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PBL Pharm Block 3 > Pharm 47 - Asthma > Flashcards

Pharm 47 - Asthma Flashcards

1
Q

Two ways asthma medications work?

A

1) By relaxing bronchial smooth muscle

2) By preventing and treating inflammation

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2
Q

How does the autonomic system regulate smooth muscle?

A

Sympathetic (adrenergic) tone causes bronchodilation; Parasympathetic (cholinergic) tone causes bronchoconstriction; Nonadrenergic, noncholinergic (NANC) fibers also innervate the respiratory tree

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3
Q

What is the main type of receptor expressed on airway smooth muscle cells? What chemical activates them?

A

Beta2-adrenergic receptors are activated by epinephrine, which is secreted by the adrenal medulla -> causes bronchodilation

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4
Q

How do parasympathetics create effects in the lungs?

A

Muscarinic (M3) receptors on airway smooth muscles are stimulated by acetylcholine -> causes bronchoconstriction

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5
Q

How do NANC fibers create effects?

A

NANC fibers are primarily under parasympathetic control. They are either stimulatory (cause bronchoconstriction) or inhibitory (cause bronchodilation). They release Neurokinin A, Calcitonin gene-related peptide, substance P, bradykinin, tachykinin, and neuropeptide Y to bronchoconstrict. NO and VIP cause bronchorelaxation.

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6
Q

What is more potent than histamine at producing bronchoconstriction?

A

Leukotriene D4

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7
Q

What are the two categories of asthma medications?

A

1) Relievers (bronchodilators)

2) Controllers/Preventers (anti-inflammatory)

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8
Q

Anticholinergics MOA

A

Antagonists at muscarinic receptors on airway smooth muscle and glands -> decreased bronchoconstriction and mucus secretion

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9
Q

Name the Anticholinergics (2)

A

Ipratropium, Tiotropium (long duration of action)

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10
Q

Anticholinergic clinical applications (3)

A

Asthma (not approved by FDA), COPD, Rhinitis

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11
Q

Adverse Effects Include Paralytic ileus, angioedema, bronchospasm; also abnormal taste, dry mouth/nasal mucus, constipation, tachycardia, urinary retention; if accidentally squirted in eye, can cause mydriasis and increased intraocular pressure -> angle-closure glaucoma

A

Anticholinergics

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12
Q

Anticholinergic contraindications

A

Hypersensitivity to drug or to soya lecithin

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13
Q

Has long duration of action b/c of slow dissociation from M1/M3 receptors

A

Tiotropium (Anticholinergic)

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14
Q

Agonists at Beta-adrenergic receptors; act through stimulatory G protein to cause smooth muscle relaxation and bronchodilation

A

Beta-Adrenergic Agonist MOA

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15
Q

Beta-adrenergic agonist

Used for asthma, anaphylaxis, cardiac arrest, open-angle glaucoma

A

Epinephrine (class and clinical applications)

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16
Q

Adverse Effects Include arrhythmias, hypertensive crisis, pulmonary edema; also tachycardia, palpitations, sweating, N/V, tremor, nervousness, dyspnea

A

Epinephrine

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17
Q

Contraindications Include Narrow-angle glaucoma (opthalmic form), MAOI use w/in 2 weeks (inhaled form)

A

Epinephrine

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18
Q

Non-selective agonist binds alpha (HTN), beta1 (cardiac stimulation), and beta2 (bronchodilation) adrenergic receptors

A

Epinephrine

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19
Q

Beta-adrenergic agonist

Used for asthma, cardiac arrest, decreased vascular flow, heart block, shock, Stokes-Adams syndrome

A

Isoproterenol

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20
Q

Adverse effects include Tachyarrythmia, palpitations, dizziness, HA, tremor, restlessness

A

Isoproterenol

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21
Q

Contraindications include Tachyarrythmias, angina, digitalis-induced tachycardia/heart block

A

Isoproterenol

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22
Q

Binds beta 1 (cardiac stimulation) and beta 2 (bronchodilation) adrenergic receptors

A

Isoproterenol therapeutic considerations

23
Q

Irritating list of Selective Beta2 Receptor Agonists (7)

A

Metaproterenol, Albuterol (Salbutamol), Levalbuterol, Terbutaline, Pirbuterol, Isoetharine, Bitolterol (MALTs with mr. PIB)

24
Q

Selective Beta2 Receptor Agonists clinical applications

A

Asthma, COPD

25
Q

adverse effects include Tachyarrythmia, palpitations, dizziness, HA, tremor, restlessness (BUT less cardiac effects since they’re Beta2 selective)

A

Selective Beta2 Receptor Agonists and M[E/O]TEROLs

26
Q

Selective Beta2 Receptor Agonists therapeutic considerations

A

Terbutaline, albuterol, pirbuterol, and bitolterol cause fewer cardiac effects; Levalbuterol is more Beta2 selective than albuterol

27
Q

-M[E/O]TEROLs (class and clinical applications)

A

Beta-adrenergic agonist

COPD (formoterol, salmeterol, arformoterol); Asthma (formoterol, salmeterol)

28
Q

Long acting (LABAs) (12-24 hours); Should not be used as asthma monotherapy b/c of increased risk of death from asthma (use with inhaled corticosteroid)

A

-M[E/O]TEROLs therapeutic considerations

29
Q

MOA Nonselective phosphodiesterase inhibitors, prevent degradation of cAMP, act as adenosine receptor antagonist -> smooth muscle relaxation and bronchodilation

A

Methylxanthines

30
Q

Name the Methylxanthines (2)

A

Theophylline, aminophylline

31
Q

Methylxanthine clinical applications

A

Asthma, COPD

32
Q

Adverse effects include Ventricular arrhythmia, seizure; also tachyarrhythmias, N/V, insomnia, tremor, restlessness

A

Methylxanthine

33
Q

Inhibition of PDE III and IV in smooth muscle -> bronchodilation; inhibition of PDE IV in T cells and eosinophils -> anti-inflammatory/ immunomodulatory; MONITOR PLASMA LEVELS; avoid co-administration with fluvoxamine, enoxacin, mexiletine, propranolol, troleandomycin -> theophylline toxicity; avoid co-administration with zafirlukast -> lower plasma concentration of zafirlukast
Drug-drug interactions w/ CYP3A inhibitors (cimetidine, -azole antifungals)

A

Methylxanthine

34
Q

MOA Inhibits Ca2+ transport into smooth muscle cells -> smooth muscle relaxation

A

Magnesium Sulfate

35
Q

Used for Atrial paroxysmal tachycardia, barium poisoning, cerebral edema, eclampsia, hypomagnesmia, seizure

A

Magnesium Sulfate

36
Q

Adverse effects include Heart block, hypotension, prolonged bleeding time, hyporeflexia, CNS depression, respiratory tract paralysis

A

Magnesium Sulfate

37
Q

Magnesium Sulfate contraindications

A

Heart block, myocardial damage

38
Q

Therapeutic considerations Include Tocolytic agent causes uterine relaxation -> delay preterm labor; may benefit pts w/ acute asthma exacerbation

A

Magnesium Sulfate

39
Q

MOA Inhibit COX-2 action and prostaglandin synthesis by inducing lipocortins; inhibition of IL-4 and IL-5 strongly reduces inflammatory response in asthma

A

Inhaled Corticosteroids

40
Q

Irritating list of Inhaled Corticosteroids (7)

A

Beclomethasone, triamcinolone, fluticasone, budesonide, flunisolide, mometasone, ciclesonide (Bec, Bud, and Mom went to Triam (Try on?) Flutes and to eat Flun (flan?) and iCicles….)

41
Q

Corticosteroid clinical applications

A

Inflammatory conditions, autoimmune diseases

42
Q

Adverse effects Include Immunosuppression, cataracts, hyperglycemia, hypercortisolism, depression, euphoria, osteoporosis, growth retardation in children, muscle atrophy; also impaired wound healing, HTN, fluid retention, oropharyngeal candidiasis, dysphonia

A

Inhaled Corticosteroid

43
Q

Corticosteroid contraindications

A

Systemic fungal infections

44
Q

Therapeutic considerations include: Does not correct underlying disease, only limits effects of inflammation; requires tapering dosage after chronic use to avoid adrenal insufficiency; inhaled corticosteroids have fewer systemic adverse effects (can be reduced further by using large-volume spacer and rinsing mouth after use); inhaled steroids (except beclomathasone and triamcinolone) are subject to 1st-pass metabolism, so they don’t reach systemic circulation

A

Inhaled Corticosteroid

45
Q

MOA Inhibit Cl- transport, which affects Ca2+ gating and prevents granule release
Also includes Nedocromil

A

Cromolyn

46
Q

Clinical applications: Asthma, allergic rhinitis, keratitis, keratoconjunctivitis, mast-cell disorder, vermal conjunctivitis

A

Cromolyn

47
Q

Adverse effects: Abnormal taste, burning eyes, cough, throat irritation

A

Cromolyn

48
Q

Therapeutic considerations: Prophylaxis of allergic asthma and exercised-induced asthma; more effective in kids/young adults vs. elderly; excellent safety profile, but not as effective as other asthma medications

A

Cromolyn

49
Q

MOA: Humanized mouse antibody; prevents IgE from binding Fc on mast cells and APCs; decreases circulating IgE

A

Omalizumab

50
Q

Omalizumab clinical applications

A

Asthma

51
Q

Adverse effects: Anaphylaxis; also, injection site reaction, rash, HA

A

Omalizumab

52
Q

Therapeutic considerations: Affects both early- and late-phase asthmatic responses, administered subcutaneously every 2-4 wks (must monitor after injection for several hours due to possible immune response)

A

Omalizumab

53
Q

Has slow onset of action so it should not be used for acute asthma flares.

A

Salmeterol

PBL Pharm Block 3 (14 decks)

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