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Pharm Spring Exam 1 > Exam I - Asthma and COPD > Flashcards

Exam I - Asthma and COPD Flashcards

1
Q

Drug List

Systemic

A

Methylprednisolone

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2
Q

Drug List

Aerosol Corticosteroids

A

Fluticasone

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3
Q

Drug List

SABA

A

Albuterol

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4
Q

Drug List

LABA

A

Salmeterol

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5
Q

Drug List

SA Muscarinic Antags

A

Ipratropium

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6
Q

Drug List

LA Muscarinic Antags

A

Tiotropium

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7
Q

Drug List
Phosphodiesterase Inhibitors
Non-selective

A

Theophylline

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8
Q

Drug List

Leukotriene Inhibitors

A

Montelukast

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9
Q

IgE Inhibitors

A

Omalizumab

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10
Q

Acute Asthma

Stimuli

A
  • Allergens
  • Viral Inxns
  • Pollutants
  • Cold Air
  • Exercise
  • Stress
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11
Q

Asthma
Immunopathogenesis
Early Phase

A
  • sharp decline FEV1
  • IgE/mast cell/histamine mediated
  • T-cell participation
  • Also: Tryptase, PGD, LTC, PAF
  • bronchodilator drugs
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12
Q

Asthma
Immunopathogenesis
Late Phase

A
  • Eosinophil -> ECP, MBP
  • Neutrophil -> Proteases, PAF
  • anti-inflammatory drugs
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13
Q

Maintenance Drugs

A
  • ICS

- anti-inflammatory

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14
Q

Maintenance Drugs

Effect

A

-airway responsiveness

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15
Q

Quick Relief

Drugs

A
  • SABA

- IV/oral CS

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16
Q

Quick Relief

Effect

A

-airway resistance

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17
Q

Therapeutic Index

Equation

A

TD50/ED50

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18
Q

Asthma Inhaler

Types

A
  • MDI w/ or w/o Spacer (+mask PRN)
  • DPI (really effective and easy for kids!)
  • Nebulizer w/ face mask
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19
Q

Deposition of

Inhaled Drugs

A
  • 10-20% inhaled
  • 80-90% swallowed + first pass
  • side effects from circulation
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20
Q

Attack Prevention

Drug Targets

A
  • Immune cells: CS, leukotrienes, IgE
  • Muscarinic cholinergic antagonists
  • B2 adrenergic agonists
21
Q

Most Effective Tx

A

-inhaled glucocorticoids (ICS)

22
Q

ICS

mechanism

A

-Suppress inflammation
(inflamm gene transcr.)
-direct inhibition of CBP/HAT gene transcr.
(acetylation of enzyme)
-indirect inhibition of HDAC2 gen transcr.
(deacetylation of DNA)

23
Q

ICS

Effects on Inflamm Cells

A
  • incr. B2 receptors on smooth musc
  • decr. Eosins, macs, dendritics
  • decr. cytokines on T cells
  • decr. T cell activation of mast/eosin
24
Q

ICS

Not mechanism

A
  • effect on mediator release

- effect on early response

25
Q

ICS

TX Timeline

A

-weeks/mos/long-term

26
Q

ICS
Not working well enough?
What to do?

A

-Add LABA before increasing ICS

27
Q

ICS

Adverse

A

-oral candidiasis, dysphonia
-suppress hypothal/pit axis
(bone resporption, skin thinning,
growth retardation)

28
Q

ICS

COPD indications

A

-only if FEV1<50%

29
Q

Systemic Glucocorticoids

Indications

A
  • acute asthma exacerbation
  • may need to use IV
  • 3-10 day short-course
  • replace with ICS upon conclusion
30
Q

Systemic Glucocorticoids

Adverse

A

-Same as ICS

31
Q

SABA/LABA

mechanism

A
  • Relax smooth muscle/bronchodilator
  • pos reg of adenylate cyclase-> cAMP
  • inhibits methylxanthines
  • Inhibit mast cells
  • inhibit vasc leakage
  • stimulate glucocorticoid receptor translocation
  • incr. mucociliary transport
32
Q

SABA
Indication
Duration/Impact

A
  • Rescue
  • effects in 3-5 min
  • peak 30-60 min
  • duration 3-6 hours
33
Q

LABA
Indication
Duration/Impact

A
  • adjunct to ICS
  • duration > 12h
  • COPD monotherapy
34
Q

SABA/LABA

Adverse

A

-muscle tremor, tachycardia, hypokalemia
-no LABA w/o concurrent ICS
(use combo inhaler)

35
Q

Muscarinic Cholingergic Antags

Mechanism

A
  • block vagus ACh on M3
  • inhib sm musc contraction
  • additive effect w/ B2 agonists
  • no anti-inflammatory action
36
Q

Muscarinic Cholingergic Antags

Indication

A
  • B2 agonist intolerance

- more effective in COPD

37
Q

Muscarinic Antags

Durations

A
  • Ipratropium: SA, 15 min to 4 hours

- Tiotropium: LA, >24 hrs

38
Q

Muscarinic Antags

Adverse

A
  • few systemic (poor absorption)

- dry mouth

39
Q

Methylxanthines

Mechanism

A

-oral!
-inhibs cAMP phosphodiesterase
(incr cAMP)
-blocks adenosine receptors on sm musc, mast cells
(reduce constriction, reduce histamine)
-deactylates histones
-decr. cytokine release

40
Q

Methylxanthines

and COPD

A
  • increases diaphragm contractility

- may increase ICS effects

41
Q

Methylxanthines

Adverse

A
  • Nausea/vomit
  • CNS stim: anxiety, tremor, convulsions
  • CV: tachycardia, arrhythmias, vasodilation
  • narrow tx window!
42
Q

Leukotriene Pathway Inhibs

Mechanism

A

-Oral
-inhibit bronchoconstriction
(blocks receptor for cysteinyl leukotrienes in COX)

43
Q

Leukotriene Pathway Inhibs

Indications

A
  • aspirin-sensitive asthmatics
  • additive for poorly controlled mild/mod asthma
  • NO ROLE IN COPD
44
Q

Leukotriene Pathway Inhibs

Adverse

A
  • rare hepatic dysfx’n

- reversible on discontinuation

45
Q

Anti-IgE

Mechanism

A
  • injected Ab
  • binds Fc portion of IgE
  • prevents IgE from binding
46
Q

Anti-IgE

Adverse

A
  • $$$$$$$$$$$
  • rare anaphylaxis
  • rare increase in malignancies
47
Q

COPD

best cure

A

stop smoking, beez

48
Q

Asthmatic Sx following URI

TX

A
  • no official recommendations

- can use SABA or SA anti-chol or LABA

Pharm Spring Exam 1 (8 decks)

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