Resp - Pharm (Asthma & other related drugs)

Question 1

What 2 pathways do asthma drugs target, and why?

Answer 1

Brochoconstriction is mediated by (1) inflammatory processes and (2) parasympathetic tone; therapy is directed at these 2 pathways

Question 2

What are 6 types of asthma drugs?

Answer 2

(1) Beta2-agonists (2) Methylxanthines (3) Muscarinic antagonists (4) Corticosteroids (5) Antileukotrienes (6) Omalizumab

Question 3

What are 2 examples of ways Beta2-agonists can be used as Asthma drugs? Give drug names and mechanisms.

Answer 3

(1) Albuterol - relaxes bronchial smooth muscle (Beta2). Use during acute exacerbation. (2) Salmeterol, formoterol - long-acting agents for prophylaxis

Question 4

What kind of drug is Albuterol? What is its mechanism? In what clinical context is it used?

Answer 4

Beta2-agonist, Asthma drug; Relaxes bronchial smooth muscle (Beta2); Use during acute exacerbation (of asthma)

Question 5

What kind of drug is Salmeterol? Name another drug that shares its mechanism/purpose. How are they used clinically?

Answer 5

Beta2-agonists, Asthma drugs; Formoterol; Long-acting agents for prophylaxis;

Question 6

What are 2 adverse effects of Salmeterol &/or Formoterol?

Answer 6

Adverse effects are tremor and arrhythmia

Question 7

Name a Methylxanthine used as an Asthma drug. What is its mechanism?

Answer 7

Theophylline - likely causes bronchodilation by inhibiting phosphodiesterase –> increase cAMP levels due to decreased cAMP hydrolysis

Question 8

In general, what is the usage of theophylline, and why? What are 2 toxicities with which it is associated?

Answer 8

Usage is limited because of narrow therapeutic index (cardiotoxicity, neurotoxicity)

Question 9

What metabolizes theophylline? What does theophylline block?

Answer 9

Metabolized by cytochrome P-450; Blocks actions of adenosine

Question 10

Name a Muscarinic antagonist used as an Asthma drug. How does it work?

Answer 10

Ipratropium - competitive block of muscarinic receptors, preventing bronchostriction

Question 11

Besides asthma, what is another clinical use for Ipratropium? What other drug shares this use, and what kind of drug is it?

Answer 11

Also used for COPD, as is Tiotropium, a long-acting muscarinic antagonist

Question 12

Give 2 examples of Corticosteroids that are used asthma drugs. What is their mechanism?

Answer 12

Beclomethasone, Fluticasone - Inhibit the synthesis of virtually all cytokines. Inactivate NF-kappaB, the transcription factor that induces the production of TNF-alpha and other inflammatory agents.

Question 13

What is the first-line therapy for chronic asthma?

Answer 13

Corticosteroids - Beclomethasone, Fluticasone

Question 14

What are 2 types of Antileukotrienes used as Asthma drugs? Give the names and mechanisms of the different drugs.

Answer 14

(1) Motelukast, Zafirlukast - block leukotriene receptors. Especially good for aspirin-induced asthma; (2) Zileuton - a 5-lipoxygenase pathway inhibitor. Blocks conversion of arachidonic acid to leukotrienes

Question 15

What is an especially good clinical use for Montelukast? What other drug shares the same mechanism/properties as Montelukast and is also especially good for this?

Answer 15

Especially good for aspirin-induced asthma; Zafirlukast

Question 16

What is Omalizumab? What is its mechanism?

Answer 16

Monoclonal anti-IgE antibody; Binds mostly unbound serum IgE and blocks binding to Fc(Epsilon)RI.

Question 17

How is Omalizumab used clinically in asthma therapy?

Answer 17

Used in allergic asthma resistant to inhaled steroids and long-acting Beta2-agonists

Question 18

What kind of drug is Methacholine? How is it used clinically?

Answer 18

Muscarinic receptor agonist; Used in bronchial provocation challenge to help diagnose asthma

Question 19

How is Bosentan used clinically? What is its mechanism?

Answer 19

Used to treat pulmonary hypertension. Competitively antagonizes endothelin-1 receptors, decreasing pulmonary vascular resistance.

Question 20

Draw a diagram depicting the relation/effects of the following drugs to/on bronchial tone: (1) ACh (2) Adenosine (3) Beta-agonists (4) cAMP (5) Muscarinic antagonists (6) Theopylline.

Answer 20

See p. 614 in First Aid 2014 for visual near bottom left of page

Question 21

Draw a diagram depicting the conceptual framework for the treatment strategies of asthma using the following interventions: (1) Avoidance (2) Omalizumab (3) Steroids (4) Beta-agonists, Theophylline, Muscarinic antagonists (5) Steroids, Antileukotrienes.

Answer 21

See p. 614 in First Aid 2014 for visual on right of page.