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65 Cards in this Set
- Front
- Back
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what is the ab involved in the initiation of asthma?
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IgE synthesized by B cells and mast cell sensitization
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How long after first exposure will mast cells degranulate upon reexposure?
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1-2 weeks
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what 2 cytokines do marcophages secrete during the 1st wave of asthma attack?
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TNF-alpha
GM-CSF |
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what 2 preformed mediators do mast cells release?
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histamine
remdeoling enzymes |
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what 2 entothelial alterations occur during the 2nd wave of an asthma attack?
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increased adherence of neutrophils due to IL-1/TNF-alpha
endothelial cells separate due to IL-1/TNF-alpha |
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what happens to neutrophils during the second wave of an asthma attack?
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integrin expression is increased via IL-8
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what 4 mediators cause capillaries to dilate during the 2nd wave of an asthma attack?
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histamine
heparin serotonin bradykinin |
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what 3 things do leukotrienes cause during the 2nd wave of an asthma attack?
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bronchoconstriction
vasodilation mucous secretion |
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what 4 things do prostaglandins do during the 2nd wave of an asthma attack?
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pain
bronchoconstriction vasodilation chemotaxis |
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what does IL-4 promote during the 2nd wave of an asthma attack?
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Ig-E synthesis
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what does IL-5 promote during the 2nd wave of an asthma attack?
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eosinophil chemotaxis
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what is the chronic hyper-reactivity of asthma attributed to? (2)
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T-cells and eosinophils
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how does the increase in Th2 activity lead to chronic asthma symptoms? (3)
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sistains IgE synthesis
mast cell activity eosinophil activity |
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what cells do not play as large a role in the chronic phase of asthma?
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mast cells
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in order for an inhaled drug to have minimum systemic effects, what 2 things should it do?
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drug should be poorly absorbed from the GI system
drug should be rapidly inactivated via first pass metabolism |
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what 2 things will beta-2 agonists do?
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relax airway smooth muscle
inhibit the release of broncho-constricting mediators from mast cells |
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what are 4 steps in the signal transduction pathway of beta-2 agonists? (3)
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increased cAMP levels and activation of PKA --> increased Ca++ efflux and Ca++ uptake into the ER --> relaxation of contractile proteins
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how fast do short acting beta-2 agonists work?
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1-5mins
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what are 3 short acting beta-2 agonists?
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albuterol
levalbuterol pirobuterol |
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what are long acting beta-2 agonists used for?
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not for use as a rescue inhaler, instead prevents asthma symptoms from occuring throughout day and night
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what are 2 long acting beta-2 agonists?
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salmeterol
formoterol |
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what 2 drugs can beta-2 agonists interact with?
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MAO-Is
tricyclic antidepressants |
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what 3 diseases should you use caution with when prescribing beta-2 agonists?
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CV disorders
convulsive disorders diabetes mellitus |
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who do you use oral beta-2 agonists for?
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children unable o use inhalers or in patients in which any inhaled substance may worsen cough
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what 2 things are glucocoricoids used for in asthma treatment?
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supress proinflammatory genes and express antiinflammatory genes
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what are 3 inhaled GCs used for asthma?
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budesonide
fluticasone triamcinolone |
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what are 2 systemic GCs used for asthma
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prednisone
methylprednisolone |
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what 7 things will decrease when Th2 and eosinophils are decreased by GCs?
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TNF-alpha
IL-2, IL-4, IL-5 leukotrienes prostaglandins mast cell production |
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what are 2 main concerns with inhaled GCs?
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oral candidiasis
pharyngitis |
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what 3 conditions should you use caution with when prescribing inhaled GCs?
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active infections
occular herpes simplex glaucoma |
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what is the 2 part theory behind combination inhalers?
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long acting beta-2 agonists cause bronchodilation
GCs decrease inflammation |
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what are 2 combination inhalers?
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salmeterol-fluticasone
formoterol-budesonide |
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what are 3 mast cell stabilizers?
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chromones
chromolyn sodium nedocromil sodium |
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what drug blocks the acute phase initiation of asthma and how?
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mast cell stabilizers by preventing mast cell degranulation
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what drug decreases airway hypersensitivity and how?
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mast cell stabilizers by inhibiting the activation of chloride channels in cells undergoing shape and volume changes associated with immune cell activation
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what is the main use for mast cell stabilization?
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exercise-induced asthma
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what are 2 leukotriene modulators?
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zarfirlukast
montelukast (singulair) |
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what is the one leukotriene sysnthesis inhibitors?
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zileuton
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what are 3 actions of leukotreienes?
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vasodilation
mucous secretion bronchoconstriction |
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what is more potent - leukotrienes or histamines?
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leukotrienes, 1000x
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what modulator is induced not preformed?
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leukotrienes
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what enzyme synthesizes leukotrienes?
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5-lipoxygenase
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what 4 cell types are leukotrienes found in?
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neutrophils
basophils eosinophils mast cells |
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what are 3 characteristics of leukotriene receptors?
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serpentine
7-transmembrane spanning domain G-protein coupled |
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what is the order of potency of effectiveness of cys-LT1 receptors?
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LTD4>LTC4>LTE4
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what 3 tissues are cys-LT1 receptors expressed in?
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smooth muscles
spleen peripheral blood leukocytes |
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what is the difference between leukotriene receptor antagonists vs synthesis inhibitors?
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receptor antagonists competitively block the effects of leukotriene binding to CysLT1
sythesis inhibitors inhibit 5-lipoxygenase |
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what is elevated a a side effect of leukotriene modulators?
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liver enzymes
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what are 3 effects of leukotriene modulators?
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decreased bronchoconstriction (decreased hyperreactivity)
decreased vasodilation (decreased edema) decreased mucous secretion |
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how are leukotrienes administered?
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orally
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what can ziluton specifically decrease? (2)
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warfarin and theophylline clearance
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why are beta-2 agonists more effective than M3 receptor antagonists?
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because M3 antagonists only restore normal tone, so the effectiveness of the medication is dependent on the normal tone
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what is a short acting drug that will block all muscarinic subtypes?
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ipatropium
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what is a long acting drug that will selectively block M1 and M2 subtypes?
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tiotropium
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is ipatropium long or short acting?
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short acting
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is tiotropium long or short acting?
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long acting
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what are the adverse reactions of mucarinic antagonists mostly due to?
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parasympathetic effects
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what are 5 contraindications for muscarinic antagonists?
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acute episodes of bronchospasm myasthenia gravis
narrow-angle glaucoma prostatic hyperplasia bladder obstruction |
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what are methylxanthines?
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smooth muscle relaxants
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what is the major downside of methylxanthine?
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narrow therapeutic window - higher levels can cause seizure or cardiac arrythmia
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what drug is methylxanthine contraindicated in and why?
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drugs that decrease the metabolism and clearance of theophylline (eg ziluton)
because it can increase plasma conentrations |
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what drug has a significant lag time and sees the return of symptoms as soon as treatment is stopped?
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anti-IgE antibodies
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what are 3 toxicities associated with anti-IgE antibodies?
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injection site reactions
disproportionate increase in CV disorders increased cancer risk |
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why are muscarinic antagonists more effective in COPD than asthma? (2)
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PNS activation is important in COPD pathology
anticholinergic effects help reduce mucous secretion |
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how long are corticosteroids used in COPD treatment?
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short term; long term is not advised
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