Asthma & COPD pharm Flashcards
(20 cards)
What is the hygiene hypothesis?
The immune system of the newborn infant is skewed toward Th2 cells and needs timely and appropriate environmental stimuli to create a balanced immune response
What are the preformed mast cell mediators?
Histamine, TNF-alpha and proteases
What are the Lipid-derived mast cell mediators?
LTC-4 (leukotrieneC-4) and LTD-4- bronchoconstriction, vasoconstriction
• LTB-4-leukocyte chemotaxis
• PGD-2 (prostaglandinD-2)-vasodilation, bronchoconstriction, mucus secretion, vasopermeability
• PAF (platelet activating factor)- bronchoconstriction, leukocyte chemotaxis
What are the cytokine mast cell mediators?
IL-l (Interleukin-l)-broad promotion of inflammation
• IL-3-mast cell division
• IL-5-eosinophil differentiation and chemotaxis
• IL-6-lymphocyte growth and differentiation
• IL 4 and 13-activation of Th2 pathway activation
• GM-CSF stimulates PMNs, eosinophils and macrophages
What are some extrinsic precipitants of asthma
Aspirin, NSAIDs, Beta blockers, cholinesterase inhibitors,
What are the 10 approaches to treating asthma?
- Increase cyclic AMP—Beta2 agonists
- Block adenosine receptors—theophylline
- Decrease cGMP—tiotropium
- Prevent mediator release—beta2 agonists
- Block mediator effects—antihistamines, LT receptor antagonists
- Inhibit mediator synthesis—lipoxygenase inhibitors
- Inhibit phosphodiesterase4 –roflumilast
- Bind serum free lgE–omalizumab
- Multiple antiinflammatory mechanisms of corticosteroids
- Bind interleukin-5 –mepolizumab
Name 3 beta agonists
Albuterol (short acting), Salmeterol (long acting), Levalbuterol
Discuss the PKs of albuterol and salmeterol
Albuterol Onset-5 min; peak at 30-60 min; duration 4-6 h
Salmeterol • Onset-15-20 min; peak at 3-4 h; duration 12 h
What are the side effects of beta agonists
Skeletal muscle tremor • Anxiety • Restlessness • Tachycardia and palpitations • Hypokalemia
Discuss the Leukotriene receptor antagonists
Montelukast; Competitive antagonists of leukotrienes
- Prevent but NOT reverse bronchorestriction
- Used for exercise induced bronchorestriction
- Not as effective as steriods
Discuss the Cholinergic Muscarinic Antagonists
Tiotropium; Ipratropium is short acting
- Given as a dry powder
- Dry mouth is the SE
- Used for COPD
- Combined with albuterol as Combivent
How does corticosteroids help with asthma?
- Up-regulate beta-adrenergic receptors
- Decrease vascular permeability
- Decrease leukotriene synthesis
- Decrease late-phase inflammatory response
SEs of inhaled corticosteroids
- Dysphonia
- Candidasis (thrush)
- Cataracts
Discuss Theophylline
- alpha blocker in bronchial smooth muscle
2. Treats COPD
MOA of Theophylline
- Relaxes bronchial smooth muscle and increases mucociliary clearance
- Increases diaphragmatic contractility and decreases its fatigue
- Dilates arterioles and venules and increases CO
- Increases GFR and diuresis
- Increases gastric acid secretion
- Decreases lower esophageal sphincter tone
SEs of Theophylline
- Headaches, N/V, Gastric discomfort (PDE4 inhibition)
- Diuresis (alpha blocker)
- Tachycardia and Seizures (alpha blocker)
Discuss the selective phosphodiesterase 4 inhibitors
Roflumilast;
- NOT a bronchodilator
- Reduces risk of COPD exacerbation with bronchitis
SE of Roflumilast
N/V, weight loss and psychiatric symptoms
Discuss Omalizumab
Monoclonal antibody against IgE; Binds free IgE
PKs of Omalizumab
- Administered sc every 2 or 4 weeks
- Peak plasma concentrations occur in 7-8 days. Elimination half-life is about 26 days
- Approved for treatment of moderate to severe persistent asthma in patients with reactions to allergens and not controlled with inhaled corticosteroids
