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Flashcards in Treatment of obstructive lung disease Deck (30):

Goals of asthma therapy

•Reduce the frequency and intensity of asthma symptoms, Prevent exacerbations, Prevent long term consequences of poorly controlled asthma


What is well controlled asthma?

Symptoms no more than twice per week, Nighttime symptoms no more than twice per month, SABA should be used less than twice weekly (with the exception of routine use prior to exercise), Peak flow near normal, Oral steroid no more than once per year, Urgent care visit no more than once per year.


List long term control meds for asthma

inhaled glucocorticoids, long-acting inhaled beta2 agonists, leukotriene modifiers, Omalizumab (anti-IgE)


What is the preferred long term control med for persistent asthma

inhaled glucocorticoids.


Allergen immunotherapy

•– potential therapy to modify disease by inducing specific allergen tolerance; tends to be more effective in managing allergic rhinitis and conjunctivitis than asthma



long-acting anticholinergic approved for COPD but not asthma


List quick relievers of asthma symptoms

Short acting Beta 2 agonists, anticholinergics, systemic glucocorticoids


What is the preferred treatment to symptoms and to prevent exercise-induced asthma

Short acting Beta 2 agonists,


anticholinergics and asthma

approved for COPD but not asthma. Used as secondary reliever for significant asthma exacerbations


List Beta adrenergic agonists used for asthma and COPD

albuterol, terbutaline, salmeterol, formoterol.


pharmacokinetics of B-agonists

rapid onset of action. Albuterol lasts 4-6hrs (quick reliever). Salmeterol and formoterol lasts 12 hrs (long term controller)


B-agonists MOA and effect

Stimulation of B-adrenergic receptors cuase bronchodilation via smooth muscle relaxation and inhibits production of respiratory secretions


List anticholinergics used for COPD (+/- asthma)

atropine, ipratropium, tiotropium


pharmacokinetics of anticholinergics

inhaled- rapid onset. Quick relievers (ipratropium) lasts up to 6 hrs, while long term controllers (titropium) lasts up to 12 hrs


Anticholinergics MOA and effect

Inhibits cholinergic receptor. Causes bronchodilation via smooth muscle relaxation and inhibits respiratory secretions


List systemic glucocorticoids used to treat acute exacerbations of asthma

hydrocortisone, prednisone, prednisolone, methylprednisolone


Systemic glucocorticoids pharmacokinetics

Oral or parenteral. 30-60min onset of action. Peaks of action in 8 hrs. hydrocortisone lasts 12-24 hours.
prednisolone, methylprednisolone last 36-48 hours


Systemic glucocorticoids MOA and effect

phospholipase inhibition; inhibition of cytokine synthesis. Anti-inflammatory and vasoconstrictor (reduces edema)


Inhaled glucocorticoids pharmacokinetics

Onset in 30-60 minutes. Peak of action is at 8 hrs for single dose, or 4 weeks for continued. Requires 1-2X daily dosing


Inhaled glucocorticoids MOA and beneficial effect

phospholipase inhibition; inhibition of cytokine synthesis. Anti-inflammatory and vasoconstrictor (reduces edema)


Long acting Beta adrenergic agonists

Salmeterol and formoterol- inhaled with fast onset and 8-12 hr duration


Warning with LABA

increase in asthma related deaths- should not be used alone b/c they do not reduce inflammation


What is combination therapy

Inhaled products are now available that combine an inhaled corticosteroid plus long acting ß-adrenergic agonist for benefits of both in the same delivery device.


What are different aerosol delivery devices

nebulizer, pressurized metered dose inhaler, dry powder inhaler


Discuss particle size and aerosols

Large particles (>5 µm in diameter) will deposit in the pharynx and the wall of the larger airways. Small particles (<1 µm in diameter) are too small to be deposited and are retained in the airways and exhaled


What is the function of a spacer on an inhaler

Large particles settle in the chamger instead of the mouth, they slow particle velocity which increases pulmonary deposition, reduce the need for timing and coordination.


Leukotriene modifiers MOA and effect

leukotriene D4 antagonist (montelukast, zafirlukast) and 5-lipoxygenase inhibition ( zileuton). Bronchodilation, anti-inflammatory, attenuates exercise induced asthma


Immunomodulator MOA and effects

Omalizumab (anti-IgE) binds to IgE to reduce likelihood of allergic response by inhibiting binding of IgE to mast cells. Adverse effects include anaphylaxis



Mast cell mediator release inhibition used for exercise induced asthma preventative therapy and can prevent allergen induced pulm response



Inhibits phosphodiesterase which has bronchodilation and some anti-inflammatory effects. Has caffeine like effects