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asthma Flashcards

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1
Q

whats asthma?

A

chronic inflammatory disease of the airway

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2
Q

what are the 2 phases of asthma?

A

immediate phase –> hypersensitivity due to irritant

Delayed phase –> chemotaxis are been released by the inflammatory cells to attract more immune cells

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3
Q

what happens to the bronchial wall in asthma due to irritations and inflammation?

A

1- Smooth muscle hyperproliferation

2- increased gland secretions

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4
Q

why asthma is not considered COPD?

A

Because asthma can be reversed by drugs

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5
Q

what are the two types of asthma??

A

chronic asthma —–> stable

acute asthma —> Severe and unstable

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6
Q

how do you administer drugs in chronic asthma?

A

orally

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7
Q

how do you administer drugs in acute asthma?

A

Inhaled

IV

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8
Q

whats extrinsic asthma?

A

the irritant comes from outside the body

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9
Q

whats intrinsic asthma?

A

the irritant comes from inside the body

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10
Q

whats the triad of asthma?

A

wheezing

cough

shortness of breath

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11
Q

what drugs are contraindicated in asthma?

A

1- beta blockers
2- morphine
3- PGI
4- cholinomimetics
5- drugs that causes histamine release

cold weather
exercise
cough during crying

all of these cause bronchoconstriction so worsens the situation

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12
Q

whats are the 2 potent bronchoconstrictors ?

A

leukotrien b4

adenosine receptor

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13
Q

whats the pathophsiology of asthma?

A

the irritation will cause inflammation then immune cells come and start producing cytokines and worsen the problems

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14
Q

what are some examples of cytokines that can be released in asthma by immune cells?

A

1- histamine
2- serotonin
3- PGD
4-leukotriens ( B4)
5- platelet activating factors
6- interlukeins
7-adenosine

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15
Q

what are the 2 primary treatments used in asthma?

A

1- Bronchodilators ( beta2 agonists )

2- Antiinflammatory

3- adjuvent treatments ( used as proph)

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16
Q

can you use NSAIDS?

A

no because it will block cox pathway and then all the archnoid acid will be converted to leukotriens and ths will worsen the situations

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17
Q

what are some examples of bronchodilators?

A

1- beta agonists
2- muscarinic blockers ( muscrinic causes constriction so blockers do opposite )

3- methlyxanthine الشاي و القهوه

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18
Q

what are some examples of selective beta agonists?

A

TEROLS —> end with terol

salbutamol –> albuterol
terbutaline
salmeterol
formoterol

metaproterenol
pirbuterol

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19
Q

which ones are SABA?

A

short acting beta agonists work only for 3-4 hours

Salbutamol ( albuterol )
terbutaline
metaproterenol
pirbuterol

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20
Q

which ones are LABA?

A

long acting beta agonists –> work for 12 hours

salmeterol
formoterol

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21
Q

whats the mechanism of beta agonists?

A

they go and activate beta 2 receptors in the bronchi and increase CAMP and this will lead relaxations of muscles

CAMP always lead to smooth muscle relaxations EVERYWHERE
except in the heart and the brain

why? CAMP when increased it will activate protein kinase A ( PKA ) which will inhibit myosin light chain kinase which is responsible for contraction

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22
Q

whats none selective beta agonists?

A

adrenaline
isoprenaline

not used anymore

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23
Q

how are beta agonists administered ?

A

inhalation or IV in acute severe asthma

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24
Q

how are short acting beta agonists excreted?

A

excreted unchanged

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25
when are short acting beta agonists used?
first line drug for the immediate phase and acute attack NOT EFFECTIVE IN DELAYED PHASE because delayed phase is mainly due to cytokines
26
what are the adverse effects of beta agonists?
T---> tachycardia because direct effect and vasodilation --> reflex tachy T --->Tremors because increased sensitivity of muscles T---> tolerance they get downregulated يزعل منك H---> hypokalemia --> beta 2 will take potassium from the blood and send it to muscle revise the effects beta receptors
27
how are the LABA excreted?
metabolized in liver by p450 and lost in faeces
28
when are laba used?
used as prophylaxis before exercises and in night before sleep it is not used for acute attacks but used in regulation with corticosteroids
29
what are ultra long acting beta agonists?
indacaterol olodaterol vilanterol bambuterol
30
when are ultra long beta agonists used?
in asthma but in combination with corticosteroids NEVER ALONE alone in COPD only
31
what are the 2 types of methylxanthine drugs?
natural semi synthetic
32
whats an example natural methylxanthine drugs?
caffeine theophylline theobromine
33
whats an example of semi synthetic methylxanthine drugs?
aminophylline its js modified theophylline
34
whats the function of Adenosine receptor? ( A1)
bronchi ---> bronchoconstriction bronchi ---> increase gland secretions CNS --> depression of CNS Heart --> inhibit conduction ( negative dromotropic effect)
35
whats the function of PDE enzyme?
breaks down CAMP and GAMP CAMP, GAMP --> 123 CAMP --> 4 7 8 GAMP --> 5 6 9
36
which versions of PDE are mainly inhibited by pde inhibitors?
3 4
37
whats the function of methylxanthine drugs?
1- they block Adenosine receptor 1 which lead too : - bronchodilation -decreased gland secretion -increases CNS activity -increase heart conduction ( positive dromotropic effect) 2- Inhibit PDE enzyme which lead increased CAMP
38
what happens when theres an increase in CAMP?
CAMP ALWAYS LEAD TO RELAXATION IN SMOOTH MUSCLES EXCEPT FOR THE HEART IT LEADS TO INCREASED CONTRACTILITY and THE BRAIN different effect in heart because its the MLCK enzyme is different in the heart compared to smooth muscles for example in kidneys anything that increase CAMP will lead to dilation and uresis
39
what are the uses of methyl xanthine ?
bronchial asthma (IV , OR ORAL) ( 2ND LINNEEE, right after SABA) IV as aminophylline and orally as theophylline Increase cns activity ( why we drink coffee and caffiene ) Migraines ( cuz of vasoconstriction Delayed physical fatigue and increased performance neonatal apnea syndrome ( baby doesnt cry after birth which is due to cns depression
40
how can we administer methylxanthine?
IV and oral BUT NO INHALERS
41
what are the adverse effects of methylxanthine?
1- excessive CNS stimulation ——-seizures 2- CVS tachycardia + Arrhythmia ( tachycarida due to increased conduction and vasodilation --> reflex tachy ) 3-Increase HCL ( GIT disturbance )
42
when is methlyxanthine contraindicated?
peptic ulcer hepatic failure renal failure
43
what you dont add to methylxanthine?
anything that inhibit metabolism you have to decrease the dose (CYP 450)
44
what do you do in smokers?
smoking and drinkers increases metabolism so you have to increase the dose
45
whats the clinical uses of methylxanthine?
second line drug for chronic asthma aminophylline is used as IV for severe acute asthma
46
which methylxanthine can be given orally?
theophylline theobromine caffeine
47
which methylxanthine can be given IV?
aminophylline and its used in acute asthma
48
whats roflumilast?
ORAL, selective PDE 4 inhibitor that decreases the risk exacerbations in patients with COPD
49
why we dont have methylxanthines in inhalation format?
because there is not a significant bronchodilation effect and risk of adverse effect is severe
50
whats the relation between methylxanthines and beta agonists?
they should not be given together because the methylxanthine will not enhance the effect of beta agonist and it will js cause side effects But beta agonists and muscranic blockers good combo
51
what should be monitored when give methylxanthine?
plasma level of the drug because its easily affected by any drug that affects the metabolism
52
whats the pathway of arachidonic acid after its formed?
2 pathways COX 2 PATHWAY : FORMATION OF PGE2 AND PGI 2 --> INFLAMMATION AND PAIN : vasodilation, vascular permeability, cytokine release, leukocyte migration , pain LOX pathway : formation of leukotriens LTC4, LTD4, etc ----> inflammation and bronchoconstriction : b.c , mucus secretion , edema, eosinophil migration
53
which group of drugs inhibit the cox 2 pathway ?
NSAIDS
54
which group of drugs inhibit the lox pathway?
leukotriene pathway inhibitors
55
whats an example of lox enzyme inhibitor?
zileuton
56
whats the function of zileuton?
inhibit lox enzyme and lead to anti inflammatory effect and bronchodilation
57
whats the other type leukotriene inhibitors ?
Leukotriene receptor blocker/antagonist (LTRA) zafirlukast montelukast
58
whats the clinical use of leukotrienes inhibitors ?
third line drug for asthma Aspirin induced asthma ( aspirin will inhibit the cox 2 pathway so it will be directed to lox pathway luekotrienes inhibitors can block the lox pathway) can be used instead of corticosteroids when they are contraindicated easy for children to take
59
in children do you use leukotrienes inhibitors or coritcosteroids?
corticosteroid aare bad for children because soo many severe adverse effects so you give leukotrienes inhibitors
60
whats the relationship between leukotriene inhibitors and methylxanthine?
leukotriene inhibitors inhibit metabolism and CYP450 so it increases the concentration of methylxanthine must decrease the dose of methylxanthine
61
examples of antimuscarinc agents?
atropine ---> not used anymore because not selective and many side effects ipratropium tiotropium bromide glycopyrronoium bromide umeclidinium bromide
62
whats the function muscarnic blockers?
they block m3 which is responsible for constriction once its blocked it wont cause constriction and it will give beta 2 receptors the upper hand تفضي المعلب
63
which muscarinic blockers are short acting ?
ipratropium bromide last for 3-5 hours
64
which muscarinic blockers are long acting?
tiotropium bromide glycopyrronium bromide umeclidinium bromide last for 12-24 hours
65
when are the long acting muscarinic blockers used?
choice for COPD asthma in addition to LABA AND inhaled corticosteroids
66
what are the adverse effects of muscarinic blockers?
urinary retention dry mouth constipation pharyngitis
67
whats the best combination in inhalers that is used now a days?
Short acting beta agonists ( albuterol for example ) short acting muscarinic blockers ( ipratropium ) or LAMA + LABA
68
why did we develope additive combinations?
because using 2 different types drugs has proved to show better results than just increasing the dose
69
whats another reason why did we develope the laba/lama combinations ?
they show better results when used combined that using them individually a lama may block the tightening of smooth muscles around your neck to help keep the airways open
70
whats the main anti inflammatory drug used in asthma?
corticosteroids
71
whats the function of corticosteroid?
1- inhibit the PLA2 enzyme stops production of archnoid acid القصه من اولها 2- inhibit immune cells ( B lymphocytes, T lymphocytes, Macrophages, mast cells 3- upregulate B receptors
72
how do corticosteroids inhibit the immune system?
they bind to GRS ( glucocorticoid receptor) and then it will result in repression of transcription factors for example : Nuclear factor kappa D (NF-KB)
73
what are some examples of inhaled corticosteroids ?
all have son triamcinolone budesonide ciclesonide flunisolide mometasone fluticasone
74
on which phase do corticosteroids work mainly?
they work on the delayed inflammatory phase only no effect on the immediate phase
75
what do you combine the inhaled corticosteroids with?
LABA/LAMA or both
76
which corticosteroid is given iv?
hydrocortisone its given in acute severe asthma
77
when are corticosteroids used?
added to bronchiodilators incase they dont work alone and in emergencies as iV as in status asthamticus
78
what are the adverse effects of corticosteroids ?
hoarse voice --> oral candidiasis ( thrush ) due to severe immune system inhibition adrenal suppression
79
what are some examples of targeted monoclonal antibody therapy?
end with mab omalizumab mepolizumab
80
whats the function of the antibodies?
they bind to igE stopping them from binding to mast cells and release of histamine and what not
81
on which phases do the antibodies work on?
both phases immediate and delayed
82
how are the antibodies administered?
subcutaneously at 2-4 weeks require expert administration
83
whats the clinical uses of the antibodies?
persistent allergic asthma that is not controlled by laba or corticosteroids
84
what are the adverse effects of the antibodies?
hypersensitivity reactions
85
what does omalizumab bind to?
igE
86
what does dupilumab bind to?
IL4 and IL3 receptors ( antagonist )
87
what does reslizumab bind to?
bind to IL-5 directly
88
what does mepolizumab bind to?
similar to reslizumab, binds to IL-5
89
what does benralizumab bind to?
IL-5 receptor
90
what are the uses of IL-5 inhibitors?
reslizumab and mepolizumab and benralizumab they are used in refractory eosinophilic asthma
91
what are the adverse effects of IL-5 inhibitors?
headache injection site reactions back pain myalgia
92
what are examples of mast cell inhibitors ?
cromolyn nedocromil
93
whats the function of cromolyn / nedocromil ?
they stabilize the mast cells and prevent their degranulation
94
how are cromolyn/nedocromil administered?
powder inhalation
95
when are the mast cell inhibitors used?
prophylaxis of asthma mainly in older children to reduce symptoms of allergic rhinitis
96
what are the adverse effects of mast cell inhibitors?
irritation of throat by powder
97
whats the best initial drug choice in acute bronchospasm?
Selective SABA --> albuterol terbutaline metaproterenol pirbuterol
98
whats the most useful drug in long term management of COPD?
SAMA --> ipratropium but its ineffective in acute bronchospasm but it aids the beta agonists تفضي الملعب
99
whats the 2nd line drug in COPD?
theophylline ( methylxanthine ) orally
100
which drugs are used prophylactically ?
cromolyn and nedocromil
101
which anti inflammatory drug is given in acute episodes of bronchoconstrictions?
corticosteroid --> orally or IV
102
whats the common regimen for moderate asthma?
inhaled corticosteroid + SABA
103
whats the common regimen for severe asthma?
inhaled corticosteroid + SABA + LABA leukotriene inhibitor can be added if needed
104
whats the common regimen for severe asthma in children?
leukotriene inhibitor + saba and laba leukotriene inhibitor replaced corticosteroids
105
whats the advantage of multi regimens than single regimen?
you will give smaller doses of multiple drugs than js large doses of single drugs
106
whats combivent?
albuterol ( saba ) + ipratropium ( sama ) combination in inhaler
107
whats advair?
salmeterol ( laba ) + fluticasone ( corticosteroid ) in combined inhaler

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