Bronchodilator/asthma

Front 1

Asthma: more adults than kids die from it, women greater than men
Goal of therapy is near or complete freedom from Sx or death, decrease of inflammation & frequency of attacks

Back 1

Permanent changes:
 Chronic bronchial inflammation
 Mucosal thickening from endema
 ↑ # of goblet cells and ↑volume of mucosal secretion
 ↓# of ciliated epithelium
 Basement membrane thickening
Infiltration of activated immune cells: eosinophils and mast cells; Thickening of smooth muscle layer

Front 2

1. What is the hyperreactivity of trachea and bronchi to a stimuli (allergens, emotions, exercise, infection etc)
2. What does 1 result in?
3. What generic thing to take to counteract 2?

Back 2

1. Asthma
2. Constriction of airway smooth m. presents w/ SOB, chest tightness,wheezing
3. Bronchodilator

Front 3

Release of epinephrine in the lungs:
1. Receptor that it acts at?
2. Action of it?
3. What are 3 other things w/ same effect?
---Sympathetic

Back 3

1. Beta 2 Adrenergic receptor -> a GPCR
2. Bronchodilates
3. VIP, PGE2, NO

Front 4

Release of ACh in the lungs
1. Receptor it activates?
2. Other things w/ same effect
3. Action of them

Back 4

1. M3 - muscarinic'
2. ADENOSINE, Histamine, LEUKOTRIENES
3. Bronchoconstriction

Front 5

Bronchodilators can be beta adrenergic agonist, Muscarinic receptor or adenosine receptor Antagonists

Antiinflammatories: Glucocorticoids, Leukotriene R antagonists and syn. inhibitors, stabilize mast cells

Back 5

Albuterol Side effects: rare but probable
 Tachycardia, Nausea, nervousness, tremors, headache
 Can induce paradoxical bronchospasm, Hypo-responsiveness & sudden death

Front 6

1. What is a endogenous non-selective adrenergic receptor agonist?
2. What is it metabolized by?
SE: tremor, lt headedness, sweating, rise in blood sugar; ^ HR, vasoconstriction, paradoxical bronchospasm

Back 6

1. Epinephrine
2. COMT and MAO

CI: heart disease, ^ BP, diabetes, thyroid disease, seizures

Front 7

Name Drug (give onset & duration) [receptors]
1. Endogenous non-selective adrenergic R agonist
2. Isoproterenol -
3. Albuterol, terbutaline, Metaproterenol
4. Salmeterol

Back 7

1. Epinephrine (Rapid onset, short duration)[a1,2;b1,2]
2. (rapid onset, short dur.) [B1=B2 >>a] -
3. (rapid onset, short dur) [B2 specific] - inhaled
4. (slow onset, long dur - 12hr) [B2 specific)

Front 8

1. What if nonspecific BB and epinephrine?
2. Drugs that can increase 1/2 life of it?
3. When is isoproterenol indicated?
4. DIfference between isoproterenol and Epi in SE?

Back 8

1. epinephrine won't work b/c b2 is blocked -> so may make asthma attack worse
2. MAOi & tricyclic antidepressants
3. Acute broncospasm
4. Isoproterenol less impact on BP

Front 9

1. difference between albuterol and isoproterenol?
2. Indication of salmeterol? SE: headache, allergic dermatitis, life threatening paradoxical bronchospasm
3. Indication of Ipratropium /Tiotropium bromide

Back 9

1. Less CV effects due to lack of B1
2. Maintenance therapy; adjunct therapy for exercise & nocturnal asthma
3. Beta blocker induced asthma attacks & nocturnal/psychogenic

Front 10

1. Non-selective muscarinic receptor antagonist, blocks M3 on smooth m cell and submucosal glands; derivative of atropine
2. How is 1 given to prevent systemic spread?
3. Onset and duration?

Back 10

1. Ipratropium bromide & Tiotropium bromide (lasts longer)
2. inhaler
3. SLow onset and longer duration 3 - 24 hours
**Risk of mortality if used w/ COPD

Front 11

1. What is an e.g. of a methylxanthine? - given orally or IV
2. What is its MOA?
3. What is its indication?
4. What is the problem w/ giving it?
&many drug interxns, age dependnet clearance

Back 11

1. Theophylline (like caffeine)
2. mb works on mast cells
3. Exercise induced asthma or asthma maintenance
4. Very narrow therapeutic index >= 20, convulsion, arrhtymia, death. <=20 anxiety, N, tremor heachache anorexia

Front 12

1. Indication for Prednisone in lungs?
2. What is its MOA?
Other inhaled corticosteroids: Beclomethasone (5-11yo), Triamcinolone, Flunisolide, Fluticasone
SE: Decreased immune fxn, adrenal suppression, wt ^

Back 12

1. Moderate to severe asthma
2. inhibits immune cell fxn, decreases release/synthesis of mediators, decreased down-regulation of B receptors

Front 13

1. Drug that is used in combo w/ salmeterol?
2. What are proinflammatory mediators that sustain rxns.
Induce: bronchoconstriction, ^ mucus, hyper responsive airways, chemotaxis, vascular permeability

Back 13

1. Fluticasone - for severe asthma not controlled w/ steroid
2. Leukotrienes

Front 14

1. Imp leukotriene in asthma? (receptor?)
2. Can antiinflammatory drugs relieve acute bronchospasm?
3. What is a leukotriene synthesis blocker? (MA)

Back 14

1. LTD4 (CysLT1/2)
2. Nope need a beta 2 agonist
3. Zileuton (inhibits 5-lipoxygenase, drops LTD4 & activation of CysLT 1 & 2)

Front 15

1. What is Zileuton and when is it indicated?
Side effects:  Dyspepsia, nausea & Rare liver dysfunction, elevation of liver enzymes (2% of patients). **Half-life: 2.5 hours **
Interacts w/ CP450 enzymes

Back 15

1. blocks 5-lipoxygenase (maintenance mild-moderate asthma, CI in breast feeding and pregnancy)

Front 16

1. MA of Zafirlukast and Montelukast
2. Indication?
Adv: rapidly absorbed PO, reduces asthma and ^ pulmonary fxn, reduces exercise induced asthma, prevents or reduces allergen induced inflammation

Back 16

1. LeUKotriene AntagoniST -> blocks CysLT1 and 2
2. Maintenance only > 6 yo
SE: Rare: liver dysfunction, systemic eosinophilia, Increased infection rate in elderly, Limited experience with drugs in this class, contraindicated, during pregnancy and lactation

Front 17

1. A drug effective by inhalation only, inhibits allergen induced release of inflammatory factor by mast cells
-used as maintenance and prophylaxis only, least SE of all asthma b/c not systemically absorbed mb irritation, dry mouth, ***drug of choice in peds or pregnancy***

Back 17

Cromolyn sodium or nedocromil sodium

Front 18

1. What is an Anti-IgE Ab that binds at the mast cell or basophil binding site?
2. Bind free or circulating IgE?
3. What does it work amazingly in?
Admin is SQ every other week

Back 18

1. Omalizumab
2. Free - b/c it binds the binding site, triggers down reg of high affinity IgE receptors
3. Asthma induced by allergens
SE: allergic reaction