Asthma Flashcards Preview

Pharm 4 > Asthma > Flashcards

Flashcards in Asthma Deck (47):
1

Receptors involved in asthma & result of stimulation

M3 in bronchial SM -> bronchoconstriction
B2 in airways -> bronchodilation

2

inflammatory mediators in asthma

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

3

treatment strategies for asthma

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

4

MOA of beta-agonist

stimulate B2 stimulates AC = increased cAMP -> bronchodilation

5

MOA of theophylline

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

6

MOA of muscarinic antagonist

block ACh to inhibit bronchoconstriction

7

Benefits of aerosolized asthma drugs

high local and low systemic concentration
fewer side effects

8

Benefit of spacer with aerosolized asthma drugs

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

9

Fluticasone

glucocorticoid for asthma
potency of 1 (most potent)

10

MOA glucocorticoids

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

11

Mometasone

GC for asthma
potency = 1 (most potent)

12

Beclomethasone

GC for asthma
potency = 0.5

13

budesonide

GC for asthma
potency = 0.5

14

flunisolide

GC for asthma
potency = 0.25 (least potent)

15

triamcinolone

GC for asthma
potency = 0.25 (least potent)

16

ciclesonide

GC for asthma

17

ADR of GCs for asthma

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

18

Types of b2-R agonists and timelines

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

19

Salbutamol

short-acting B2-agonist

20

albuterol

short-acting B2-agonist

21

terbutaline

short-acting B2-agonist

22

metaproterenol

short-acting B2-agonist

23

Salmeterol

long-acting B2-agonist
dry powder diskus

24

formeterol

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

25

Corticosteroid + LABA combos

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

26

ADR of B2-R agonist

fine tremors of finger/hand
palpitations
dizziness
restlessness/agitation

27

Use and MOA of muscarinic receptor antagonist

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

28

Ipratropium, oxitropium, tiotropium

muscarinic receptor antagonists

29

Use and MOA of LKT modulators

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

Types of LKT modulators

LKT-R blockers & LKT synthesis blockers

31

Montelukast

LKT-R blocker for asthma
Only drug approved for preventing exercise-induced asthma

32

Zafirlukast

LKT-R blocker for asthma

33

Zileuton

LKT synthesis inhibitor for asthma
inhibits LOX

34

ADR of LKT modulators

Minimal; may cause mild rise in liver enzyme levels

35

Use and MOA mast cell stabilizer

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

Sodium cromoglicate

mast cell stabilizer for asthma or allergic rhinitis

37

Nedocromil sodium

mast cell stabilizer for asthma or allergic rhinitis

38

Use and MOA of xanthine derivatives

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

39

ADR of xanthines

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

40

Omalizumab

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

41

Other potential asthma drugs

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

42

treatment of status asthmaticus

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

43

Why use anti-ACh in status asthmaticus

central suppression of conduction in vestibular cerebellar pathways

44

Why use GCs in status asthmaticus

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

45

Use of magnesium sulfate in status asthmaticus

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

46

Asthma drugs for pregnant women

Use same inhaled drugs because benefit >>> risk

47

Asthma drugs for children

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