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Asthma, COPD, Rhinitis > Asthma > Flashcards

Asthma Flashcards

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1
Q

What are common symptoms of asthma?

A

coughing

Wheezing

Chest tightness

SOB

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2
Q

What are the general mechanisms responsible for asthma (the “immunologic disease”)?

A

1) obstructive lung disease = bronchoconstriction

2) inflammation of the airway wall = airways respond to inflammation by airway edema, mucus secretion..

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3
Q

How does mast cell sensitization occur?

A

(1) exposure to antigen will induce systemic generation of antibodies by B cells and TH2 helper cells
(2) IgE antibodies will become fixated on the surface of the mast cell
(3) When antigens bind the antibody, degranulation follows

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4
Q

What mediators do mast cells release?

A

Histamine

Proteases

Heparin

Leukotrienes

Prostaglandins

Platelet activating factor (PAF)

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5
Q

What are preformed vs. lipid-derived mast cell mediators?

A

Preformed = immediate onset = histamine, protease

Lipid-derived = slower onset but LONGER duration = heparin, leukotrienes, Prostaglandins, PAF

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6
Q

Which are potent bronchoconstrictors?

A

Lipid-derived mast cell mediators

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7
Q

What effects do histamine have?

A

Vasodilation

Vasopermeability

Itch

Cough

Bronchoconstriction

Rhinorrhea

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8
Q

How does the second mechanism (inflammation of the airway wall) come about?

A

Immune cells get recruited during asthmatic inflammation

Their mediators are inflammatory and cause injury/inflammation in the airways

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9
Q

What is non-allergic asthma?

A

Inhaled irritants induce bronchoconstriction

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10
Q

What are 3 major pathways for treating asthma?

A

(1) anti-IgE therapy
(2) target inflammation with beta2 agonists, leukotriene modifiers, corticosteroids, or theophylline, anti-IgE therapy
(3) target bronchoconstriction with beta2 agonists, leukotriene modifiers, muscarinic receptor antagonists, theophylline

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11
Q

What is an advantage of aerosol delivery of drugs?

A

Produces high local concentration in the lungs with low systemic delivery

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12
Q

What drugs is aerosol delivery the main route for?

A

Beta2 adrenergic receptor agonists

Glucocorticoids

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13
Q

What are glucocorticoids used for asthma?

A

Maintenance therapy = reduces inflammation

Administered prophylactically !!!

Does NOT relax airway SM though

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14
Q

What are some examples of inhaled corticosteroids?

A

Beclomethasone

Triamcinolone

Flunisolide

Fluticasone

Budesonide

Fluticasone + salmeterol

Budesonide + formoterol

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15
Q

What’s the MOA for ICS?

A

Target lung inflammation

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16
Q

What are some side effects of ICS?

A

Oropharygneal candidiasis

Dysphonia

Modest decreases in bone density

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17
Q

What second messenger promotes bronchodilation?

A

Increased cAMP

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18
Q

What effect do beta2 adrenergic agonists have?

A

Bronchodilation

Activation of the receptor stimulates Gs and increases cAMP to relax bronchial SM

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19
Q

What effects do beta2 agonists have on inflammatory cells?

A

Stimulation of beta2 receptors on mast cells leads to increased cAMP and decreased mast cell degranulation

Cytokines production is impaired
Immune cell function is inhibited

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20
Q

What is a potential problem of beta2 adrenergic agonists?

A

Desensitization can occur = prolonged stimulation leads to loss of responsiveness, receptor downregulation

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21
Q

What are beta2 receptor agonists used for?

A

Rescue therapy!

Relief of acute bronchospasm

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22
Q

What are examples of beta2 adrenergic agonists?

A

Metaproterenol

Albuterol

Salmeterol

Terbutaline

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23
Q

Which is a SABA and which is a LABA?

A

SABA = short acting beta2 agonist = albuterol

LABA = salmeterol

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24
Q

What are side effects associated with beta2 adrenergic agonists?

A

Tremor

Hypokalemia

Tachycardia

Anxiety

Insomnia

Palpitations

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25
Compare SABAs versus LABAs.
SABAs = effective for rescue therapy and for preventing exercise-induced asthma LABAs = used in combination with ICS
26
What is a concern with LABAs?
Can lead to beta2 adrenergic receptor desensitization, downregulation
27
How do muscarinic antagonists work?
Block vagal nerve mediated bronchoconstriction and bronchial secretions mediated by ACh on SM
28
What are important examples of muscarinic antagonists?
Ipratropium = only COPD Tiotropium = both COPD + asthma
29
What are some side effects of muscarinic antagonists?
Dry mouth Urinary retention Constipation Tachycardia
30
What are important examples of leukotriene modifiers?
Zileuton Montelukast Used prophylactically in treatment of mild asthma
31
What are side effects of leukotriene modifiers?
Hepatotoxicity (liver function tests) Rare Chung-Strauss syndrome (allergic response that can be fatal)
32
How do Cromolyns work?
Inhibit mast cell degranulation Used prophylactically for maintenance therapy
33
What promotes bronchoconstriction?
Adenosine receptor activation ACh
34
What facilitates bronchodilation?
Increased cAMP
35
Theophylline is an example of what?
Methylxanthines
36
How do methylxanthines work?
Adenosine receptor antagonists Inhibit PDE, leading to increased cAMP in SM and mast cells
37
What effects do methylxanthines have?
Relaxation of SM (bronchodilation, vasodilation) CNS stimulation Diuretic effect
38
What are side effects of methylxanthines?
CNS stimulation (convulsions) Arrhythmias, tachycardia Hypotension
39
What is an important example of anti-IgE antibody?
Omalizumab
40
How do humanize anti-IgE antibodies work?
Prevent sensitization and fixation of antibody on mast cell NOT an acute bronchodilator
41
For acute effect + rescue, what drug should be used?
SABA - to decrease bronchospasm since it's short-acting
42
For prophylaxis, anti-inflammatory effects, which drugs should be used?
Inhaled glucocorticoids (which can be combined with LABAs) Leukotriene modifiers Anti-IgE
43
Which drugs are anti-inflammatory?
Glucocorticoids Leukotriene modifiers Cromolyns Anti-IgE antibodies
44
Which drugs are bronchodilators?
Beta2 adrenergic agonists Muscarinic antagonists Methylxanthines
45
What receptors mediate bronchial smooth muscle constriction?
M3 LT-2 A1
46
What is the first line drug for asthma?
Beta2 agonists - "-terol" drugs
47
What two actions does theophylline have?
1) antagonist at Adenosine1 receptor (to block constriction of bronchial SM) 2) PDE inhibition - prevent degradation of cAMP to also help mediate SM relaxation
48
What two actions do glucocorticoids have?
1) act at glucocorticoid receptor to affect gene transcription of inflammatory mediators 2) inhibits PLA2 = dec. arachidonic acid = decreased inflammation
49
What treatment is the next step for an acute asthma exacerbation if there is no improvement following administration of inhaled beta agonist?
Systemic glucocorticoids 1) restore airway responsiveness to endogenous catecholamines and exogenous beta2 agonists 2) anti-inflammatory action delayed
50
What are indications for salmeterol?
Long term asthma treatment Long term COPD tx
51
What are indications for fluticasone?
Long term asthma tx Long term COPD tx
52
What are indications for tiotropium?
Long term asthma tx Long term COPD tx
53
What are indications for theophylline?
Long term asthma tx Long term COPD tx
54
What are indications for ipratropium?
Acute asthma exacerbation Long term asthma tx Acute COPD exacerbation Long term COPD tx
55
What are indications for albuterol?
Acute asthma exacerbation Long term asthma tx Acute COPD exacerbation Long term COPD tx
56
What are indications for methylprednisolone?
Acute asthma exacerbation Long term asthma tx Acute COPD exacerbation Long term COPD tx
57
What are indications for cromolyn?
Long term asthma tx
58
What are indications for montelukast?
Long term asthma tx
59
What are indications for omalizumab?
Long term asthma tx
60
What are indications for zileuton?
Long term asthma tx
61
What are indications for roflumilast?
Long term COPD tx
62
What is the MOA of zileuton?
Inhibits LOX = dec. leukotrienes = dec. inflammation (and dec. contraction)
63
What is the MOA of montelukast?
Blocks Leukotriene receptor = dec. bronchial contraction
64
What is the MOA of tiotropium and ipratropium?
Block M3 receptor = dec. bronchial contraction
65
What is the asthma tx plan for intermittent asthma?
SABA taken PRN
66
What is the tx plan for asthma affecting a patient more than 2x a week?
ICS (low dose)
67
What are alternatives to ICS for patient on Step 2 of asthma treatment?
Cromolyn "-lukasts" Theophylline
68
What is the tx plan for asthmatic with symptoms daily?
ICS (low dose) - no compromising!! LABA
69
What are alternatives for LABA for patient at step 3 of asthma tx plan?
Zileuton "-lukasts" Theophylline
70
What is the tx plan for asthmatic suffering symptoms throughout the day (step 4)?
ICS (medium dose) - no compromising! LABA
71
What are alternatives for LABA at step 4 of asthma tx plan?
Zileuton "-lukasts" Theophylline
72
What is the tx plan for step 5 of asthma plan?
ICS (high dose) LABA If theres an allergic component - consider omalizumab
73
What is the treatment plan for asthmatic at step 6 of persistent asthma?
ICS (high dose) LABA Oral corticosteroid **if allergic component, consider omalizumab
74
What effect does stimulation of H1 receptors on arterioles, endothelial cells and venules have?
Arterioles = relaxation = inc. blood flow Endothelial cells = contraction = SP release Venules = contraction = edema
75
What effect does SP release following flare in "triple response" have?
Vasodilation
76
What does SP stand for? What is it?
Substance P Vasodilatory peptide

Asthma, COPD, Rhinitis (2 decks)

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