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
