bronchodilators and antihistamines

Question 1

What is the best form of treatment for Asthma?

Answer 1

Treat with an anti-inflammatory for prophylactic treatment and use a bronchodilator for symptomatic treatment.

Question 2

What is the best treatment for COPD?

Answer 2

Triple Therapy = anti-cholinergic, bronchodilator, and anti-inflammatory

Question 3

What are the 3 aerosol delivery methods?

Answer 3

Metered-dose inhaler, nebulizers, and dry-powder inhaler

Question 4

What are the main uses of short acting beta-agonists?

Answer 4

Immediate treatment of bronchospasm or prophylaxis of exercise-induced asthma

Question 5

What is the mechanism of action of beta-agonists?

Answer 5

Stimulates the Gs subunit activating adenylyl cyclase causing bronchodilation and inhibition of mast cell degranulation (minor effect)

Question 6

What are possible side effects of beta-agonists?

Answer 6

Overuse can cause systemic effects and activation of beta1 receptors

Question 7

What is salmeterol? Describe it use and a similar drug.

Answer 7

Salemeterol is LABA which is typically used for the prophylaxis of night time asthma attacks.

Formoterol is similar.

Question 8

What is an effect of long-term LABA therapy? How can this be avoided?

Answer 8

Long-term therapy with LABAs can cause decreased effectivity of SABA in rescue therapy. This effect can be avoided by combining therapy with inhaled corticosteroids.

Note: Once asthma has been stabilized, remove LABBA therapy if possible, and use just inhaled corticosteroids.

Question 9

What are the situations in which oral Beta-agonists should be used?

Answer 9

Briefly, in children who cannot operate their inhaler due to age or URI. Patients where use of inhaler causes exacerbation of asthma.

Question 10

What are the adverse effects of beta-agonists?

Answer 10

Skeletal musle tremors, tachycardia, hypokalemia, and hyperglycemia

Question 11

What are ipratropium and tiotropium? How are they delivered?

Answer 11

Both of these are quaternary amine muscarinic antagonists. They cause bronchodilation, but do not enter the CNS or GI tract easily. Ipratropium is only an inhaled aerosol, while tiotropium is a dry powder.

Question 12

What is the principal use of ipratropium?

Answer 12

Used in combination with albuterol to treat COPD.

Question 13

What is the mechanism of action of theophylline?

Answer 13

Blocks adrenergic receptors, lowers intracellular calcium, and hyperpolarizes cell membranes

Question 14

Why is theophylline no longer a 1st line agent for asthma?

Answer 14

It has a modest effect and narrow therapeutic window requiring periodic monitoring of blood levels.

Question 15

What is the mechanism of action for corticosteroids?

Answer 15

Bind to the intracellular steroid receptor and regulate transcription.

Question 16

When is corticosteroid therapy indicated in an asthmatic?

Answer 16

When a patient requires the use of a beta-agonist more than 4 times a week

Question 17

What drugs are used in systemic corticosteroid therapy? When would such a therapy be indicated in an asthmatic patient?

Answer 17

Methyprednisone and prednisone should be used in severe acute asthma exacerbations.

Question 18

What are potential side effects of corticosteroid therapy?

Answer 18

The most common adverse effects are candidiasis and dysphonia due to the oral depostion of drug. Can also see osteoporosis, metabolic disorders, hypothalamic suppression, and skin-thinning

Question 19

What is the MOA of cromolyn compounds? what are their uses?

Answer 19

Cromolyn sodium is DIRECT inhibitor of histaminer release and INDIRECTLY inhibits antigen-induced bronchospasmm. these drugs are used for prophylactic therapy.

Question 20

What is montelukast and it’s use?

Answer 20

This is a leukotriene inhibitor which binds the LTD4 receptor. Used for oral prophylaxis of exercise and aspirin induced asthmas.

Question 21

What is the mechanism MOA of antihistamines?

Answer 21

Block the H1 receptor and most effects of histamine

Question 22

What is the difference between 1st generation and 2nd generation anti-histamines?

Answer 22

1st generation - cross the BBB and can cause sedation

2nd generation - do not cross the BBB

Question 23

What are the clinical indications of anti-histamines?

Answer 23

Allergic conditions - rhinitis, urticaria, conjunctivitis, anaphylaxis (adjunct with epi)

Note: not effective against bronchial asthma

Can also be used for motion sickness and insomnia

Question 24

What are the first genertation antihistamines?

Answer 24

Diphenhydramine, chlorpheniramine, and promethazine

Question 25

What are the second generation antihistamines?

Answer 25

Fexofenadine, loratidine, and cetirizine

Question 26

What are the clinical effects of anti-histamines?

Answer 26

relieve itching, nasal discharge, and sneezing. Not a decongestant.

Question 27

What are the side effects of anti-histamines?

Answer 27

First-Gen Only = Sedation, CNS disturbances, dry mouth, and urinary retention

Second-Gen = GI disturbances (also first-gen)

Question 28

What type of drug is used for congestion?

Answer 28

alpha-agonists: phenylephrine, pseudoephedrine, all the zolines

Question 29

What are two opioid anti-tussives?

Answer 29

Dextromethorphan and codeine

Question 30

How do opioids eliminate cough?

Answer 30

Enter the CNS and suppress the cough reflex.

Question 31

What are two expectorants?

Answer 31

N-acetyl-cysteine and guaifenesin

Question 32

What is the most effective drug for relief of allergic rhinitis?

Answer 32

Intranasal corticosteroids

Question 33

What is amantadine?

Answer 33

This is an antiviral used to prevent type A influenza