Asthma and COPD

Question 1

Acute anti-asthmatic regime

Answer 1

Bronchodilators
(Quick relief medications)

• Short acting B2- Agonists
• Antimuscarinics
• Methylxanthines

AIDs:
GCs
mast cell stabilizers
Leukotrienes antagonists
IgE antibody
Long acting B2-agonists

Question 2

B2 agonists for asthma

Answer 2

Short acting:
Salbutamol
Terbutaline

Long acting: (with inhaled GCs)
Salmetrol
Formoterol

Question 3

MOA for Bronchodilators: β2 -agonists

Answer 3

Stimulate adenylyl cyclase = ↑↑cAMP in smooth muscles&raquo_space; bronchodilation

Question 4

ADRs of Bronchodilators: β2 -agonists

Answer 4

Muscle tremor
(direct effect on skeletal muscle β2 receptors)

Tachycardia
(direct effect on atrial β2 receptors) & arrhythmias

Hypokalemia
(due to β2 receptor stimulation of potassium entry into skeletal muscle)

Metabolic effects
(↑ FFA, glucose, lactate, pyruvate, insulin) •

TOLERANCE

Contraindicated: β receptor antagonists

Question 5

Bronchodilators: Anti-muscarinic agents

Answer 5

IPRATROPIUM (short acting)
TIOTROPIUM (long acting)

Question 6

MOA of Bronchodilators: Anti-muscarinics

Answer 6

Competitively inhibition of acetylcholine at airways muscarinic receptors

˃» Prevent Ach mediated bronchoconstriction & inhibit mucus secretion

Question 7

Bronchodilators: Anti-muscarinic Caution?

Answer 7

patients with benign prostatic enlargement or glaucoma

Question 8

Bronchodilators: Methylxanthines Agents

Answer 8

THEOPHYLLINE (oral)
AMINOPHYLLINE (IV)

Question 9

MOA of Methylxanthines

Answer 9

Inhibit phosphodiesterase (PDE-3) resulting in ↑cAMP&raquo_space;
bronchodilation

Also block adenosine receptors.

Question 10

PK of Methylxanthines

Answer 10

• Narrow TW
• Metabolized by CYP1A2 and 3A4
• Age dependent metabolism
• half-life in children is shorter

Question 11

ADRs of Methylxanthines:

Answer 11

-Tachicardya
- Arrhthmia
- palpitations
- Tremors
- Insomnia
-Nervousness and Seizures

Use Beta blockers for cardia toxicity

Question 12

What two corticosteroids that have great first-pass metabolism

Answer 12

Budesonide and Fluticasone

Question 13

GCs MoA

Answer 13

-inhibition of Phospholipase-A2
-mast cell stabilization
-Upregulation of B2 adrenergic receptors

Question 14

ADRs of GCs

Answer 14

Inhaled:
- fungal Infection and hoarseness of voice (prevented by gargle)
-Large dose —- systemic

systemic:
- Na and H2O retention, hypertension, peptic ulcer, hyperglycemia, cataract

• immune suppression

-Cushing’s syndrome and adrenal suppression

-withdrawal cause adrenal insufficiency

Question 15

Leukotriene modifiers drugs

Answer 15

Lipoxygenase inhibitor:
(↓↓ Leukotriene synthesis):
-ZILEUTON

Leukotriene receptor antagonists:
-MONTELUAST
-ZAFIRLUKAST

Question 16

Adrs of Leukotriene modifiers (antagonists)

Answer 16

Churg-Strauss syndrome:
vasculitis that may affect the heart, peripheral nerves, and kidney

Question 17

Mast cell stabilizers

Answer 17

CROMOLYN
NEDOCROMIL

Question 18

IgE antibody for treatment of severe asthma

Answer 18

Omalizumab

Question 19

Bronchodilators used for COPD and MOA

Answer 19

ipratropium

Question 20

Mucolytic agents used for COPD

Answer 20

acetylcysteine

bromohexine

ambroxol

Question 21

Roflumilast moa

Answer 21

Long-acting selective phosphodiesterase-4 inhibitor
▪ ↓↓ frequency of exacerbations of COPD