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30 Cards in this Set
- Front
- Back
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What are the goals of asthma treatment?
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Reduce impairment
(symptoms like cough and breathlessness, <2 rescue beta agonist uses/week, maintain normal pulmonary function and activity) Risk Reduction (exacerbations, permanent airflow obstruction, medication side effects) |
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What are the treatment steps for asthma?
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1: short acting beta agonists (albuterol)
2: inhaled corticosteroids 3: Long acting beta agonist (salmeterol, formoterol, arformoterol) or increased dose of inhaled corticosteroids. Might also consider leukotriene modifier, tiotropium, or theophylline. 4: Do what was not done in 3 (increase inhaled steroids or add long acting beta agonist) 5: High dose inhaled corticosteroids and consider omalizumab 6: Oral prednisone |
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What are the 2 categories of asthma targets and what drugs work in each category?
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Acute airflow obstruction: beta agonists, anticholinergics
Airway inflammation: corticosteroids, anti leukotrienes, anti IgE, allergen avoidance |
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What are the primary rescue medicines?
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Beta2-agonists
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When are rescue medications given?
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Given for relief of dyspnea, cough, wheeze, or chest tightness
Given prophylactically for exercise |
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How long do rescue medicines last for?
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4-6 hours
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Alpha adrenergic receptor: affects in asthma?
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Vasoconstriction
Few receptors in airway smooth muscle |
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Beta adrenergic receptors: how do they signal?
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Signal through G proteins to alter cAMP, SRC tyrosine kinase
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Where are beta 1-3 receptors found?
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1: cardiac
2: airway smooth muscle, vascular smooth muscle 3: adipose tissue (enhance lipolysis) |
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What drug is chiral? Why does this matter?
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Albuterol
S enantiomer binds poorly to the receptor, is cleared slowly, and in animals may provoke inflammation. Use R enantiomer for Rx. |
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What are examples of controller medications?
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Inhaled corticosteroids
Leukotriene modifers Omalizumab |
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What are the very general affects of controller medications?
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Can improve function
Can improve symptoms Uncertain if it alters natural history and may affect the structural changes of remodeling |
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Inhaled corticosteroids: metabolism?
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First pass liver metabolism reduces systemic availability
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Inhaled corticosteroids: MOA
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unknown
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Side affects of inhaled corticosteroids
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Suppression of growth in children
Oral thrush and vocal cord dysfunction Increased cataracts Increased loss of bone |
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Name the three long acting beta-2 agonists. How long do they act?
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Salmeterol
Formoterol Arfomoterol 12 hours |
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Indacaterol: length of action?
side effects? |
24 hours
Cough Little tremor Tachycardia |
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Name the steroid/LABA inhalers and the combinations they represent.
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Advair: fluticasone/salmeterol
Symbicort: budesonide/formoterol Dulera: mometasone/formoterol |
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How are muscarinic receptors for acetylcholine involved with asthma?
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M1 and M3 mediate constriction of airway smooth muscle. M2 inhibits release of acetylcholine from parasympathetic nerves in airway
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Tiotropium MOA, length of action
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Hits M1 and M2 receptors
24 hours |
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Name the leukotriene modifier
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Zileuton
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Zileuton: MOA, side effects
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Inhibitor of 5-lipooxygenase
Liver dysfunction, so rarely used |
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What are the leukotriene receptor antagonists?
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Montelukast
Zafirlukast |
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Leukotriene modifiers: how frequently are they affective? what patients?
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1/3 of patients
Aspirin sensitive asthma |
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What is the anti IgE antibody?
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Omalizumab
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How does omalizumab affect asthma?
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Reduces allergic bronchoconstriction and late phase reactions
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What are the side effects of omalizumab?
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Anaphylaxis
Churg-Strauss |
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What are the disadvantages of omalizumab besides side effects?
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Does not cure asthma
Very expensive |
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Describe the things available to treat COPD.
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Smoking cessation
Inhaled ipratropium, beta agonist using MDI Long acting - tiotropium Oxygen |
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COPD Rx: prevention drugs? increased sputum? severe dz?
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Flu vaccine, pneumovax
Antimicrobials for increased sputum (amoxicillin, doxycycline, macrolides) Inhaled corticosteroids |
