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Pharmacology Exam #3 > Asthma > Flashcards

Flashcards in Asthma Deck (48)
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1

Pathologic increase in the bronchoconstrictor response to antigens and irritants
Caused by bronchial inflammation

Bronchial hyperreactivity

2

Phosphodiesterase (PDE)

Enzymes that degrades cAMP (active) to AMP (inactive)

3

Tacyhphylaxis

Rapid loss of responsiveness to a stimulus (e.g. drug)

4

Asthma Diagnosis

1. Airflow obstruction
2. Reversibility of airflow obstruction
3. Prolonged expiration and diffuse wheezes
4. LIMITATION OF AIRFLOW on PFTs or bronchoprovocation challenge

5

What is drug therapy aimed to target?

1. Narrow airway
2. Tightened muscles
3. Inflammation

6

What are the asthma treatment goals?

1. Prevent bronchoconstriction-early phase, rescue
2. Reduce inflammation- Late/Chronic phase, controller
3. Prevent irritant reaction (IgE)- Late/Chronic phase

7

What drugs target early response phase (bronchoconstriction)?

1. Beta agonists
2. Theophylline
3. Muscarinic antagonists
4. Leukotriene antagonist

8

What drugs target late response phase (inflammation)?

1. Steroids
2. Cromolyn
3. Leukotriene antagonists

9

What is the ultimate goal in drug therapy?

Relax bronchial tone

10

Beta Agonists MOA

Stimulate adenylyl cyclase (AC)
Increases cAMP in smooth muscle cells
Bronchodilator response

11

When would you use Albuterol (Short acting beta agonist )?

Acute asthma-->Rescue

12

When would you use Salmeterol (long acting beta agonist)?

Asthma proyphlaxis
COPD

13

Albuterol SEs

Tremor
Tachycardia

14

Salmeterol SEs

Tremor
Tachycardia
CV events

15

Lists antimuscarinic agents

Ipatropium
Tiotropium

16

antimuscarinic agents MOA

Competitively block muscarinic receptors
Prevent bronchoconstriction mediated by vagal discharge

17

When would you use antimuscarinic agents?

Asthma
COPD

18

antimuscarinic agents SEs

Dry mouth
Cough

19

What is unique about antimuscarinic agents?

REVERSE bronchoconstriction in some asthma pt's (esp. children)
AND in COPD pt's

20

Where can you find Methylxantines?

Plants:
1. Caffeine
2. Tea (Theophylline)
3. Cocoa (Theobromine)

21

Methylxantines MOA

1. Inhibits phosphodiesterase (PDE)
-increases cAMP-->Bronchodilation
2. Adenosine receptor antagonist

22

Who would we consider using Methylxantines in?

Prophylactic for nocturnal asthma attacks

23

Methylxantines effects

1. Bronchodilation
2. Cardiac stimulation
3. CNS effect
4. Increased muscle strength

24

Methylxantines SEs

1. Insomnia
2. Seizures
3. Tremor
4. Arrhythmias
5. Anorexia

25

What drug can reverse Theophylline (Methylxantine) CV toxicity?

Beta blockers

26

What does Theophylline clearance depend on?

Age

27

Who is Theophylline clearance increased in?

1. Young adolescents
2. Smokers

28

What is first line therapy for moderate-to-severe asthma?

ICS:
-Beclomethasone
-Fluticasone
-Mometasone
-Budesonide

29

ICS MOA

1. Inhibition of phospholipase A2
2. Inhibit expression of COX-2
3. Increase B adrenoreceptor responsiveness
4. Prevent full expression of inflammation and allergy

30

ICS SEs

1. Pharyngeal candidiasis
2. Minimal systemic steroid toxicity
3. Mild growth retardation

31

Who would we consider using oral Prednisone in?

Severe refractory chronic asthma
Acute exacerbations

32

What is the number one cause of adrenal insufficiency?

Exogenously administered glucocorticoids (catabolic steroids)

33

What are important medications for status asthmaticus?

IV Prednisolone
IV Hydrocrotisone

34

What is the most potent systemic steroid?

Dexamethosone

35

List a leukotriene receptor blocker

Montelukast (singulair)
LTD4 receptor antagonist

36

What is Montelukast effective in preventing?

Exercise, antigen and ASA induced bronchospasm
Prophylaxis

37

List a Lipoxygenase inhibitor

Zileuton

38

what allergy is Zileuton effective against?

ASA

39

Zileuton MOA

selectively inhibits 5-lipoxygenase
reduces synthesis of leukotrienes

40

Zileuton drug toxicity

elevated liver enzymes

41

What drugs would we use prior to gardening?

Cromolyn and Nedocromil

42

Cromolyn and Nedocromil SEs

Cough

43

Omalizumab MOA

Antibody that binds to the IgE on sensitized mast cells

44

Omalizumab effects

Decreases inflammatory mediator release
Decrease allergic inflammation
Prevents exacerbation of asthma

45

Mepolizumab MOA

Monoclonal antibody to IL-5

46

Who would we use Mepolizumab in?

Severe eosinophilic asthma

47

What is there an increase in when we treat adults with Mepolizumab?

Herpes Zoster

48

What should we consider adding in adult house dust mites sensitive patients with allergic rhinitis who have exacerbations despite ICS tx provided FEV1 is 70% predicted?

Sublingual immunotherapy (SLIT)