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14 Cards in this Set
- Front
- Back
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Current drug therapy for asthma includes ____ and _____ types of therapy.
Who does the worst (biggest FEV1 % fall per dose) in a histamine and methacholine challenge test? |
maintenance and rescue/acute
Asthma --> COPD --> Normal |
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What classes are used for rescue therapy?
Is there direct sympathetic innervation of bronchial smooth muscle? Para? |
B2 agonists:
epinephrine, albuterol No. Adrenal EPI --> dilation Yes --> ACh --> M3 --> contraction |
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What is salmeterol (formoterol is similar)? When is it useful?
Is it good to rely on PRN relief-drugs (B2-agonists) during times of deteriorating asthma (long-term)? Should B2-agonists be used in maintenance therapy? Regular use longer than ___ of B2 agonists is not advised b/c it can lead to drug tolerance. |
a long-acting B2-selective agonist; primarily in concert w/ inhaled corticosteroids.
No. Controversal. Evidence of decreased needed response during acute episodes; increase in death; w/o concurrent corticosteroids, maintenance B2-agonists tx may *Increase* the lvl of inflammation. 1wk. |
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What does salmeterol do to the dose of ICS needed?
What is Advair? |
Decreases it.
ICS + salmeterol |
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Beclomethasone, triamcinolone, flunidolide, fluticasone, budesonide... all are ICS examples. Which are long-acting?
What is the mech of ICS in asthma? what is the goal of ICS tx in asthma? Side effects? (3) |
fluticasone, budesonide.
target lung inflammation w/o systemic effect (even though much is swallowed, they're structured so that the liver will metabolize them before hitting the system) improved sx, and lowered need for rescue tx w/ B2-agonists. Thrush (oropharyngeal candidiasis) dysphonia modest decrease in bone density |
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Should ICS be used in children?
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have to closely monitor it, especially in those <4yo. It hasn't been adequately studied; most work so far shows that most children tx'ed reach full height.
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What is the pharmacological importance of cAMP i/Lung? (3)
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^^ cAMP --> ^^PKA --> ^^protein phosphorylation
1.) relaxation of airways 2.) i/ mast cells inhibits degranulation 3.) i/immune & inflamm cells inhibits their "function" |
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What two drugs inhibit cyclic nucleotide phosphodiesterase? effect?
Do these aid in controlling chronic inflammation or bronchospasm? |
caffeine, theophylline
elevates cAMP lvls. Both. |
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What are some advantages of Theophylline?
Mech? (2) Toxicities? High or low therapeutic index? Commonly involved in ADRs? What drugs with a similar idea behind them will likely be more effective? |
orally admin, very cheap.
- inhibits all 15 PDEs - antag of adenosine receptors (which when actv cause bronchoconstriction) - anxiety, restlessness, agitation, seizures... - Very low - Yes PDE isozyme 4 inhibitors (the isozyme found in most inflamm cells) |
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What do Cromolyn Sodium and nedocromil do?
**note, not required knowledge** |
mech unclear: mast cells stabilizers?
used in maintenance therapy in mild to moderate asthma; may have advantages in tx'ing children. |
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What are zafirlukast (accolate) and montelukast (Singulair)? Do they typically have higher compliance than ICS?
What are some disadvantages of them? Which (not listed here) is limited by it's liver toxicity? |
leukotriene blockers
Yes, typically. have not been proven to be as generally effective as ICS in maintenance of moderate to severe asthma. zileuton. |
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What is Omalizumab? Mech? Administered?
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Antibody against IgE
IgE bound by it can't b/ mast cells and basophils (prevents allergic rxn at an early step). Single subCut injection every 2-4wks; hl = 26days; single injection reduces free IgE by 95%; cost is $12,000 a year. |
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What are ipratropium (Atrovent) and tiotropium (Spiriva)?
difference b/t them? More effective in COPD or asthma? Why? |
muscarinic competitive antagonists
Ipratropium has no selectivity, and tiotropium is m1/m3 selective. COPD, b/c parasymp actv is more of a factor in COPD. |
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What might the Gly16 (as opposed to the Arg16) form of the B2 receptor be associated with?
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more severe dz, more pronounced receptor desensitization.
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