Flashcards in Asthma Deck (48)
Pathologic increase in the bronchoconstrictor response to antigens and irritants
Caused by bronchial inflammation
Enzymes that degrades cAMP (active) to AMP (inactive)
Rapid loss of responsiveness to a stimulus (e.g. drug)
1. Airflow obstruction
2. Reversibility of airflow obstruction
3. Prolonged expiration and diffuse wheezes
4. LIMITATION OF AIRFLOW on PFTs or bronchoprovocation challenge
What is drug therapy aimed to target?
1. Narrow airway
2. Tightened muscles
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
What drugs target early response phase (bronchoconstriction)?
1. Beta agonists
3. Muscarinic antagonists
4. Leukotriene antagonist
What drugs target late response phase (inflammation)?
3. Leukotriene antagonists
What is the ultimate goal in drug therapy?
Relax bronchial tone
Beta Agonists MOA
Stimulate adenylyl cyclase (AC)
Increases cAMP in smooth muscle cells
When would you use Albuterol (Short acting beta agonist )?
When would you use Salmeterol (long acting beta agonist)?
Lists antimuscarinic agents
antimuscarinic agents MOA
Competitively block muscarinic receptors
Prevent bronchoconstriction mediated by vagal discharge
When would you use antimuscarinic agents?
antimuscarinic agents SEs
What is unique about antimuscarinic agents?
REVERSE bronchoconstriction in some asthma pt's (esp. children)
AND in COPD pt's
Where can you find Methylxantines?
2. Tea (Theophylline)
3. Cocoa (Theobromine)
1. Inhibits phosphodiesterase (PDE)
2. Adenosine receptor antagonist
Who would we consider using Methylxantines in?
Prophylactic for nocturnal asthma attacks
2. Cardiac stimulation
3. CNS effect
4. Increased muscle strength
What drug can reverse Theophylline (Methylxantine) CV toxicity?
What does Theophylline clearance depend on?
Who is Theophylline clearance increased in?
1. Young adolescents
What is first line therapy for moderate-to-severe asthma?
1. Inhibition of phospholipase A2
2. Inhibit expression of COX-2
3. Increase B adrenoreceptor responsiveness
4. Prevent full expression of inflammation and allergy
1. Pharyngeal candidiasis
2. Minimal systemic steroid toxicity
3. Mild growth retardation
Who would we consider using oral Prednisone in?
Severe refractory chronic asthma
What is the number one cause of adrenal insufficiency?
Exogenously administered glucocorticoids (catabolic steroids)
What are important medications for status asthmaticus?
What is the most potent systemic steroid?
List a leukotriene receptor blocker
LTD4 receptor antagonist
What is Montelukast effective in preventing?
Exercise, antigen and ASA induced bronchospasm
List a Lipoxygenase inhibitor
what allergy is Zileuton effective against?
selectively inhibits 5-lipoxygenase
reduces synthesis of leukotrienes
Zileuton drug toxicity
elevated liver enzymes
What drugs would we use prior to gardening?
Cromolyn and Nedocromil
Cromolyn and Nedocromil SEs
Antibody that binds to the IgE on sensitized mast cells
Decreases inflammatory mediator release
Decrease allergic inflammation
Prevents exacerbation of asthma
Monoclonal antibody to IL-5
Who would we use Mepolizumab in?
Severe eosinophilic asthma
What is there an increase in when we treat adults with Mepolizumab?