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Pharmacyology 3 > Asthma > Flashcards

Asthma Flashcards

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
Q

most widely used bronchodilators

A

B2 agonist

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26
Q

B2 agonist MOA

A
  • Increase cAMP
  • relax smooth muscle
  • regulation of K channels
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27
Q

t/f B2 agonist is replacement therapy for asthma

A

False!
NOT!
effective target

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28
Q

nonselective B agonist

A

epinephrine

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29
Q

Short acting B2 agonist

A

albuterol

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30
Q

long acting B2 agonist

A

salmeterol

formoterol

31
Q

albuterol use

A
  • actue bronchoconstriction
  • exercise induced
  • as needed
  • short action (not for maintenance)
32
Q

another name for albuterol

A

albutamol

33
Q

albuterol PK

A
  • inhalation
  • 1-5 min onset
  • 2-6 hr duration
  • racemic
34
Q

albuterol adverse effects

A
  • tachycardia
  • muscle tremor
  • some CNS stimulation
35
Q

Overuse of albuterol

A
  • associated with increased mortality
  • receptor desensitization
  • worsening of disease
  • treat symptom, not pathology
36
Q

Long acting B2 agonists PK

A 
high B2 selectivity
long DOA (due to lipophilic nature)
37
Q

Salmeterol long DOA

A

lipophilic tail binds to specific exosite on B2 receptor

38
Q

Formoterol long DOA

A

no specific anchor

39
Q

Salmeterol structure

A

Catecholamine like activation moiety

ancho/tail moiety

40
Q

IS salmeterol or formoterol have faster onset for asthma?

A

formoterol

41
Q

T/F salmeterol can be used for acute bronchoconstriction

A

false!

use albuterol if on salmeterol or formoterol

42
Q

salmeterol use

A

long term asthma
COPD
overnight suppression of nocturnal asthma

43
Q

T/F formoterol must not be used for treating acute bronchoconstriction

A

true

44
Q

formoterol use

A

long term asthma
prevention of exercise induced bronchospasm
COPD

45
Q

Salmeterol/formoterol side effects

A
  • typical B2 agonist

- for asthma, always together with inhaled anti-inflammatory steroid

46
Q

BBW salmeterol/formoterol

A

asthma related death

47
Q

T/F LABA are safe used alone in COPD

A

true

48
Q

LABA alone for asthma

A

increases mortality

49
Q

LABA used only in combo with what?

A

anti-inflammatory steroids for asthma

50
Q

Oral albuterol considerations

A
  • less effective
  • more systemic side effects
  • slower onset
  • longer DOA
51
Q

oral albuterol uses

A

children

patients whose cough worsened by inhaled aerosols

52
Q

first line therapy for asthma

A

glucocorticoids
used alone or combo with bronchodilators
- Prednisone

53
Q

ICS drugs

A

fluticasone

budesonide

54
Q

ICS MOA

A
  • 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
Q

ICS and bronchoconstriction

A

indirectly reduce

56
Q

ICS uses

A

mild to moderate persistent asthma

prophylaxis

57
Q

ICS have altered the outlook for asthmatics

A
  • control symptoms
  • improve lung function
  • reduce irreversible airway changes
  • improve QOL
  • dosage/use may be lowered
  • decrease SABA use
58
Q

T/F fluticasone and budesonide are short acting

A

false

long acting

59
Q

ICS have high affinities for what receptor?

A

GC

60
Q

ICS adverse effects

A
  • minimal at typical doses
  • increase with dose
  • hoarseness, pharyngeal candidiasis
  • GC side effects
  • steroid resistant asthma
61
Q

ICS and LABA uses

A
  • often combined because different targets
  • convenient for long term control
    LABA not for asthma mono therapy
62
Q

ISC alone use

A

asthma

63
Q

LABA + ICS

A

asthma

64
Q

LABA alone use

A

COPD

65
Q

Prednisone use (airway)

A

severe chronic asthma

parenterally for acute attacks

66
Q

Side effects of prednisone (airway)

A
  • all GC effects greater with systemic
  • less selective for GC
  • increased BP, glucose intolerance, glaucoma, imunnosuppresion
  • taper off
67
Q

Methylxanthines

A

theophylline

68
Q

theophylline MOA

A

relatively weak bronchodilators

  • think phosphodiesterase inhibition
  • alters cellular Ca regulation
  • long term effects on histone deacetylases
69
Q

theophylline use

A
  • add on in acute asthma
  • adjunct in long term preventative therapy
  • decrease symptoms in persistent and nocturnal asthma
70
Q

Theophylline admin

A
  • orally, multiple times per day
  • short DOA
  • not for inhalation
71
Q

theophylline inhibits

A

PDE

72
Q

theophylline adverse effects

A
  • narrow therapeutic index
  • large variability in metabolism
  • increase metabolism in infants and smokers
  • drug interactions
73
Q

high doses of theophylline

A
  • nausea
  • nervousness
  • anxiety
  • HA
  • insomnia
  • abnormal heart rhythm
74
Q

toxic levels of theophylline

A
  • severe cardiac arrhythmias

- seizures

Pharmacyology 3 (12 decks)

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