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44 Cards in this Set

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