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IC > Treatment of Asthma > Flashcards

Treatment of Asthma Flashcards

1
Q
  • recurrent episodes of coughing, shortness of breath, chest tightness, and wheezing
  • mild: occasional symptoms, on exposure to allergens or pollutants, after exercise or upper viral respiratory infection
  • severe: frequent attacks of wheezing dyspnea especially at night –> limitation of activity
A

asthma

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2
Q

asthma:
- _______ of smooth muscle
- mucosal thickening from _______ and cellular infiltration
- airway lumen: thick, viscid mucus plug

A

contraction

edema

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3
Q

FEV1, FEV1/FVC, and peak expiratory flow rate may be _______ during an asthma attack

A

reduced

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4
Q

total lung capacity, functional residual capacity, and residual volume may be _______ as a consequence of airflow obstruction and incomplete emptying of lung units

A

increased

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5
Q

______ reaction of asthma: exposure to allergen - IgE - allergen reexposure - allergen antibody rxn - mast cell activation - mediator release - smooth muscle contraction - brochoconstriction - decreased FEV1

A

early reaction (within 2 hours)

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6
Q

______ reaction: cytokine and other factors, T cells, mast cells - eosinophils and neutrophils, proteases, PAF - increased edema and mucus hypersecretion - bronchoconstriction - increased bronchial reactivity - late fall in FEV1

A

late reaction (4-6 hours)

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7
Q

Beta-2 agonists _______ cAMP synthesis by adenylyl cyclase, PDE inhibitors _______ cAMP degradation

A

increase

slow

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8
Q

bronchoconstriction inhibited by muscarinic receptor __________, adenosine receptors ________

A

antagonists

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9
Q

albuterol, bitolterol, pirbuterol, metaproterenol, terbutaline, salmeterol, formoterol are what drug class?

A

beta2 agonists

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10
Q

salmeterol and formoterol?

A

long acting beta-2 agonists

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11
Q

epinephrine, ephedrine, isoprotereneol?

A

sympathomimetics

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12
Q

aminophylline, theophylline, dyphylline, pentoxifylline?

A

methylxanthines

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13
Q

ipatropium, tiotropium, atropine

A

muscarinic antagonists

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14
Q
  • act by stimulating adenylyl cyclase to increase cAMP - smooth muscle relaxation and bronchodilation
  • drug of choice for acute asthma attacks
  • longer acting for prophylaxis
  • max 30 min, lasts 3-4 hours
  • skeletal muscle tremor, nervousness, weakness
A

beta-2 agonists

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15
Q
  • tachycardia, arrythmia, worsening of angina due to stimulation of beta-1
  • act rapidly in acute asthmatic attacks, inhaled or injected subQ
A

sympathomimetics (epi, ephedrine)

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16
Q
  • used as oral sustained release or parenteral
  • PDE inhibition, increase cAMP, cardiac stimulation, vascular smooth muscle relaxation
  • reduced cytokine release
  • adenosine antagonists
  • bronchodilation, CNS stimulation
  • positive inotropic and chronotropic effects may produce arrythmias and increase BP
  • stimulate gastric acid, weak diuretics, improve diaphragmatic function
A

methylxanthines ( theophylline, aminophylline, theobromine)

17
Q
  • most effect methylxanthine bronchodilator
  • relieve obstruction in acute attack, inexpensive, oral
  • 12 hr, therapuetic and toxic levels related to plasma levels
  • insomnia, anorexia, nausea, vomiting, headache
  • metabolized by liver
A

theophylline

18
Q
  • block Ach binding at muscarinin receptors

- inhibit responses to vagal stimulation, relax bronchial smooth muscle, decreased mucus secretion

A

Muscarinic receptor antagonists ( ipratropium, tiotropium, atropine)

19
Q
  • given IV or inhalation, bronchodilation for 5 hours

- adverse: dry mouth, urinary retention, tachycardia, loss of accomodation, agitation

A

atropine

20
Q

-aerosol or nasal spray, poorly absorbed and minimal CNS effects

A

ipratropium bromide

21
Q

long duration of action, 24 hours, M antagonist

A

tiotropium

22
Q

beclomethasone, budesonide, dexamethosone, flunisolide, fulticasone, mometasone

A

glucocorticoids

23
Q
  • don’t relax smooth muscle directly, inhibit the production of inflammatory cytokines
  • reduce reactivity, reduce edema
  • oral, injection, aerosol
A

glucocorticoids

24
Q
  • systemic delivery only in patients requiring emergency treatment
  • inhaled: oral candidiasis, hoarseness
A

glucocorticoids

25
Q
  • LTD4 receptor antagonists

- given orally, in children unable to comply with inhalation therapy

A

montelukast, zafirlukast

26
Q

inhibits binding of IgE to mast cells, lower plasma IgE, reduces bronchospastic antigen response, lessen corticosteroid requirement

A

omalizumab

27
Q
  • inhibits binding of IL-5 to mast cells
  • reduces level of blood eosinophils
  • in patients with worsening, severe asthma attacks
A

mepolizumab, reslizumab

28
Q
  • reduce mast cell degranulation
  • effective prophylaxis
  • protective before exercise or allergen exposure
  • inhibit hyperreactivity in antigen/exercise induced asthma
  • don’t affect bronchial smooth muscle or bronchospasm
  • inhibit mast cell activation, reduce release of histamine
A

cromolyn sodium, nedocromil sodium

IC (29 decks)

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