Obstructive Lung Disease Flashcards Preview

Block 3b1 PHM > Obstructive Lung Disease > Flashcards

Flashcards in Obstructive Lung Disease Deck (57):
1

Short acting B2 Agonist

Albuterol

2

Tx for acute asthma exacerbation

Albuterol

3

Long acting agents (2) for prophylaxis

Salmeterol/Formoterol

4

AE: Tremor/Arrhythmia

Salmeterol/Formoterol

5

Inhaled Corticosteroids (2)

Fluticasone/Budesonide

Others: 'sone' & 'ide'
Beclomethasone, Mometasone, Ciclesonide

6

MOA of inhaled corticosteroids (i.e.: Fluticasone/Budesonide)

Inhibits cytokine synthesis; Inactivates NF-KB, transcription factor that induces production of TNF alpha and other inflammatory agents

7

1st line therapy for chronic asthma (2)

Fluticasone/Budesonide

8

AE: oral thrush (2)

Fluticasone/Budesonide

9

Muscarinic Antagonists (2)

Tiotropium/Ipratroprium

10

MOA of muscarinic antagonists (i.e.: Tiotropium/Ipratroprium)

Competitively block muscarinic receptors, preventing bronchoconstriction T

11

Long acting muscarinic antagonists (2)

Tiotropium; Aclidinium

12

Antileukotrienes (2)

Montelukast/Zafirlukast

13

MOA of antileukotrienes (i.e.: Montelukast/Zafirlukast)

block leukotriene receptors (CysLT1)

14

5-lipoxygenase pathway inhibitor; blocks conversion of arachidonic acid to leukotrienes

Zileuton, antileukotriene

15

Anti-IgE monoclonal antibody

Omalizumab

16

MOA of Omalizumab

binds unbound serum IgE & blocks FCERI binding

17

Tx for allergic asthma w/ increased IgE levels

Omalizumab

18

Methylxanthines (2)

Theophylline, Roflumilast

19

MOA of Theophylline

Blocks action of adenosine
Metabolized by cytochrome P-450
↑cAMP due to ↓cAMP hydrolysis

20

Methylxanthine w/ limited use bc of narrow TI

Theophylline

21

non-specific muscarinic receptor M3 agonist to diagnose asthma

Methalcholine

22

MOA of Cromolyn

"mast cell stabilizer"
Inhibits mediator release from mast cells
↓ chemotaxis
sensory nerve effects (↓ cough, neuropeptide release)

23

Clinical Roles of B2 Agonism (2)

Acute relief: min tachyphylaxis

Bronchoprotection: known triggers (cold air/allergens); attenuates w/ repeated use

24

Drug w/o anti-inflammatory properties

B2 agonists

25

Drug to avoid PO administration

B2 agonists

26

Drugs (2) w/ concerns for tachyphylaxis & what they should NOT be administered w/o...

Long acting B2 agonists: Salmeterol/Formoterol
Should NOT be administered w/o inhaled steroids in asthma

27

AE of B2 adrenergic agonists

Tachycardia, tremor, nervousness
Not entirely selective
B2 receptors also found on heart

28

MOA of corticosteroids

Bind cytoplasmic receptor assoc w/ HSP 70, 90 and immunophilin (target of cyclosporine)

Translocation to nucleus, acts as transcription factor w/ widespread cellular effects

Modulate production of anti-inflammatory proteins modifying histones & their transcription

29

Effects of glucocorticoids

↓ lymphocytes & macrophages; ↓ cytokine release
↓ endothelial cell adhesion molecules (ICAM-1)
↓ prostaglandin & leukotriene C4
↓ fibroblast proliferation
Eosinophil apoptosis

30

AE of Glucocorticoids

Immunosuppression, Gastric Ulcers, Osteoporosis, Muscle Wasting, Cataracts

31

Do inhaled corticosteroids offer immediate bronchorelaxation?

NO

32

What are the side effects of inhaled steroids & what can be done to avoid them?

Dysphonia (hoarseness), Thrush
Pneumonia (mild risk) in COPD patients

Rinse mouth, use spacer device

33

What are the short and long term effects of oral corticosteroids?

Short: VERY effective, preferred to increasing dose of inhaled steroid; initiate Tx early in exacerbation

Long: for asthma & COPD-associated w/ sig toxicity

34

Where are the anticholinergics or muscarinic receptors found?

Heart, CNS, GI, sweat glands, GU, eye

35

What are the anticholinergics w/ systemic & non-systemic effects?

Atropine: systemic effects

Ipratroprium bromide: 'quaternary ammonium' not systemically absorbed

36

Side effect of inhaled anticholinergic

Dry mouth

37

Synergistic combination of muscarinic antagonist & B2 agonist

Ipratropium; albuterol

38

Effects of leukotrienes in asthma

Potent effectors of airway obstruction
Bronchial constriction
Vasodilation
Edema
Leukocyte chemotaxis

39

In addition to inhaled corticosteroid, what is the other add-on controller agent in asthma?

Leukotriene modifiers

40

Which leukotriene is good to add for allergic rhinitis?

Montelukast

41

Adenosine receptor antagonist that can mediate bronchospasm & Histone deacetylase modulator (HDAC)

Theophylline

42

AE of Theophylline within therapeutic range (a)? dose dependent toxicity (b)?

a) Nervousness, insomnia, dyspepsia
b) Nausea, emesis, tachyarrhythmias, seizures

43

What is the 3rd line agent in asthma?

Theophylline

44

What is the phosphodiesterase-4 isotope specific methylxanthine?

Roflumilast, w/ a better side effect profile than Theophylline although (-) GI effects & weight loss

45

What is the FDA approved methylxanthine for SEVERE copd?

Roflumilast, ↓ exacerbation rates but not for acute bronchorelaxation

46

Characteristics of mab's

highly specific, long T1/2, subQ admin, $

47

What is the drug used in Tx-resistant asthma?

Omalizumab

48

What are anti IL-5 mab's? (2)

Mepolizumab, Reslizumab

49

Role of lL-5

cytokine for growth, differentiation, recruitment, activation and survival; may impair response to helminth infection & zoster

50

What are the 2 drugs used as add-on Tx for severe disease w/ eosinophilic phenotype?

Mepolizumab & Reslizumab

51

What are adjunct Tx for asthma?

Vaccination vs. pneumococcus/influenza
Allergen immunotherapy
Smoking cessation
Control allergic rhinitis
Mg

52

Describe the pyramid levels of Asthma Tx

Oral Steroids (long term)

Theophylline, Leukotriene modifiers, Tiotropium, Long acting B2 agonists

ICS

SABA

53

What are the advantages and limitations of inhaled corticosteroids?

↓ exacerbations but do NOT change FEV1 or parenchymal destruction

54

Uses of mast cell stabilizer

Prophylaxis of mild to moderate persistent asthma & exercise induced asthma

55

What is the effect of Theophylline on endogenous B2 adrenergic receptors?

Enhance activity of endogenous Beta2 adrenergic receptors

56

All of the following are asthma controller medications, which affect the underlying causes of the disease EXCEPT:

Inhaled Corticosteroids
Inhaled muscarinic receptor antagonists
Leukotriene receptor antagonists
Mast cell stabilizers

Inhaled muscarinic receptor antagonists

57

How do inhaled corticosteroids work synergistically w/ B2 agonists?

Inhaled corticosteroids up regulate B receptors to enhance responsiveness to B agonists