Pharm: L16: Asthma

Question 1

Selective B2 Agonists (SLOW = LAP; Fast = SF)

1. Albuterol
   a. Effects Last for how long?
   b. How long does it take for it to take effect?
   c. What does it do?
   d. How is it taken?

Answer 1

1. a. 4-6 hrs
   b. Immediate
   c. Stops an attack
   d. Inhaled

Question 2

Selective B2 Agonists

1. Levalbuterol, and Pirbuterol
   a. Effects Last for how long?
   b. How long does it take for it to take effect?
   c. What does it do?
   d. How is it taken?

Answer 2

1. a. 4-6 hrs
   b. Immediate
   c. Stops an attack
   d. Inhaled

Question 3

Selective B2 Agonists

1. SALMETEROL
   a. What is it?
   b. Purpose?
   c. How long does it take to take effect?
   d. Should ALWAYS be combined with what?
   e. What is similar to it?
   f. LASTS for HOW LONG?

Answer 3

1. a. Long-Acting B2 agonist
   b. Prevention and Prophylaxis (DECREASES Nocturnal Asthma)

c. 20-30 minutes
d. a Steroid (Advair) (CORTICOSTEROID SHOULD ALWAY BE USED WITH Salmeterol and Formoterol)
e. Formoteral
f. 12 HOURS!

Question 4

Selective B2 Agonists

1. Formoterol

Answer 4

*See SALMETEROL…pretty much the same thing.

Question 5

Other Bronchodilators

1. THEOPHYLLINE
   a. Treat what?
   b. What is it?
   c. What does it BLOCK and INHIBIT?
   d. When is it used?
   e. Problem with it?

Answer 5

1. a. COPD (Bronchodilation)
   b. CNS Stimulant
   c. Blocks Adenosine Receptor and Inhibits Phosphodiesterase
   d. for asthma not controlled by B-Agonists
   e. Low THERAPEUTIC INDEX

*INCREASES cAMP

Question 6

Other Bronchodilators

1. IPRATROPIUM
   a. Treat what?
   b. Usually combined with what other drug?

c. Type of drug?
d. Used in conjunction with what?
e. Side effects?

Answer 6

1. a. COPD
   b. Beta Agonist (Albuterol)

c. Muscarinic Antagonists
d. with a B2 agonist when B2 Agonist by itself is not enough to treat symptoms or when Pts cant tolerate B-Agonists

e. Dry mouth….Paradoxical Bronchoconstriction

Question 7

Other Bronchodilators

1. Tiotropium
   a. Similar to what?

b. Why would you use this one though?

Answer 7

1. a. Ipratropium
   b. Longer Duration of Action (only have to take 1 time each day. May work in pts that dont respond as well to Ipratropium)

Question 8

Inhaled Corticosteroids

1. What are the Five Inhaled Corticosteroids? (BFTFB)

Answer 8

1. Beclomethasone, Fluticasone, Triamcinolone, Flunisolide, Budesonide

BFT (-ONE); FB (-IDE)

Question 9

Inhaled Corticosteroids

1. What do they do?
2. What is becoming the First Line of Tx?
3. Side Effects?
4. When is it used ORALLY?

Answer 9

1. Decrease inflammation, bronchial reactivity, improve response to B Agonists
2. Inhaled Steroids
3. Few…not absorbed systemically
4. Severe Asthma or Exacerbations

Question 10

Inhaled Corticosteroids: Side Effects

1. BIG one that happens in the mouth?

Answer 10

1. ORAL CANDIDIASIS (THRUSH): Treat with Antifungal meds

* Hoarseness common with Inhaled.

Question 11

Leukotriene Inhibitors

1. What do they do?

Answer 11

1. Inhibit early response to Allergen, Decrease Asthmatic Response to exercise or cold AIR, and decrease need for inhaled or oral Steroids

Question 12

Leukotriene Inhibitors

1. Side Effects?

Answer 12

1. Few: URIs, sore throat, Headache, Abdominal Pain. Sleepiness and Psychiatric Changes (RARE)

Question 13

Leukotriene Inhibitors

What are the 3 INhibitors?

Answer 13

1.ZMP (-LUKAST)

Question 14

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Answer 14

j

Question 15

j

Answer 15

j

Question 16

Other

1. CROMOLYN SODIUM
   a. Inhibits release of what?
   b. Is it a bronchodilator?
   c. How is it taken?
   d. MOST COMMON COMPLAINT?
   e. Main use?

Answer 16

1. a. of Histamine from Mast cells
   b. NO!
   c. Inhaled (usually only children use it)
   d. TASTES BAD
   e. Prophylactic Treatment

Question 17

Other

1. OMALIZUMAB
   a. What is it?
   b. Purpose?
   c. How is it taken?
   d. SIDE EFFECTS?

Answer 17

1. a. Monoclonal Antibody to IgE’s High Affinity
   b. Prevent Allergic Reactions in Patients w/Mod to Severe Asthma

c. Subcutaneous Injection every 2-4 wks
d. RASH, INJECTION SITE REACTIONS, SMALL DECREASE in PLATELETS!

Question 18

Asthma

1. What is a MAJOR FEATURE?
2. BRONCHIOLES are Constricted by what Innervation?
   a. Relaxed by what?

Answer 18

1. INFLAMMATION
2. CHOLINERGIC INNERVATION
   a. Beta-2 Receptors

Question 19

Mediators of Inflammation in Asthma

1. Inflammatory Cells
2. Prostaglandins
3. Interleukins-4,5 and 13
4. Platelet-Activating Factor
5. Leukotrienes

Answer 19

1. Many…but EOSINOPHILS are big
2. D2 potent BRONCHOCONSTRICTOR
3. Attract and Activate EOSINOPHILS and stimulate IgE production by B Lymphocytes
4. Immediate Bronchoconstriction
5. Freed during inflammation in lung. Cause Bronchoconstriction

Question 20

Asthma Drug Treatment: Meant to do 3 things?

Answer 20

1. Decrease inflammation, Prevent and Reverse Bronchospasm

Question 21

Drugs: Purpose

1. B2 Adrenergic Agonists?
2. Long-Acting B2 Agonists?
3. Cholinergic Antagonists?
4. Corticosteroids?
5. Leukotriene Inhibitors?
6. CROMOLYN?

Answer 21

1. Tx at time of attack
2. Decrease chance of Bronchospasm and Prevent Attacks
3. Cause Bronchodilation (COPD)
4. Decrease inflammation
5. Decrease Inflammation
6. Decrease Histamine Release from Mast Cell and Prevent Bronchospasm

Question 22

COPD

1. Includes what 2 things?
2. Chronic Bronchitis
   a. What’s immobilized?
   b. What Makes more Mucous?

Answer 22

1. Chronic Bronchitis and Emphysema
2. a. Cilia (particles stay in)
   b. Goblet Cells

Question 23

B-Agonists

1. What is most widely used for Tx of Asthma?
   a. What do they do?

Answer 23

1. B2 agonists
   a. Relax smooth muscle in airway and Inhibit Histamine release from mast cells.

*Usually inhaled…also oral form if needed and Injected in emergencies

Question 24

B2 Agonists: Side Effects?

Answer 24

1. Few. Tachycardia, Nervousness, Dizziness, Tremor

Question 25

Other Bronchodilators 1. Given how? 2. Side Effects?

Answer 25

1. Oral 2. CNS: Nervousness, Insomnia, Similar to Caffeine... OD = Fatal usually due to Arrhythmias and Seizures