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32 Cards in this Set

  • Front
  • Back
6 classes of drugs for asthma
1. beta 2 agonists
2. muscarinic blockers
3. cromones (inhibit mast cell release)
4. antiphosphodiesterases
5. leukotriene receptor blockers
6. glucocorticoids
Epi for asthma? when to use?
in emergency situation for a severe attack

would have lots of S/E
albuterol
beta 2 selective agonist
terbutaline
beta 2 selective agonist
salmeterol
beta 2 selective agonist (long lasting)
when would oral beta 2 agonists be used?
coordination impaired people or people whose airways are irritated by aerosols
what are side effects from too much albuterol?
tachycardia
muscle tremor
dizziness
arrhythmias
mechanism of beta 2 agonist treatment of asthma
beta 2 - adenylyl cyclase - cAMP - PKA -
MAJOR
1. bronchodilation (inhibit MLCK)

MINOR
2. decrease mast cell release
3. increase ciliary function
4. vascular endothelium - maintain integrity (decrease permeability)
what is main innervation of bronchial smooth muscle?
parasympathetic. no sympathetic innervation, just receptors
ipatroprium
anticholinergic

most effective in COPD and emphysema rather than asthma
combivent
ipatropium + albuterol
method of action of anticholinergics
1. block muscarinic receptor induced vasoconstriction
2. decrease secretions
3. decrease vasodilation (decreases inflammation)

most effective in COPD and emphysema rather than asthma
theophylline
antiphosphodiesterase

increases cAMP
methylxanthines
antiphosphodiesterases
When are antimuscarinics for asthma a good idea?
people with psychogenic exacerbation of asthma

people on beta blockers for hypertension, migraines, tachycardia, arrhythmia, etc
Mechanisms of antiphosphodiesterases?
MAJOR:
1. inhibits phosphodiesterase

minor:
1. blocks adenoside receptors
2. decreases fatigue of respiratory muscles and helps to strengthen accessory breathing muscles (makes it helpful for COPD)

narrow therapeutic index
what drug is good for someone who has asthma in the early morning?
salmeterol (long lasting wont run out on them)
method of action of glucocorticoids on asthma treatment?
change gene expression
decreases inflammation in airway
decreases vascular permeability
increases # of beta2 receptors! (gene expression)
beclomethasone
glucocorticoid (inhaled)

front line controller therapy
fluticasone
glucocorticoid (inhaled)

front line controller therapy
advair
advair = fluticasone and salmeterol

great drug b/c it has quick reliever + inflammation controller
S/E of aerosol glucocorticoids
1. adrenal suppression (- FB)
2. bone resorption
3. increase blood glucose (stress hormone)
4. cataracts
5. purpura
6. dysphonia
7. candidiasis - thrush in throat due to immune suppression
8. growth retardation in children
method of action of cromones
MAJOR: inhibit mast cell release

2. decrease response to inhaled allergins
3. inhibits irritant receptors in airway
4. decreases plasma exudation in airway
cromolyn
cromone
nedocromil
cromone
how long do cromones take?
6 weeks
drug for exercised induced asthma?
cromones: cromolyn or nedecromil
what can be used for children with allergen induced asthma before going to glucocorticoids?
cromones
omalizumab
monoclonal antibody against IgE
xolair
omalizumab
how does NO cause vasodilation and bronchodilation?
NO activates guanylyl cyclase, which produces cGMP, which inactivates MLCK, which decreasing smooth muscle contraction.

[NO inhibits MLCK]
NO effects?
vasodilation
bronchodilation
atherosclerosis - less NO, less antioxidant activity
septic shock - mediates vasodilation
inflammation - exacerbates inflammatory states

may one day be used in lung transplant patients, resp edema, pulm embolism, pulm HTN, etc, etc b/c it causes bronchodilation