Pharm 47 - Asthma Flashcards Preview

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Flashcards in Pharm 47 - Asthma Deck (53)
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1

Two ways asthma medications work?

1) By relaxing bronchial smooth muscle
2) By preventing and treating inflammation

2

How does the autonomic system regulate smooth muscle?

Sympathetic (adrenergic) tone causes bronchodilation; Parasympathetic (cholinergic) tone causes bronchoconstriction; Nonadrenergic, noncholinergic (NANC) fibers also innervate the respiratory tree

3

What is the main type of receptor expressed on airway smooth muscle cells? What chemical activates them?

Beta2-adrenergic receptors are activated by epinephrine, which is secreted by the adrenal medulla -> causes bronchodilation

4

How do parasympathetics create effects in the lungs?

Muscarinic (M3) receptors on airway smooth muscles are stimulated by acetylcholine -> causes bronchoconstriction

5

How do NANC fibers create effects?

NANC fibers are primarily under parasympathetic control. They are either stimulatory (cause bronchoconstriction) or inhibitory (cause bronchodilation). They release Neurokinin A, Calcitonin gene-related peptide, substance P, bradykinin, tachykinin, and neuropeptide Y to bronchoconstrict. NO and VIP cause bronchorelaxation.

6

What is more potent than histamine at producing bronchoconstriction?

Leukotriene D4

7

What are the two categories of asthma medications?

1) Relievers (bronchodilators)
2) Controllers/Preventers (anti-inflammatory)

8

Anticholinergics MOA

Antagonists at muscarinic receptors on airway smooth muscle and glands -> decreased bronchoconstriction and mucus secretion

9

Name the Anticholinergics (2)

Ipratropium, Tiotropium (long duration of action)

10

Anticholinergic clinical applications (3)

Asthma (not approved by FDA), COPD, Rhinitis

11

Adverse Effects Include Paralytic ileus, angioedema, bronchospasm; also abnormal taste, dry mouth/nasal mucus, constipation, tachycardia, urinary retention; if accidentally squirted in eye, can cause mydriasis and increased intraocular pressure -> angle-closure glaucoma

Anticholinergics

12

Anticholinergic contraindications

Hypersensitivity to drug or to soya lecithin

13

Has long duration of action b/c of slow dissociation from M1/M3 receptors

Tiotropium (Anticholinergic)

14

Agonists at Beta-adrenergic receptors; act through stimulatory G protein to cause smooth muscle relaxation and bronchodilation

Beta-Adrenergic Agonist MOA

15

Beta-adrenergic agonist
Used for asthma, anaphylaxis, cardiac arrest, open-angle glaucoma

Epinephrine (class and clinical applications)

16

Adverse Effects Include arrhythmias, hypertensive crisis, pulmonary edema; also tachycardia, palpitations, sweating, N/V, tremor, nervousness, dyspnea

Epinephrine

17

Contraindications Include Narrow-angle glaucoma (opthalmic form), MAOI use w/in 2 weeks (inhaled form)

Epinephrine

18

Non-selective agonist binds alpha (HTN), beta1 (cardiac stimulation), and beta2 (bronchodilation) adrenergic receptors

Epinephrine

19

Beta-adrenergic agonist
Used for asthma, cardiac arrest, decreased vascular flow, heart block, shock, Stokes-Adams syndrome

Isoproterenol

20

Adverse effects include Tachyarrythmia, palpitations, dizziness, HA, tremor, restlessness

Isoproterenol

21

Contraindications include Tachyarrythmias, angina, digitalis-induced tachycardia/heart block

Isoproterenol

22

Binds beta 1 (cardiac stimulation) and beta 2 (bronchodilation) adrenergic receptors

Isoproterenol therapeutic considerations

23

Irritating list of Selective Beta2 Receptor Agonists (7)

Metaproterenol, Albuterol (Salbutamol), Levalbuterol, Terbutaline, Pirbuterol, Isoetharine, Bitolterol (MALTs with mr. PIB)

24

Selective Beta2 Receptor Agonists clinical applications

Asthma, COPD

25

adverse effects include Tachyarrythmia, palpitations, dizziness, HA, tremor, restlessness (BUT less cardiac effects since they're Beta2 selective)

Selective Beta2 Receptor Agonists and M[E/O]TEROLs

26

Selective Beta2 Receptor Agonists therapeutic considerations

Terbutaline, albuterol, pirbuterol, and bitolterol cause fewer cardiac effects; Levalbuterol is more Beta2 selective than albuterol

27

-M[E/O]TEROLs (class and clinical applications)

Beta-adrenergic agonist
COPD (formoterol, salmeterol, arformoterol); Asthma (formoterol, salmeterol)

28

Long acting (LABAs) (12-24 hours); Should not be used as asthma monotherapy b/c of increased risk of death from asthma (use with inhaled corticosteroid)

-M[E/O]TEROLs therapeutic considerations

29

MOA Nonselective phosphodiesterase inhibitors, prevent degradation of cAMP, act as adenosine receptor antagonist -> smooth muscle relaxation and bronchodilation

Methylxanthines

30

Name the Methylxanthines (2)

Theophylline, aminophylline