Asthma Copd

Front 1

Inhalation Corticosteroids mentioned?

Back 1

Triamcinolone, Fluticasone, and Prednisolone

Front 2

What are the actions of inhalational corticosteroids?

Back 2

Inhibit leukotriene, prostaglandin, and thromboxane synthesis. Reduce bronchiolar smooth muscle contraction, vascular permeability, and airway mucus secretions.

Restore responsiveness of bronchial smooth muscle to beta agonists

Inhibit activity of mast cells, eosinophils, neutrophils, macrophages, and lymphocytes.

Front 3

Adverse effects of inhalational corticosteroids?

Back 3

Known to cause changes in microflora that can lead to oral candidiasis

Front 4

What is the anticholinergic used for bronchodilation?

Back 4

Ipratropium (oral-inhalation, or nasal)

Front 5

Mechanism of action of Ipratropium

Back 5

Synthetic quaternary antimuscarinic agent that is a competitive antagonist at muscarinic cholinergic receptors.

Action is to decrease formation of cGMP which decreases contractility of smooth muscles due to actions of cGMP on intracellular calcium

Front 6

Adverse effects of Ipratropium?

Back 6

Xerostomia is the most common side effect. It is not known to causes tremor or arrhythmias like beta agonists.

Front 7

Which drug is a good choice for use in COPD pt's, especially those w/ psychogenis exacerbations

Back 7

Ipratropium

Front 8

Oral-inhalation powered drug that is used for the treatment of bronchospasm associated w/ COPD?

Back 8

Tiotropium (spiriva)

Once daily dose, NOT used for asthma.

Pt's do not like this drug

Front 9

What is the first line therapy for COPD when symptoms become persistent?

Back 9

Inhaled anticholingergic therapy

Front 10

Actions of Tiotropium?

Back 10

Anticholinergic having both Bronchodilatory and Bronchoprotective actions. Acts on M1, M2, and M3 receptors (M3 are airway receptors)

Front 11

Name the Methyl Xanthines (non-inhalational used orally/IV)

Back 11

Aminophylline, THEOPHYLLINE, Dyphylline, Oxtriphylline

Theophylline is only one used for treatment of asthma

Front 12

Actions of Methyl Xanthines?

Back 12

Relax smooth muscle of bronchial airways and pulmonary blood vessels. Antiinflammatory and immunomodulatory

Additonal non-bronchodilatory effects: increase diaphragmatic strength, cortical alertness

Also a weak inhibition of phosphodiesterase, adenosine antagonist, and increases levels of epinephrine

Front 13

Therapeutic effects of Methyl Xanthines?

Back 13

Increase Repiratory Muscle Strength
Increase Resp. Muscle endurance
Increase central ventilatory drive
Bronchodilation

(stimulate skeletals, relaxes smooth, + Chrono/inotropic)

Front 14

Adverse effects of Methyl Xanthines?

Back 14

Tremor, Headaches, anxiert, nausea, diarrhea, overdoses can cause lethal CV effects, diuresis

Methyl Xanthines have many Drug Interactions

Front 15

Main use of Theophylline and Aminophylline?

Back 15

Treatment of acute exacerbations of reversible airway obstruction including status asthmaticus in pt's not responding to 1st line therapies and who have not have theophylline in previous 24 hours.

Theophylline also decreases sleep apnea in heart failure.

Front 16

Name the two drugs discussed that inhibit mast cell degranulation?

Back 16

Cromolyn Sodium and Nedocromil

These drugs can be used in combo w/ corticosteroids. Preparations are available OTC (Nasal solution)

Front 17

Mechanism of action of Cromolyn?

Back 17

Inhibition of mast cell degranulation by inhibiting IgE antibody-antigen induced Ca influx. Prevents histamine and SRS-A release.

Ineffective for treatment of acute attack. Can attentuate late phase response

Front 18

Uses of Cromolyn?

Back 18

Asthma in kids. Prophylactic agent in treatment of mild/moderate asthma.

Pretreatment block antigen and exercise induced asthma.

Good for pt's wakened during sleep due to asthma

MINIMAL SIDE EFFECTS

Front 19

What are the three Leukotriene Antagonists and Lipoxygenase inhibitors mentioned?

Back 19

Zileuton (Lox inhib)
Zafirlukast
Mantelukast (SAFEST OF 3)

NOT FOR TREATMENT OF ACUTE EXACERBATIONS

Front 20

Name the Lipoxygenase inhibitor mentioned?

Back 20

Zileuton

Front 21

Contraindications of Zileuton?

Back 21

Contraindicated in pat's w/ active liver disease or w/ transaminase elevations greater than 3 times upper limit.

Causes a flue like syndrome

Front 22

Zafirlukast

Back 22

orally active leukotriene receptor antagonist for tx of asthma. Controls persisten asthma symptoms in adults, kids over 5.
Selectively inhibitrs leukotriene types D4, E4 and leukotriene receptors

Inhibits activity of cytochrome isoenzymes CYP3A4 and CYP2C9

Front 23

Montelukast (singular)

Back 23

Oral for prophylaxis/chronic treatment of asthma. DOES NOT INHIBIT CYP2C9 and CYP3A4

Uses include asthma in children (>12mths), chronic treatment/prevention of asthma. Prevention of Aspirin induced asthma, seasonal allergies, and exercise induced asthma.

Front 24

Rare side effect of Motelukast?

Back 24

Systemic eosinophilia w/ clinical features of vasculitis (treated w/ corticosteroids).

Front 25

Side effects shared by Montelukast, Zileuton, Zafirlukast?

Back 25

All cause increase in hepatic enzymes and dsypepsia/headache

Front 26

What is the monoclonal antibody used to treat asthma?

Back 26

Omalizumab (monoclonal Ab directed against IgE)

Front 27

Mechanism of Omalizumab?

Back 27

Binds to human IgE preventing binding of IgE to cells associated w/ allergic response

Front 28

Uses of Omalizumab?

Back 28

Approved for use in pts >12 to treat allergic asthma inadequately controlled depsite use of inhaled corticosteroids.

SubQ injection

Front 29

Soluble IL-4 Receptor mentioned

Back 29

Nuvance

Front 30

Nuvance action?

Back 30

Soluble IL-4 receptor that is a cytokine antagonist. IL-4 stimulates production of IgE. May be a positive prophylactic therapy.

Front 31

Investigational drug for COPF an Asthma?

Back 31

Roflumilast

Front 32

Roflumilast actions?

Back 32

Inhibits PDE4 causeing higher cAMP levels and bronchodilation.

Front 33

General action of Beta agonists?

General action of Theophylline?

Back 33

Beta agonists function to increase conversion of ATP to cAMP.

Theophylline decreases the conversion of cAMP to AMP.

Front 34

Actions of Sympathomimetics (beta 2 agonists)

Back 34

Relaxation/dilation of bronchial smooth muscle. Long acting agents include Salmeterol, Formoterol, Foradil all used for prophylaxis.

Drugs also facilitate mucociliary transport of secretion and promote expectoration.

Front 35

Beta2 adrenergics discussed?

Back 35

Albuterol (onset 5 - 10 min)
Salmeterol/Pirbuterol/Formoterol: long acting
Isoproterenol not used much b/c of pro-arrhythmic effects

Salmeterol + Fluticasone = Advair (controversy).

Front 36

Toxicities associated w/ Beta 2 Adrenergics

Back 36

Skeletal muscle tremor, can cause tachycardia/arrhythmias. Excessive use of short acting sympathomimetics known to cause loss of responsiveness to drug. Corticoids used to restore response.

Front 37

Isoetharine

Back 37

Beta-2 agonist. Short acting, metabolized by COMT

Front 38

Metaproterenol/Terbutaline

Back 38

Longer acting (not metabolized by COMT)

Front 39

Albuterol

Back 39

Inhalation, not metabolized by COMT. Increased Beta-2 selectivity, usually most appropriate choice of aerosols in acute asthma attacks

Front 40

Salmeterol

Back 40

Beta 2 selective agonist. NOT FOR ACUTE. Used for long term tx of asthma and prevention of bronchospasm in adults w/ reversible COPD.

Front 41

Side effects associated w/ Salmeterol?

Back 41

Tachycardia, Hyperglycemia, Hyperkalemia

Front 42

What is the Corticosteroid, Beta-agonist combination drug administered by inhalation for asthma?

Back 42

Salmeterol:Fluticasone (ADVAIR)

Front 43

Catecholamines used for Asthma?

Back 43

Epinephrine, Isoproterenol,

Front 44

Mechanism of action for Epinephrine?

Back 44

Number 1 drug for treatment of status asthmaticus (can cause V.Fib).

Activates alpha and beta receptors. Alpha effects relieve mucosal edema and upper airway congestion. Used for tx of acute bronchospasm, resp. manifestations of anaphylaxis, or tx or severe asthma.

Front 45

Isoproterenol?

Back 45

Non-selective Beta agonist. Not used much b/c of cardiac effects.