tropiums
59
which anticholinergic is a TERTIARY ammonium derivative?
atropine
60
can you give anticholinergics for COPD?
yes
61
how does an anticholinergic work for a COPD pt (mechanism)?
causes LESS airway constriction via inhibiting ACh (I think)
62
what are the 2 side effects of ipratropium?
bitter taste | glaucoma if nebulized w/ a face mask
63
what are all ICS derivatives of?
hydrocortisone
64
what is the mechanism of action of ICS?
Activates ligand-activated transcription factors bc they're LIPOPHILIC (recruit HDACs to decrease inflammation)
65
which drugs are ICS?
beclomethasone budesonide fluticasone
66
why should you combine an ICS w/ a beta agonist?
over time, ICS increase B2 receptors so eventually you'll get a better B2 response
67
how often are ICS used per day?
BID
68
which ICS is a prodrug?
beclomethasone diproprionate | prodrug cleaved by esterases in lung to active steroid
69
which ICS have greater first pass metabolism?
fluticasone & budesonide
70
which ICS have less systemic & side FX?
fluticasone & budesonide
71
what is in advair?
fluticasone | salmeterol
72
what is in symbicort?
budesonide | formoterol
73
what are the 3 local side fx of ICS?
1. dysphonia 2. cough 3. oropharyngeal candidiasis
74
what are the 9 systemic side fx of ICS?
1. osteoporosis 2. bruising 3. adrenal suppression/insuff 4. growth suppression 5. cataracts 6. glaucoma 7. metabolic issues 8. psych issues 9. pneumonia
75
which drug is a leukotriene antagonist?
montelukast
76
how do you administer montelukast?
oral
77
what is good about montelukast clinically?
avoids "steroid phobia" & is widely used for kids
78
what does montelukast improve?
mild-moderate asthma & aspirin-sensitive asthma
79
what can you do for pts who are not responding to an ICS?
add Montelukast
80
what are the 2 rare side fx of montelukast?
1. hepatic dysfxn | 2. Churg-Strauss
81
how does omalizumab work?
anti-IgE | binds up anything bound to IgE (macs, lymphs, mast cells) to decrease chronic inflammation
82
when should you prescribe omalizumab?
severe asthma not responding to ICS/LABA
83
what is the route of omalizumab & how often do you take it?
subQ every 2-4 wks
84
how do you determine omalizumab dosing?
titering IgE ab in pts
85
what is STEP 1 of asthma tx?
SABA PRN
86
what is STEP 2 of asthma tx?
low-dose ICS | alt = LTRA
87
what is STEP 3 of asthma tx?
ICS + LABA | alt = higher dose ICS, ICS + LTRA, or ICS + theophylline
88
what is STEP 4 of asthma tx?
high-dose ICS + LABA +/- LTRA or theophylline | alt = omalizumab
89
what is STEP 5 of asthma tx?
step 4 + omalizumab &/or long term oral corticosteroid
90
which steps of asthma tx involve referral to a specialist?
4 & 5

Block 9 Week 4 (5 decks)

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