Asthma & COPD

Question 0

Beclomethasone

Answer 0

A Glucocorticoid
Binds to intracellular GC receptor & modulates gene expression leading to increased
lipocortin 1which inhibits PLA2 leading to decreased inflammation
For asthma; decreases eosinophils, mast cells & cytokines; reduces endothelial permeability; increases B2 receptors; decreases mucous secretion
Adverse Effects: peptic ulcer, osteoporosis, increase risk of infection, increases Na & water retention, adrenal atrophy, acne, slow growth in children, redistribution of body fat, mood & personality changes, elevated blood glucose

Question 1

Albuterol & Terbutaline

Formoterol, Salmeterol

Answer 1

B-2 adrenergic agonist
Increases cAMP leading to bronchodilation, decreases mast cell, decreases plasma exudation, increases mucous clearance, decreases cholinergic neurotransmission, increases surfactant
Use with corticosteroids. Don’t use alone.
Adverse Effects: high doses causes tachycardia, palpitations, tremor
1) SABA, short duration & quick acting
For relieving acute asthma attack & prophylaxis
2) LABA, long duration & slow acting
For prevention of asthma attacks

Question 2

Ipratropium bromide & Tiotropium bromide

Answer 2

Anticholinergic agents
Blocks all muscurinic receptors thus effective at blocking M3 receptor which is responsible for bronchial smooth muscle contraction. Thus leading to bronchodilation.
For asthma, COPD
Tiotropium also used for emphysema
Ipratropium combined w B2 agonist gives prolonged effect.

Question 3

Theophylline

Answer 3

Xanthine derivative
Inhibits phosphodiesterase 4 which causes increased cAMP leading to suppression of inflammation (CD4 & CD8 T lymphocytes) & possibly causes bronchodilation.
For asthma, COPD
Adverse Effects: transient nausea, vomiting, headache & insomnia; persistent vomiting; arrhythmia, intractable seizures
Contraindicated w use w B2 agonist & smoking

Question 4

Montelukast & Zafirlukast

Zileuton

Answer 4

Leukotriene antagonists
Montelukast & Zafirlukast: competitive antagonist at leukotriene D4 receptors
Zileutin: 5-lipoxygenase inhibitor leading to decreased leukotriene synthesis
For mild to moderate persistent asthma, prevention of exercise induced asthma
Adverse Effects: minimal effects; Zileuton rarely causes severe hepatotoxicity
Mainly used as adjunct therapy w corticosteroids & B2 agonist

Question 5

Nedocromil & Sodium cromoglycerate

Answer 5

Cromones (Mast cell stabilizers)
Prevents release of mediators thus inhibiting immediate & late response to allergen challenge
For prophylaxis of asthma
Not to be used for acute asthma attacks bc doesn’t relieve bronchospasm

Question 6

Omalizumab

Answer 6

Anti-Ig E monoclonal antibody
Decreases lymphocytes, eosinophilic bronchial inflammation, frequency & severity of exacerbations
For chronic severe asthma not controlled by corticosteroid & LABA
Adverse Effects: anaphylaxis