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Pharm 4 > Asthma > Flashcards

Asthma Flashcards

1
Q

Receptors involved in asthma & result of stimulation

A

M3 in bronchial SM -> bronchoconstriction

B2 in airways -> bronchodilation

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2
Q

inflammatory mediators in asthma

A

Primary/early: histamine, protease, chemotactic factors (ECF, NCF)
Secondary/late: LKT B4, C4, D4, PGD2, cytokines

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3
Q

treatment strategies for asthma

A

manage inflammation with corticosteroids, mast cell stabilizers, LKT-R modulators
manage bronchoconstriction with B2-R agonists, anti-muscarinics, xanthine derivatives

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4
Q

MOA of beta-agonist

A

stimulate B2 stimulates AC = increased cAMP -> bronchodilation

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5
Q

MOA of theophylline

A

inhibits PDE = decreased cAMP breakdown = increased cAMP and bronchodilation
Also blocks adenosine to inhibit bronchoconstriction

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6
Q

MOA of muscarinic antagonist

A

block ACh to inhibit bronchoconstriction

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7
Q

Benefits of aerosolized asthma drugs

A

high local and low systemic concentration

fewer side effects

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8
Q

Benefit of spacer with aerosolized asthma drugs

A

improves ratio of inhaled to swallowed drug, no hand-mouth coordination needed

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9
Q

Fluticasone

A

glucocorticoid for asthma

potency of 1 (most potent)

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10
Q

MOA glucocorticoids

A

Decreased inflammation by modulating cyto/chemokine production, inhibiting eicosanoid synth, inh accumulation mast cells, decrease vascular permeability
Does NOT relax bronchial SM

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11
Q

Mometasone

A

GC for asthma

potency = 1 (most potent)

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12
Q

Beclomethasone

A

GC for asthma

potency = 0.5

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13
Q

budesonide

A

GC for asthma

potency = 0.5

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14
Q

flunisolide

A

GC for asthma

potency = 0.25 (least potent)

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15
Q

triamcinolone

A

GC for asthma

potency = 0.25 (least potent)

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16
Q

ciclesonide

A

GC for asthma

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17
Q

ADR of GCs for asthma

A

Dysphonia and oral candidiasis (prevent by gargling saline water)
Systemic GC effects w/ high dose
Growth retardation in children (will achieve normal adult height)

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18
Q

Types of b2-R agonists and timelines

A

Short-acting: max dilation in 15-30 minutes lasting 3-4 hours; for sx relief only
Long-acting: max dilation delayed, lasts 12+ hours; prophylaxis only; *usually combined with inhaled steroid & contraindicated for asthma if not used w/ steroid

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19
Q

Salbutamol

A

short-acting B2-agonist

20
Q

albuterol

A

short-acting B2-agonist

21
Q

terbutaline

A

short-acting B2-agonist

22
Q

metaproterenol

A

short-acting B2-agonist

23
Q

Salmeterol

A

long-acting B2-agonist

dry powder diskus

24
Q

formeterol

A

long-acting B2-agonist
dry powder aerosolizer
also indicated for exercise-induced asthma

25
Q

Corticosteroid + LABA combos

A

Advair: fluticasone + salmeterol
Symbicort: budesonide + formoterol
Dulera: mometasone + formoterol

26
Q

ADR of B2-R agonist

A

fine tremors of finger/hand
palpitations
dizziness
restlessness/agitation

27
Q

Use and MOA of muscarinic receptor antagonist

A

adjuvant therapy to B2-agonist and corticosteroids, also for allergic rhinitis
antagonizes M3-R and increases mucociliary clearance

28
Q

Ipratropium, oxitropium, tiotropium

A

muscarinic receptor antagonists

29
Q

Use and MOA of LKT modulators

A

Oral for mild-mod asthma prophylaxis, in combo w B-agonist and GC; also tx for allergic rhinitis
Antagonizes LKT actions to inhibit bronchoconstriction and decrease microvascular leakage and mucus production
inhibits influx of basophils and lymphocytes into airways

30
Q

Types of LKT modulators

A

LKT-R blockers & LKT synthesis blockers

31
Q

Montelukast

A

LKT-R blocker for asthma

Only drug approved for preventing exercise-induced asthma

32
Q

Zafirlukast

A

LKT-R blocker for asthma

33
Q

Zileuton

A

LKT synthesis inhibitor for asthma

inhibits LOX

34
Q

ADR of LKT modulators

A

Minimal; may cause mild rise in liver enzyme levels

35
Q

Use and MOA mast cell stabilizer

A

oral w poor bioavailability; used in asthma and allergic rhinitis as nasal spray
stabilizes mast cell from degranulation and inhibits release of inflammatory mediators from mast cell
*No effect on bronchodilation or SM relaxation

36
Q

Sodium cromoglicate

A

mast cell stabilizer for asthma or allergic rhinitis

37
Q

Nedocromil sodium

A

mast cell stabilizer for asthma or allergic rhinitis

38
Q

Use and MOA of xanthine derivatives

A

bronchodilation and inhibition some aspects of late-phase asthma
inhibits PDE -> increase cAMP
inhibits cell surface receptors for adenosine

39
Q

ADR of xanthines

A

CNS stimulant -> alertness, tremors, seizures
CVS stimulant -> increased HR, chronotropy (arrhythmia)
weak diuretic effect (increased GFR and dec tubular reabsorption)

40
Q

Omalizumab

A

anti-IgE mab to inhibit binding to mast cell and degranulation

41
Q

Other potential asthma drugs

A

anti-IL-4, IL-5, IL-13 mabs and antagonists of cell adhesion molcules

42
Q

treatment of status asthmaticus

A

OACI: oxygen, continuous albuterol, systemic corticosteroids, intubation/ mechanical ventilation
B2-agonists, anti-ACh, GCs, bronchodilators (B2-ag > xanthine)

43
Q

Why use anti-ACh in status asthmaticus

A

central suppression of conduction in vestibular cerebellar pathways

44
Q

Why use GCs in status asthmaticus

A

decreased mucus production, improve oxygenation, reduct requirement for B2-agonist or theophylline, activate properties to prevent late bronchoconstriction

45
Q

Use of magnesium sulfate in status asthmaticus

A

IV MS may relax SM -> bronchodilation and compete with Ca at Ca-mediated SM binding sites

46
Q

Asthma drugs for pregnant women

A

Use same inhaled drugs because benefit&raquo_space;> risk

47
Q

Asthma drugs for children

A

Be mindful of excessive steroid use and hand-mouth coordination with MDIs

Pharm 4 (8 decks)

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