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55 Cards in this Set
- Front
- Back
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What kind of infiltrate is seen in bronchioles during acute asthma?
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Eosinophils, neutrophils, and Th2 lymphocytes.
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What is the neural/humoral component of bronchial asthma?
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Stimulation of bronchial tree activates vagal afferents leading to vagal efferent release of acetylcholine. This causes bronchoconstriction.
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What are the 7 classes of long term control asthma medications?
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Inhaled Corticosteroids
Systemic Corticosteroids Inhaled Cromolyn Sodium Inhaled Long-Acting Beta2 Agonists Theophylline Systemic Leukotriene Modifiers Omalizumab |
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What is the mechanism of action of inhaled corticosteroids?
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They bind to receptors which bind to glucocorticoid response elements on DNA. These promote transcription of anti-inflammatory mediators.
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What are the adverse effects of inhaled corticosteroids?
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Oral candidiasis - due to immune supression
Dysphonia Reflex cough and bronchospasm |
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What is the drug of choice in the inhaled corticosteroid class of drugs?
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Fluticasone propionate
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Budesonide
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Inhaled corticosteroid
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Belcomethasone Dipropionate
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Inhaled corticosteroid
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What is the effect of increasing inhaled corticosteroids?
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Little increase in effect. Higher increase in adverse risk.
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What is the effect of inhaled corticosteroids on growth rate.
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It decreases the rate of growth in children but does not have any effect on overall growht achieved.
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What is the effect of inhaled corticosteroids on bone metabolism/osteoporosis?
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Low-medium doses have no major effects. Elderly females may be at risk for development.
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What is the effect of inhaled corticosteroids on the hypothalamic-pituitary-adrenal axis.
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High doses may case suppression. Low doses have no significant risk.
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When are systemic corticosteroids used to treat asthma?
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Used for long term prevention of severly uncontrolled asthma. Otherwise not indicated due to adverse effects.
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What is the mechanism of action of inhaled Cromolyn Sodium?
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Unknown. Suspected that is due to inhibition of inflammatory cell cytokine and mediator release.
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How is cromolyn sodium taken?
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It must be inhaled prophylactically to prevent an attack. Not usefull to relieve an existing attack
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What is a major contributor to lack of compliance in taking cromolyn sodium?
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It must be take 4 times a day.
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Neodocromil
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Similar to cromolyn sodium. May be more effective in preventing exercise/cold air induced asthma.
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What are the adverse effects of the cromolyn sodium drugs?
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They are usually very safe. Can cause transient cough.
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What is the clinical use of long acting B2 agonists.
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Recomended for combination use with inhaled corticosteroids. Not recomended for monotherapy.
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Salmeterol
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Long acting B2 agonist
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Formoterol
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Long acting B2 agonist
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Advair
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Combo drug of Fluticasone and Salmeterol.
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Symbicort
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Combo drug of Budesonide and Formoterol
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When should long acting B2 agonists be used?
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They can be added to inhaled corticosteroids use to control moderate asthma instead of increasing the dose of the inhaled corticosteroid. Shown to be more effect.
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What is the black box warning recently added to long acting B2 agonists?
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It states that they may cause bronchospasm leading to death.
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What is the mechansim of action of theophylline
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Inhibits phosphodiesterase and leads to increased cAMP causing smooth muscle relaxation. May also antagonize adenosine receptors.
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When is theophylline used?
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Can be used as an adjuvant to inhaled corticosteroids.
May be used as a long preventative therapy but not preferred. |
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What are the adverse effects associated with theophylline?
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Narrow therapeutic range.
Above 15ug/ml can cause anorexia, nausea, vomiting, insomnia, tremor. Above 40ug/ml may cause seizures and cardiac arrhythmias. |
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What are the clinical uses of leukotriene modifiers?
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Alternative monotherapy to inhaled corticosteroids or additional therapy. Less effective in combo therapy than long acting B2 agonists.
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Montelukast
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Leukotriene modifier
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Zafirlukast
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Leukotriene Modifier similar to montelukast.
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What is the mechansim of action of monteleukast
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Leukotriene CysLT receptor antagonist.
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What are the clinical uses of montelukast?
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Asthma and Allergic Rhinitis.
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What are the adverse effects associated with montelukast?
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May cause neuropsychiatric effects. Agitation, aggression, anxiousness, hallucinations, depression, insomnia, suicial thinking.
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What are the adverse effects of Zafirlukast?
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GI disturbances
Churg-Strauss Syndrome |
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What are the drug-drug interactions associated with Zafirlukast?
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Increases the half life of warfarin.
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Zileuton
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Leukotriene Modifier
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What is the mechanism of action of Zileuton?
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It inhibits 5-lipoxygenase which decreases conversion of arachidonic acid to leukotrienes. Blocks production of all leukotrienes.
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What are the adverse reactions associated with zileuton?
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Can cause liver toxicity.
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What is the mechanism of action of omalzumab?
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It is a recombinant IgG monoclonal antibody that inhibts binding of IgE to its receptor on mast cells and basophils.
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How is omalizumab elminated from the body?
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It follows typical IgG antibody elimination. Liver elmination, excretion in bile. Serum elimination time is 26 days.
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When is omalizumab used clinically?
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It is used in patients with severe persistant asthma that is not effectively treated with inhaled corticosteroids, LABA, or leukotriene modifiers.
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What adverse reactions are associated with omalizumab
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Anaphylaxis
Malignancies |
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Albuterol
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Short acting B2 agonist
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Levalbuterol
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Short acting B2 agonist. More expensive
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What is the mechanism of action of the short acting B2 agonists?
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They cause a functional antagonsim to bronchoconstriction.
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What is the therapy of choice to releive acute symptoms of asthma?
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Short acting B2 agonists.
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What are the adverse effects associated with short acting B2 agonists?
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May exacerbate cardiovascular disease due to sympathomimetic effect.
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What is the mechanism of action of the inhaled anticholinergics?
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Competitive antagonism of muscarinic cholinergic receptors.
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Tiotriopium Bromide
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Inhaled anticholinergic
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Ipatropium Bromide
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Inhaled anticholinergic
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What are the indications for inhaled anticholinergic use?
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COPD and bronchospasm. They are not FDA approved for asthma but they are used to treat bronchospasm related to asthma
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What are the adverse effects of the inhaled anticholinergics?
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They produce antocholinergic effects. Constipation, tachycardia, blurred vision, dry mouth.
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Prednisone
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Systemic corticosteroid. Short term use.
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Methylprednisolone
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Systemic corticosteroid. Short term use
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