Treatment of Asthma

Question 1

drug types used for asthma

Answer 1

• Bronchodilators - short term relivers (rescue inhalers)
  
  • Attempt to increase cAMP in the cells
    
    • B2 agonists directly increase cAMP synthesis
    • PDE inhibitors slow cAMP degradation
  • Inhibition of bronchoconstriction
    
    • Muscarinic receptor antagonists - take away PNS stimulated bronchoconstriction
    • Adenosine receptor antagonists (theophylline)
• Anti-inflammation agents = long term controllers (steroids)
• Prophylaxis agents = prevent attack frequency and severity

Question 2

aminophylline, theophylline, dyphylline, pentoxifylline

Answer 2

bronchodilators - methylxanthines

similar chemical structure to caffeine

oral sustained release prep

theophylline is still used becuase its dirt cheap

lots of side effects: inhibits phosphodiesterase (less breakdown of cAMP) = cardiac stim (inotropic and chornotropic) and vascular smooth muscle relax = reflex tach, may also oppose adenosine at the receptor = helpful

CNS stimulation = alertness, insomnia, tremors, convusions

increased gastric acid secretion = GERD

weak diuretics

improves contractility of diaphram = helps with theraputics

just think of what coffee does

need to be able to measure blood levels - therapeutic and toxic effects are related to blood plasma levels

Question 3

albuterol, bitolterol, pirbuterol,salmeterol, formoterol

Answer 3

bronchodilators - B2 adrenergic agonists

salmeterol and formoterol are long acting - applied systemically = may have SE

topical admin = no adverse cardiac effects

Question 4

metaproterenol, terbutaline

Answer 4

bronchodilators - B2 agonists

Question 5

epinephrine, ephedrine

Answer 5

bronchodilator - sympathomimetic

cardiac adverse effects (tach, arrythmia, worsening of angina due to stimulation of B1 receptors)

ephedrine - not used much anymore

Question 6

isoproterenol

Answer 6

bronchodilators - sympathomimetics

Question 7

ipratopium, tiotropium

Answer 7

bronchodilators - muscarinic antagnoists

unpredictable efficacy - depends on how active the persons PNS is

ipratropium bromide - aersol or nasal spray - minimal CNS effects

tiotropium - longer duration of action (24 hours)

Question 8

atropine

Answer 8

bronchodilator - muscarinic antagonist

AE: mouth drying, urinary retention, tachy, loss of accomedation, agitation

Question 9

Beclomethasone, fluticasone, mometasone

Answer 9

anti inflam (conrollers) - glucocorticoids

inhiibit inflam cytokines - dont relax bronch SM

lots of AE with systemic use, not the case with topical

Question 10

budesonide

Answer 10

anti- inflam (controlers) - glucocorticoids

Question 11

flunisolide

Answer 11

anti - inflam (controllers) - glucocortoicoids

Question 12

montelukast, zafirlukast,

Answer 12

anti-inflam (controllers) - leukotriene antag

orally avalible

LTs = potent chemoattractants

good for asthma and IBD

AE: cardiac depression,

Question 13

zileuton

Answer 13

anti-inflam controllers - leukotriene antag

back on the market after reformulation

Question 14

omalizumab

Answer 14

anti-IgE antibody - inhibits binding of IgE to mast cells (binds to FC portion on IgE)

lowers IgE levels

reduces need for steroids

doesnt help if IgE is already bound to mast cells

Question 15

mepolizumab

Answer 15

anti - IL-5 AB

Question 16

reslizumab

Answer 16

anti-IL-5 AB

Question 17

cromolyn sodium, nedocromil sodium

Answer 17

prophylactic agents - reduce mast cell degranulation

only helps if given before degran

help protect against attacks if given before exercise or allergen exposure