E2: Asthma

Question 1

What innervation constricts and relaxes the lungs?

Answer 1

-Bronchioles are constricted by cholinergic innervation and relaxed b beta 2 innervation

Question 2

What happens in emphysema?

Answer 2

• Wall of the alveoli break down, so the few alveoli left become larger. Less surface area of gas exchange
• Fibrosis and loss of elasticity makes it difficult to breath

Question 3

How do Beta2 agonists help treat asthma?

Answer 3

• Most widely used treatment for asthma

- B2 receptors increased cAMP, which relaxes airway smooth muscle and inhibits histamine release from mast cells

Question 4

What are the B2 agonists used as rescue inhalers (SABA)?

Answer 4

• Albuterol, levabuterol

- These act immediately to stop an attack in progress and last 4-6 hours

Question 5

What kind of drug is Salmeterol?

Answer 5

Long acting B2 agonist for prevention and prophylaxis

Question 6

What should LABAs always be combined with?

Answer 6

A steroid (advair)

Question 7

What are the common side effects of B2 agonists?

Answer 7

-Tachycardia, nervousness, dizziness, tremor

Question 8

What is the black box warning of LABAs?

Answer 8

May increase risk of asthma related death

Question 9

What kind of drug is Ipratropium?

Answer 9

Muscarinic antagonist

Question 10

What are the indicated for Ipratropium?

Answer 10

• Useful for patients intolerant of B2 agonists
• Used on COPD
• Combined with albuterol

Question 11

What is the MOA of Theophylline?

Answer 11

• Increases cAMP, phosphodiesterase inhibitor
• Blocks adenosine receptors
• Results in relaxation of smooth muscle and stimulates CNS and heart

Question 12

What are the side effects of theophylline?

Answer 12

• Low therapeutic index
• drug interaction with cimetidine
• Nervousness, insomnia, anxiety, and tremor
• Tachycardia and arrhythmias
• Decreases diaphragm fatigue, increases contraction
• Weak diuretic

Question 13

What are the anti-inflammatory drugs used in asthma?

Answer 13

• Corticosteroids
• Leukotrienes inhibitors
• Cromolyn sodium

Question 14

How do corticosteroids treat asthma?

Answer 14

• They decrease inflammation, reduce bronchial reactivity, improve response to beta agonist.
• Inhaled steroids are becoming first line treatment

Question 15

What are the side effects of inhaled or oral steroids?

Answer 15

-Oral candidiasis
-Hoarseness
-osteoporosis
-

Question 16

What kind of drugs are Zileuton, Zafirlukast, and Monkelukast?

Answer 16

Leukotriene receptor antagonists

Question 17

Which LTA inhibits 5-lipoxgenase?

Answer 17

Zileuton

Question 18

What are the side effects of LTAs?

Answer 18

• Upper respiratory infections, sore throat, headache, abdominal pain, sleepiness
• No effect on attack in progress
• may allow decreased steroid dose

Question 19

What kind of drug is Omalizumab?

Answer 19

Monoclonal antibody receptor that may decrease the need for steroids and reduce asthma exacerbation

Question 20

What is the MOA of omalizumab?

Answer 20

-Monoclonal antibody to IgEs, high affinity Fc receptor, prevents binding of IgE to cells associated with allergic response and lowers free serum IgE concentrations

Question 21

What is the use of Omalizumab in asthmatics?

Answer 21

Moderate to severe allergic asthma

Question 22

What are the side effects of omalizumab?

Answer 22

Rash, injection site reactions, small decrease in platelets

Question 23

What is the MOA of Cromolyn sodium?

Answer 23

-Inhibit release of histamine from mast cells, not bronchodilators

Question 24

What are the 3 types of LABAs?

Answer 24

• Salmeterol (Salmeterol/fluticasone)
• Formoterol/mometasone or Formeterol/budesonide
• Vilanterol/fluticasone

Question 25

What kind of drugs are ipratropuim and tiotropium?

Answer 25

Muscarinic antagonists | -Quaternary compounds widely used to treat COPD

Question 26

What drugs increase the clearance of theophylline?

Answer 26

Phenytoin, smoking, Rifampin, and oral contraceptives

Question 27

What drugs decrease the clearance of Theophylline?

Answer 27

Cimetidine

Question 28

What happens in Theophyline OD?

Answer 28

- May be fatal due to arrhythmia | - moderate toxicity has headache, palpitations, dizziness, hypotension

Question 29

What ar the 5 ICS?

Answer 29

Beclomethasone, flunisolide, triamcinolone, fluticasone, and Budesonide

Question 30

What are the two oral steroids used for asthma?

Answer 30

Methylprednisolone and prednisone

Question 31

What are the common side effects of the inhaled corticosteroids?

Answer 31

Thrush, hoarseness, decreased bone density

Question 32

Can leukotriene inhibitors stop and asthma attack?

Answer 32

No, an inhaled B agonist would still be required

Question 33

When is benralizumab indicated for asthma?

Answer 33

For severe asthma with eosinophilic phenotype

Question 34

What are the common side effects of leukotriene inhibitors?

Answer 34

Headache, abdominal pain, slight increase in URIs, sore throat, sleepiness -Possible psychiatric reactions like agitation, aggression, hallucinations, and nightmares

Question 35

What is the used of Leukotriene inhibitors in asthma?

Answer 35

-Inhibit early response to allergen, decrease asthmatic response to exercise or cold air, and decrease the need for steroids