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Pharmacyology 3 > Asthma > Flashcards

Asthma Flashcards

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1
Q

asthma definition

A
  • chronic inflammatory disorder (excess mucus)
  • bronchoconstriciton
  • release of inflammatory mediators
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2
Q

inflammatory mediators in asthma

A

mast cells
basophils
eosinophils
t cells

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3
Q

asthma triggers

A 
allergens
cold air
exercise
pollutants
drugs (aspirin)
viral infections
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4
Q

2 phases of asthma

A

early phase: acute bronchoconstriction

late phase: influx of inflammatory cells and second wave mediator release

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5
Q

asthma therapy options

A
  • patient education
  • BSM: bronchodilators
  • inflammation: slow/reverse progression
  • specific mediators
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6
Q

COPD definition

A

progressive
mostly irreversible airflow obstruction
strongly associated with smokin

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7
Q

Clinical features of COPD

A
  • dyspnea on exertion
  • sputum production
  • chronic cough
  • includes chronic bronchitis and emphysema
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8
Q

Targets of COPD drug therapy

A
  • pulmonary infections: vaccine
  • hypoxemia: O2
  • BSM: bronchodilators
  • inflammation
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9
Q

bronchodilators

A

target airway constriction

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10
Q

anti-inflammatory agents for airway diseases

A

inflammation as underlying cause

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11
Q

inhibitors of mediator release and action in airway disease

A

specific mediators contribute to both acute and chronic disease

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12
Q

Localized admin of inhalation

A

convenient
faster onset
reduce systemic side effects

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13
Q

___um is optimal for deposition on small airway surface

A

1-5um

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14
Q

larger particles are deposited where and smaller particles deposited where?

A

large: oral cavity
small: exhaled

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15
Q

Why is patient education crucial for inhaled drugs?

A

efficacy is compromised if patients fail to admin correctly

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16
Q

Delivery devices of inhaled drugs

A

MDI
DPI (dry powder inhalers)
nebulizers

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17
Q

MDI

A
  • drug suspended in compressed gas propellant
  • actuation and inhalation must be coordinated
  • difficult to use correctly
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18
Q

roughly ____% of MDI dose reaches lungs

A

10%

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19
Q

HFC or CFC MDI used today?

A

HFC

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20
Q

DPI

A
  • dry micronized powder

- proper use: forceful deep inhalation

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21
Q

Who is DPI not ideal for?

A

children

elderly

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22
Q

Nebulizers

A
  • less portable/convenient
  • air bubbled through drug solution
  • easiest for children, elderly, ill
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23
Q

Swallowed inhaled drugs go where?

A

liver: inactivated
GI: bloodstream –> systemic effect + inactive

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24
Q

What drugs are good for inhalation?

A

bad orally

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25
most widely used bronchodilators
B2 agonist
26
B2 agonist MOA
- Increase cAMP - relax smooth muscle - regulation of K channels
27
t/f B2 agonist is replacement therapy for asthma
False! NOT! effective target
28
nonselective B agonist
epinephrine
29
Short acting B2 agonist
albuterol
30
long acting B2 agonist
salmeterol | formoterol
31
albuterol use
- actue bronchoconstriction - exercise induced - as needed - short action (not for maintenance)
32
another name for albuterol
albutamol
33
albuterol PK
- inhalation - 1-5 min onset - 2-6 hr duration - racemic
34
albuterol adverse effects
- tachycardia - muscle tremor - some CNS stimulation
35
Overuse of albuterol
- associated with increased mortality - receptor desensitization - worsening of disease - treat symptom, not pathology
36
Long acting B2 agonists PK
``` high B2 selectivity long DOA (due to lipophilic nature) ```
37
Salmeterol long DOA
lipophilic tail binds to specific exosite on B2 receptor
38
Formoterol long DOA
no specific anchor
39
Salmeterol structure
Catecholamine like activation moiety | ancho/tail moiety
40
IS salmeterol or formoterol have faster onset for asthma?
formoterol
41
T/F salmeterol can be used for acute bronchoconstriction
false! | use albuterol if on salmeterol or formoterol
42
salmeterol use
long term asthma COPD overnight suppression of nocturnal asthma
43
T/F formoterol must not be used for treating acute bronchoconstriction
true
44
formoterol use
long term asthma prevention of exercise induced bronchospasm COPD
45
Salmeterol/formoterol side effects
- typical B2 agonist | - for asthma, always together with inhaled anti-inflammatory steroid
46
BBW salmeterol/formoterol
asthma related death
47
T/F LABA are safe used alone in COPD
true
48
LABA alone for asthma
increases mortality
49
LABA used only in combo with what?
anti-inflammatory steroids for asthma
50
Oral albuterol considerations
- less effective - more systemic side effects - slower onset - longer DOA
51
oral albuterol uses
children | patients whose cough worsened by inhaled aerosols
52
first line therapy for asthma
glucocorticoids used alone or combo with bronchodilators - Prednisone
53
ICS drugs
fluticasone | budesonide
54
ICS MOA
- do not relax airway smooth muscle - bind glucocorticoid receptors - alter transcription of diverse genes - suppressive effects on inflammatory cells - equal effectiveness and differing potencies
55
ICS and bronchoconstriction
indirectly reduce
56
ICS uses
mild to moderate persistent asthma | prophylaxis
57
ICS have altered the outlook for asthmatics
- control symptoms - improve lung function - reduce irreversible airway changes - improve QOL - dosage/use may be lowered - decrease SABA use
58
T/F fluticasone and budesonide are short acting
false | long acting
59
ICS have high affinities for what receptor?
GC
60
ICS adverse effects
- minimal at typical doses - increase with dose - hoarseness, pharyngeal candidiasis - GC side effects - steroid resistant asthma
61
ICS and LABA uses
- often combined because different targets - convenient for long term control LABA not for asthma mono therapy
62
ISC alone use
asthma
63
LABA + ICS
asthma
64
LABA alone use
COPD
65
Prednisone use (airway)
severe chronic asthma | parenterally for acute attacks
66
Side effects of prednisone (airway)
- all GC effects greater with systemic - less selective for GC - increased BP, glucose intolerance, glaucoma, imunnosuppresion - taper off
67
Methylxanthines
theophylline
68
theophylline MOA
relatively weak bronchodilators - think phosphodiesterase inhibition - alters cellular Ca regulation - long term effects on histone deacetylases
69
theophylline use
- add on in acute asthma - adjunct in long term preventative therapy - decrease symptoms in persistent and nocturnal asthma
70
Theophylline admin
- orally, multiple times per day - short DOA - not for inhalation
71
theophylline inhibits
PDE
72
theophylline adverse effects
- narrow therapeutic index - large variability in metabolism - increase metabolism in infants and smokers - drug interactions
73
high doses of theophylline
- nausea - nervousness - anxiety - HA - insomnia - abnormal heart rhythm
74
toxic levels of theophylline
- severe cardiac arrhythmias | - seizures

Pharmacyology 3 (12 decks)

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