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44 Cards in this Set
- Front
- Back
What leukotriene is a chemoattractant of inflammatory cells?
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LTB4
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Chronic inflammation in the bronchi leads to what?
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hyperreactivity to inhaled substances like histamine, muscarinic agonists, SO2 and cold air
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What are the short acting and long acting Beta-2 agonists?
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Short:
1) albuterol 2) terbualine 3) metaprolenol 4) terenol Long: 1) Salmeterol 2) formoterol |
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How long do the short acting beta-2 agonists last? Long acting?
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1) 6hours
2) 12hours |
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What is tachyphylaxis?
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Rapid loss of responsiveness to a stimulus
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What is the MOA of beta-2 agonists?
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stimulate adenylyl cyclase to increase cAMP in smooth muscle cells leading to bronchodilation
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Which beta-2 agonists are good for asthma prophylaxis?
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Long acting:
1) sameterol 2) formoterol |
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Can patients with COPD benefit from beta-2 agonists?
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yes
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What are the adverse effects of beta-2 agonists?
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1) tremor
2) beta-1 activity in high doses 3) tachycardia 4) arrhythmias 5) tachyphylaxis |
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What are the 3 types of methylxanthines?
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1) caffiene = coffee
2) theophylline = tea 3) theobromine = cocoa |
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What is the MOA of methylxanthines (theophylline)?
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inhibit phosphodiesterase to prevent degradation of cAMP. They may also block adenosine receptors in the CNS
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what effects does theophylline have on the body?
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1) bronchodilation
2) increased diaphragm strength contraction 3) CNS and cardiac stimulation 4) vasodilation with INCREASED blood pressure 5) increased GI motility |
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What is pentoxifylline? What is it used for?
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a methylxanthine derivative that helps with intermittent claudication from decreasing blood viscosity
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What are the toxicities of theophylline?
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1) GI distress
2) tremor 3) insomnia 4) N/V 5) hypotension 6) arrythmias 7) convulsions |
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What can be used to reverse the effects of theophylline on the heart?
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beta-2 blockers
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What is ipratropium? What drug is long acting with a similar mechanism?
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1) a quaternary amine antimuscarinic
2) tiopropium |
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What is the MOA of ipratropium?
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competitively blocks muscarinic receptors in airways and prevents CN X discharge
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When can ipratropium be used?
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1) 33-66% of asthma cases (especially children)
2) COPD Note: does not effect inflammatory aspects of asthma |
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What drug is successful in nearly all asthmatic patients?
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beta-2 agonists
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What are the side-effects of ipratropium?
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1) atropine like effects
2) NO tremor or arrythmias like beta-2 agonists |
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Why is cromolyn so unusual for a drug?
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1) high insolubility so low blood levels
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What is the MOA of cromolyn?
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decrease the release of leukotrienes and histamine from mast cells
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Can cromolyn help with a asthmatic person whose airways are already broncho constricted?
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no it can only help if given before the person is exposed to allergen to prevent release of histamines
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What other condition can cromolyn be given with?
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ingested with meal for food allergy and applied to skin for allergic reactions
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What are the toxicities of cromolyn?
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cough and irritation of airways
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Which corticosteroids are given for asthma?
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1) beclomethasone
2) budesonide 3) dexamethasone 4) flunisolide 5) fluticasone 6) mometasone |
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What is the first line therapy for moderate to severe asthma?
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corticosteroids
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What are the IV corticosteroids used in status asmthaticus?
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1) prednisolone
2) hydrocortisone |
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What is the MOA of corticosteroids?
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decrease arachidonic acid synthesis by inhibiting phopholipase A2 and inhibit COX-2
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What are toxicities of corticosteroids used in asthma?
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1) changes in oropharyngeal flora causing candidiasis
2) regular can cause growth retardation in children but they eventually reduce full height |
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what is the MOA of zafirlukast?
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antagonist of LTD4 and LTE4 receptor
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What is the MOA of montelukast?
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antagonist of LTD4 and LTE4 receptor
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what types of asthmas are zafirlukast and montelukast effective against?
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excerise-, antigen-, and aspirin-induced bronchospasm
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Are zarfirlukast and montelukast recommended for acute asthma?
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no
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What are the toxicities of zafirlukast and montelukast?
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1) Churg-Strauss syndrome- medium and small vessel autoimmune vasculitis, leading to necrosis, mainly in lung
2) allergic granulomatous angiitis - extravascular granulomas, hypereosinophilia, and pulmonary and systemic small-vessel vasculitis Note: they are same conitions |
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What is the MOA of zileuton?
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inhibits 5-lipoxygenase needed for conversion of arachidonic acid to leukotrienes
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What is zileuton effective in preventing?
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exercise-, antigen and aspirin-induced asthma
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What is the toxicity of zileuton?
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1) elevated liver enzymes
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What is the MOA of omalizumab?
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monoclonal antibody against IgE that binds IgE on sensitized mast cells
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Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
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Albuterol
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Longer acting Beta 2 agonist is recommended for prophylaxis of asthma
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Salmeterol
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SelectiveB1 Receptor blockers that may be useful in treating patients even though they have asthma
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Acebutolol, atenolol, esmolol, metoprolol
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Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma
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Pindolol and acebutolol
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Long acting beta 2 agonist used in asthma
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Salmeterol
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