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Asthma and drugs Flashcards

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1
Q

asthma mechanism

A

bronchial hyperresponsiveness causes reversible bronchoconstriction

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2
Q

asthma can be triggered by

A
  1. viral URI
  2. allergens
  3. stress
  4. exercise
  5. tobacco
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3
Q

test asthma with

A

metacholine challenge

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4
Q

asthma symptoms and clinical findings

A
  1. cough 2. wheezing 3. tachypnea 4. dyspnea
  2. hypoxemia 6. decreased inspiratory/expiratory ratio
  3. puslus paradoxous 8. mucus plugging
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5
Q

pulsus paradoxus - seen in

A
  1. cardiac teponade 2. asthma 3. obstructive sleep apnea

4. pericarditis 5. croup

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6
Q

pulsus paradoxus - definition

A

decreased in amplitude of systolic BP by >10 during inspiration

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7
Q

inspiratory/expiratory ratio in asthma

and why

A

decreased

expiration is prolonged

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8
Q

asthma - histology

A
  1. smooth muscle hypertrophy
  2. Curschmann spirals
  3. Charcot - Leyden crystals
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9
Q

Curschmann spirals

A

shed epithelium forms whorled mucus plugs (IN ASTHMA)

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10
Q

Charcot - Leyden crystals

A

eosinophilic, hexagonal, double-pointed, needle-like crystal from breakdown of eosinophils in sputum (IN ASTHMA)

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11
Q

Charcot - Leyden crystals - seen in

A

asthma

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12
Q

asthma bronchoconstriction is mediated by

A
  1. inflammatory process

2. parasympathetic tone

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13
Q

asthma drugs

A
  1. β2 agonists (albuterol, salmeterol, formoterol)
  2. corticosteroids (fluticasone, budesonide)
  3. Muscarinic antagonists (ipratropium)
  4. Antileukotrienes (montelukast, zafirlukast, zileuton)
  5. omalizumab
  6. Methylxanthines (theophylline)
  7. Metacholine
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14
Q

asthma - β2 agonists drugs

A
  1. albuterol
  2. saleterol
  3. formoterol
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15
Q

asthma - albuterol mechanism of action

A

β2 agonists–> relaxes bronchial smooth muscle

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16
Q

asthma - albuterol used in

A

during acute exacerbation

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17
Q

asthma - salmeterol mechanism of action

A

β2 agonists–> relaxes bronchial smooth muscle

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18
Q

asthma - formoterol mechanim of action

A

β2 agonists–> relaxes bronchial smooth muscle

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19
Q

asthma - β2 agonists mechanim of action

A

relaxes bronchial smooth muscle (increase cAMP)

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20
Q

asthma - salmeterol side adverse effects

A
  1. tremor

2. arrhythmia

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21
Q

asthma - formoterol side adverse effects

A
  1. tremor

2. arrhythmia

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22
Q

asthma - corticosteroids drugs

A
  1. fluticasone

2. budesonide

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23
Q

role of corticosteroids (fluticosine, budesonide) in asthma therpay

A

1st line therapy for chronic asthma

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24
Q

asthma - corticosteroids (fluticosine, budesonide) - mechanism of action

A

Inhibit the synthesis of virtually ALL CYTOKINES. Inactivate NF-kB, the transcription factor that induces production of TNF-a and other inflammatory agents

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25
asthma - muscarinic antagonists drugs
1. ipratropium | 2. Tiotropium
26
asthma - muscarinic antagonists (ipratropium, tiotropium) mechanism of action
competitively blocks muscarinic receptors, PREVENTING BRONCHOCONSTRICTION
27
lung - muscarinic antagonists (ipratropium, tiotropium) - | used in
1. athma | 2. COPD
28
asthma - muscarinic antagonists (ipratropium, tiotropium) - except asthma is used in
COPD
29
asthma - ipratropium vs tiotropium according to action
tiotropium is long acting
30
metacholine mechanism of action
Muscarinic receptor M3 agonist --> bronchoconstriction
31
metacholine - used in
used in bronchial challenge test to help diagnose astma
32
asthma challenge test can also be with
histamine
33
omalizumab - mechanism of action
Monoclonal anti-IgE antibody. It binds mostly unbound serum IgE and blocks binding to FcεRI
34
omalizumab used in
allergic asthma resistant to inhaled steroids and long-acting β2-agonist
35
omalizumab binds mostly
unbound serum IgE
36
athma - antileukotrienes drugs
1. montelukast 2. zafirlukast 3. Zileuton
37
montelukast, zafirukast mechanism of action
block leukotriene receptor (CysLT1)
38
Zileuton mechanism of action
5-lipoxygenase pathway inhibitor. Block conversion of arachnoid acid to leukotrienes
39
montelukast, zafirukast - clinical use
asthma (especially aspirin-induced asthma)
40
zileuton side effect
hepatotoxicity
41
asthma - methylxanthines drugs
Theophylline
42
theophylline mechanism of action
inhibits phosphodiesterase --> increased cAMP --> BRONCHODILATION
43
theophylline is metabolized by
cytochrome P-450
44
theophylline block action of
adenosine
45
adenosine receptor antagonists
1. theophylline | 2. caffeine
46
theophilline usage in asthma is limited because
narrow therapeutic index
47
theophylline adverse effects
1. cardiotoxicity | 2. neurotoxicity
48
asthma related response to mediators (leukotrienes, histamine etc) is divided to
early response --> bronchoconstriction --> symptoms | late response --> inflammation --> bronchial hyperreactivity
49
late response in asthma? | inhibitors of this response?
inflammation | inhibited by steroids and abtuleukotrienes
50
early response in asthma? | inhibitors of this response?
bronchoconstriction | inhibited by β-agonists, theophylline, muscarinic, antagonists
51
cAMP in asthma therapy
it induces bronchodilation
52
adenosine in lungs
bronchoconstriction
53
ach in lungs
bronchoconstriction
54
asthma treatment for acute exaceberation
albuterol
55
1st line therapy for chronic asthma
corticosteroids (fluticasone, budesonide)
56
aspirin-induced asthma treatment
montelukast | zafirlukast
57
asthma drug with cardiotoxicity as a side effect
theophylline
58
asthma drug with hepatotoxicity as a side effect
zileuton
59
asthma drug with neurotoxicity as a side effect
theophylline
60
asthma drug with narrow therapeutic index
theophylline
61
allergic asthma resistant to inhaled steroids and long acting β-agonists
omalizumab
62
omalizumab binds mostly unbound serum IgE and blocks
binding to FcεRI
63
asthma's symptoms vary over in time in their
1. occurrence 2. frequency 3. intensity
64
causes of prolonged expiration
1. bronchoconstriction (airway narrowing) 2. airway wall thickening 3. increased mucus
65
symptoms of asthma may be triggered or worsened by factors such as
1. viral URI 2. allergens 3. stress 4. exercise 5. tobacco
66
asthma full treatment
there is not full treatment, only control
67
bronchial hyperresponsiveness in asthma is due to
inflammation
68
think asthma as a diagnosis when
1. Recurrent episodes of wheezing 2. Cough at night 3. Coughing or wheezing after exercise 4. Cough, wheezing, chest tightness after exposure to allergens or pollutants 5. Colds "go down to the chest" or take longer than 10 days

respiratory (27 decks)

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