Asthma & COPD

Question 1

Name a systemic corticosteroid

Answer 1

methylprednisolone

Question 2

Name an aerosol corticosteroid

Answer 2

fluticasone

Question 3

Name a beta2 adrenergic agonist that is short acting?

Answer 3

albuterol

Question 4

Name a beta2 adrenergic agonist that is long acting?

Answer 4

salmeterol

Question 5

Name a short-acting muscarinic antagonist

Answer 5

ipratropium bromide

Question 6

Name a long-acting muscarinic antagonist

Answer 6

tiotropium

Question 7

Name a methylxanthine phosphodiesterase inhibitor

Answer 7

theophylline

Question 8

Name a leukotriene pathway inhibitor

Answer 8

montelukast

Question 9

Name an IgE inhibitor

Answer 9

omalizumab

Question 10

What is the main mechanism for maintenance drugs?

Answer 10

**prevent **asthma attacks . . . they affect

airway responsiveness/reactivity

Question 11

Which group of drugs affect airway resistance?

Answer 11

quick relief meds, relieve bronchoconstriction

Question 12

What is the deposition of inhaled drugs?

Answer 12

Particles too small will come right back out.
Those that are too big will be swallowed.
2-5 micrometers = optimal and will be inhaled

Question 13

Which are the most effective sites to pharmacologically target to prevent asthma attacks?

Answer 13

CS, IgE, leukotriene inhibitors >> neutrophils

muscarinic antagonists, B2 agonists, methylxanthines >> cholinergic reflex, bronchoconstriction

Question 14

What is the most effective treatment in **preventing **asthma attacks?

Answer 14

inhaled glucocorticoids (ICS)

ICS suppress inflammation . . . DO NOT CURE disease.

In hrs, antiinflammatory effect; maximal benefit weeks/mo. Add B2 agonist before raising steroid dose.

Question 15

True/False: 17 alpha substitution increases the topical activity of corticosteroids.

Answer 15

True.

Why?

Question 16

How do corticosteroids suppress inflammatory gene transcription?

Answer 16

Recall: the corticosteroid gets translocated to the nucleus where it directly affects gene translation (stops acetlyation).

Question 17

Name the effects of corticosteroids on airway cells

Answer 17

*corticosteroids increase the transcription of beta 2 receptors

Question 18

What are two main adverse affects with corticosteroids?

Answer 18

inhalation >> oropharyngeal candidiasis and dysphonia

high dose/systemic >> HPA suppression (bone resorption, skin thinning, growth retardation)

Question 19

When are systemic glucocorticoids used?

Answer 19

with asthma exacerbations

• short term 3-10 days, must withdraw over 1-2 weeks

Question 20

When do you use B2 agonists in asthma?

Answer 20

short acting: rescue
long acting: + ICS

*most asthmatics can be controlled with ICS + B2 agonist
NOTE: B2 agonists increase glucocorticoid nuclear translocation (complement each other)

Question 21

Bronchodilators

Answer 21

Question 22

What is the difference between albuterol and salmeterol?

Answer 22

albuterol

• short acting 3-5 min
• peak 30-60 min
• duration 3-6 hr
• *salmeterol**
• duration >12 hr

Question 23

MOA of B2 agonists

Answer 23

Question 24

When do you know that asthma is not adequately controlled?

Answer 24

Using rescue inhaler >2x/week

Question 25

True/false: Long acting B2 agonists should NOT be prescribed unless accompanied by ICS.

Answer 25

True *combination inhaler preferred* \* HOWEVER, LABA can be prescribed alone in COPD

Question 26

When would you use an inhaled muscarinic antagonist?

Answer 26

IF patient intolerant of B2 agonists.

Question 27

What's the different between ipratropium and tiotropium?

Answer 27

* *_ipratropium_** - short acting 15-30 min - duration **3-4 hrs** * *_tiotropium_** - duration **\>24hrs**

Question 28

**True/false:** anticholinergic drugs inhibit vagally mediated airway tone, producing bronchodilation.

Answer 28

True

Question 29

Which asthma drug has a narrow therapeutic window and needs plasma level monitoring?

Answer 29

theophylline

Question 30

What is the goal of anti-IgE therapy?

Answer 30

Neutralize serum IgE, thus there is **no allergen induced activation of immune cells.**

Question 31

What asthma drug is cheapest and most expensive?

Answer 31

cheap: theophylline expensive: anti IgE monoclonal antibody

Question 32

True/false: COPD is defined as the presence of airflow limitation _that is not fully reversible._

Answer 32

True

Question 34

True/false: there is no sympathetic innervation of bronchiole smooth muscle, but there are Beta 2 receptors on the lung.

Answer 34

True

Question 35

Conceptual model for immunopathogenesis of asthma

Answer 35

2 phases **_early reaction_** *driven by mast cell and histamine* **_late reaction_** *more inflammatory mediators*