Asthma Drugs

Front 1

What are the 7 classes of long term medications used for the treatment of asthma?

Back 1

1) Inhaled corticosteroids
2) Systemic corticosteroids
3) Inhaled Cromolyn sodium and Nedocromil
4) Inhaled long-acting beta2 agonists
5) Theophylline
6) Systemic Leukotriene modifiers
7) Omalizumab

Front 2

What are the drugs of choice for asthma treatment long-term?

Back 2

Inhaled corticosteroids

Front 3

What are three important inhaled corticosteroids?

Back 3

1) Budesonide
2) Fluticasone
3) Mometasone furoate

Front 4

What is the mechanism of inhaled corticosteroids?

Back 4

They are anti-inflammatory medications that reduce the markers of airway inflammation in the airway

Front 5

Who should use inhaled corticosteroids?

Back 5

Asthmatics who use beta2 agonists more than twice a week or twice a month during nighttime attacks

Front 6

What are the clinical effects of inhaled corticosteroids?

Back 6

1) reduction in symptom severity
2) improved peak expiratory flow
3) decreased airway hyperresponsiveness

Front 7

Describe the localized adverse effects of inhaled corticosteroids

Back 7

1) Oral Candidiasis
2) Dysphonia (hoarseness)
3) reflex cough and bronchospasm

Front 8

Describe the systemic adverse effects of inhaled corticosteroids

Back 8

They are similar to that of oral steroids but significantly less likely to occur
1) impaired growth in children
2) osteoporosis
3) disseminated varicella
4) hypothalamic-pituitary dysfunction

Front 9

Describe the mechanism of action of cromolyn sodium

Back 9

It stabilizes mast cells and decreases their degranulation

Front 10

Of what is cromolyn sodium used as the major treatment?

Back 10

Prophylactic treatment of exercise-induced asthma

Front 11

Why are cromolyn sodium and nedocromil no longer used?

Back 11

The clinical response is less predictable than inhaled corticosteroids and take 4-6 weeks to reach maximum benefit

Front 12

What are the examples of long-acting beta2 agonists? (that we need to know)

Back 12

1) salmeterol
2) formoterol
3) salmeterol/fluticasone combo
4) budesonide/formoterol combo

Front 13

Until recently, what was the preferred agent for concomitant use with inhaled corticosteroids?

Back 13

Long-acting beta 2 agonists

Front 14

Should beta 2 agonists be used as monotherapy in the treatment of asthma?

Back 14

No, they are contraindicated as monotherapy

Front 15

Salmeterol and formoterol are also used to treat what disease?

Back 15

COPD

Front 16

Which is better, raising a steroid dose or adding a long-acting beta agonst?

Back 16

It is better to add a long-acting beta 2 blocker

Front 17

If a patient has an acute exacerbation of asthma, should they us a long acting beta2 agonist?

Back 17

No, they have a black box warning against the use in acute exacerbation

Front 18

Describe the proposed mechanism of action of theophylline

Back 18

It can cause smooth muscle relaxation by inhibition of phosphodiesterase resulting in an increase in cAMP

Front 19

Describe the clinical use of theophylline

Back 19

It is a mild-to-moderate bronchodilator used as an adjuvant to inhaled corticosteroids for prevention of nocturnal symptoms

Front 20

Describe the therapeutic range of theophylline

Back 20

It is very narrow

Front 21

What are the adverse side effects of theophylline?

Back 21

anorexia, nausea and vomiting nervousness, insomnia, tremor, ulcer or reflux aggravation

above 40mcg/ml can cause seizures and arrhythmias

blood levels need to be monitored

Front 22

What are the three leukotriene modifiers?

Back 22

1) montelukast
2) zafirlukast
3) zileuton

Front 23

What is the mechanism of action of montelukast?

Back 23

It is a leukotriene receptor antagonist

Front 24

What are the clinical uses of montelukast?

Back 24

It is used in mild asthma or allergic rhinitis

Front 25

What are the adverse side effects of montelukast?

Back 25

Possible neuropsychiatric events

Front 26

What is the mechanism of action of zileuton?

Back 26

It is a leukotriene synthesis inhibitor that blocks 5-lipoxygenase

Front 27

What are the clinical uses of zileuton?

Back 27

Exercise induced asthma and aspirin induced asthma

Front 28

What are the adverse side-effect associated with zafirlukast?

Back 28

1) GI upset
2) Churg-Strauss

Front 29

What are the clinical uses for leukotriene modifiers?

Back 29

They can be used as monotherapy for mild asthma (but less effective than inhaled corticosteroids) or as an adjunct to steroids in moderate asthma; they are not used for acute attacks

Front 30

What are some drug interactions associated with zafirlukast?

Back 30

1) inhibits metabolism of warfarin
2) meals decrease bioavailability

Front 31

What are the adverse reactions of zileuton?

Back 31

liver toxicity; should be avoided in pregnancy

Front 32

What is the mechanism of action of omalizumab?

Back 32

It is an IgG antibody that binds to human IgE and functions to inhibit the binding of IgE to antibody, limiting the release of mediators from the mast cells

Decreases IgE receptor expression

Front 33

Who can be treated with omalizumab?

Back 33

Adults or adolescents older than 12 with severe persistent asthma with a positive skin test to an allergen with increased IgE levels and an FEV1 between 40-80% predicted

Front 34

What is the black box warning associated with omalizumab?

Back 34

anaphylaxis (can be delayed up to a 4 days)

Front 35

What are the drugs used for quick relief of asthma ?

Back 35

1) inhaled short-acting beta2 agonists
2) inhaled anticholinergics
3) systemic corticosteroids

Front 36

What is most common inhaled short-acting beta2 agonist?

Back 36

albuterol and levalbuterol

Front 37

What are the clinical indications of short-acting beta 2 blockers?

Back 37

1) acute asthma attack
2) exercise-induced bronchospasm
3) regularly scheduled use is NOT RECOMMENDED

Front 38

What are the names of the inhaled anticholinergic?

Back 38

tiotropium bromide
ipratropium bromide

Front 39

Describe the mechanism of action of tiotropium

Back 39

It is a competitive inhibitor of muscarinic cholinergic receptor inhibitor

Front 40

Inhaled anticholinergics are used to treat what illnesses?

Back 40

COPD and asthma

Front 41

What systemic corticosteroids are used in the treatment of asthma and in what situation would they be used?

Back 41

Prednisone and methylprednisone; they are used for asthma exacerbations unresponsive to bronchodilators

Front 42

function of Endoplasmic Reticulum (ER)

Back 42

stores
separates
cell's transport system

Rough ER has ribosomes, smooth does not