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76 Cards in this Set

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What are the classifications of asthma severity
Mild intermittent; mild persistent; moderate persistent; sever persistent
Name three β-adrenergic agonists used to treat asthma
Terbutaline, albuterol, salmeterol (sympathomimetics)
Name a muscarinic antagonist used to treat asthma
Name a methylxanthine used to treat asthma
An four corticosteroids used to treat asthma
Beclomethasone; Fluticasone; Budesonide; Prednisone
Name three leukotriene pathway modifiers used to treat asthma
Zileuton, Zafirlukast; Montelukast
Name two release inhibitors used to treat asthma
Cromolyn, nedocromil
Name an anti-IgE therapy used to treat asthma
How do β2-agonists help treat asthma
Bronchodilation via β2-receptor mediated smooth muscle dilation
How do corticosteroids help treat asthma
Decrease production and release of proinflammatory cytokines; decrease inflammatory cell activation, recruitment, and infiltration; decrease vascular permeability; decrease mucous production; increase number and sensitivity of β2-adrenergic receptors
How do mast cell stabilizers help treat asthma
Prevent mast cell degranulation thereby dereasing release of histamine, platelet activating factor, leukotrienes, and other mediators that cause bronchoconstriction
How do inhaled anticholinergics help treat asthma
Competitively inhibit muscarinic receptors thereby inhibiting vagal-mediated bronchoconstriction; reduce mucous production
How do phosphodiesterase inhibitors help treat asthma
Increase cAMP which causes bronchodilation
How do 5-lipoxygenase inhibitors help treat asthma
Inhibits production of LTC4, LTD4, and LTE4 from arachidonic acid thereby preventing bronchoconstriction
What β2-agonist is commonly used as a tocolytic agent (stops premature labor by relaxing uterine smooth muscle)
What cation can be used as a tocolytic agent
Are β2-agonists metabolized by COMT
No (β2-agonists are not catecholamines)
Is cromolyn used for treatment of prevention of an asthma attack
Is nedocromil effective during an acute asthma attack
What are the side effects of mast cell stabilizers
Bitter taste; throat irritation
What are the side effects of β2-agonists
Tachycardia; muscle tremors; anxiety; arrhythmias; Hyperglycemia; Hypokalemia; Hypomagnesemia (systemic side effects are minimized when drug is delivered via inhalation)
What are the side effects of 5-lipoxygenase inhibitors are leukotriene antagonists
Increased liver function test (LFTs); Headache; Churg-Strauss syndrome
What is the main nonsystemic side effect of inhaled corticosteroids
What is thrush
Oropharyngeal candidiasis
How can you prevent thrush when using inhaled corticosteroids
Use of spacer device; rinse mouth with water after medication use
What is a possible systemic side effect of inhaled corticosteroids
Decreased growth of long bones
If using an inhaled corticosteroid and β2-agonist together, which do you use first
β2-agonist (bronchodilates the airways thereby increasing amount of corticosteroid that is delivered to its site of action)
What are the side effects of theophylline
Central nervous system excitation (narrow therapeutic index)
Give an example of a methylxanthine other than theophylline
Why do inhaled anticholinergics have a minimal side effect profile
Quaternary ammonium derivatives of atropine, therefore, do not leave the pulmonary system and cannot cross the blood-brain barrier
What are examples of systemic anticholinergic side effects
Dry mouth; Dry eyes; Constipation; Urinary retention; Blurred vision; Mydriasis; Drowsiness; Tachycardia
How do you treat β-blocker induced bronchospasms
Ipratropium, Tiotropium
Name two drugs used to treat an acute asthma attack
Epinephrine; Albuterol
What is the IV form of theophylline called
Aminophylline (2:1 complex of theophylline and ethylenediamine)
What is the term used to describe a severe asthma attack that does not respond to usual asthma therapy
Status asthmaticus
How is status asthmaticus treated
Oxygen; Inhaled albuterol; Intravenous or oral corticosteroids; inhaled anticholinergics
What is the drug of choice for mild asthma
Short-acting β2-agonist
What is the maintenance drug of choice for chronic asthma
Inhaled glucocorticoid
How is theophylline primarily metabolized
Hepatic cytochrome P-450 enzymes (CYP 1A2 and CYP 3A4)
Give examples of medications that can lead to increased theophylline levels when used concomitantly
Cimetidine; Erythromycin; Fluoroquinolones
What drug can cause asthma, nasal polyps, and rhinitis
What is asthma
Asthma is a reversible chronic inflammatory disease of the tracheobronchial airways characterized by airflow obstruction and increased responsiveness to a variety of stimuli
Name the causes of airway obstruction in asthma
Inflammation of the bronchial wall; Constriction of the bronchiolar smooth muscle; Increased mucus secretion
How is asthma clinically manifested
Shortness of breath; Coughing; Wheezing; Use of accessory muscles of respiration; Chest tightness
What precipitates an asthma attack
Allergens; Infections; Psychological factors
List the pharmacologic options for asthma therapy
Sympathomimetic agents (β2-adrenergic agonists); Corticosteroids; Anticholinergics; Leukotriene inhibitors; Methylxanthines—theophyilline; Cromolyn sodium and nedocromil
Which asthma agents are considered safe to use in pregnant women
All of them; pregnant women with asthma should be treated as aggressively as are nonpregnant asthma patients
How do β2-adrenergic agonists work
They work by increasing cAMP, which results in bronchodilation
Name four β2-adrenergic agonists that are commonly used for asthma therapy
Salmeterol—long acting, not for acute symptoms
How are β2-adrenergic agonists usually administered
Most of these drugs are inhaled, which minimizes their systemic side effects because β2 agonists are poorly absorbed into the circulation via the lungs
What is the clinical role of sympathomimetic agents
Because they are rapid onset, β-adrenergic agonists are the drugs of choice for acute relief of bronchospasms
Are there adverse effects of inhaled bronchodilators
Yes. The most common are tremor and tachycardia
How do steroids work in treating asthma
Steroids reduce inflammation by: Reversing mucosal edema; Decreasing the permeability of capillaries; Inhibiting the release of leukotrienes and cytokines
When are corticosteroids used in asthma management
For both acute and maintenance asthma management
Name four inhaled steroids used in the management of chronic asthma
What are the adverse effects of inhaled corticosteroids
Cough, oral thrush, and dysphonia
What are the adverse effects of systemic corticosteroids such as prednisone
The list is long and includes abnormalities in glucose metabolism, increased appetite, weight gain, hypertension, and adrenal suppression
How do anticholinergics work
Parasympathetic stimulation causes bronchial constriction and mucus secretion. Anticholinergics are used to block these responses and maintain bronchial dilation of the airway
Name an anticholinergic agent used to treat asthma
Ipratropium, an inhaled anticholinergic
What are the clinical uses of Ipratropium
Treatment of asthma and chronic obstructive pulmonary disease
What side effects may patients experience while using ipratropium
Dry mouth and sedation. The drug has very few side effects owing to poor systemic absorption
Describe how leukotriene inhibitors work
They block the formation of leukotrienes from arachidonic acid
Give two examples of leukotriene inhibitors and state the mechanism of action of each
Zileuton—5-lipoxygenase inhibitor
Zafirlukast—LTD4 receptor antagonist
What is the route of administration of leukotriene inhibitors
In asthma, what is the clinical role of leukotriene inhibitors
They prevent bronchoconstriction and airway inflammation. Leukotriene inhibitors are used for chronic maintenance therapy; they should not be used for acute bronchospasm
What are the adverse effects of leukotriene inhibitors
Zileuton—some cases of hepatitis have been reported
Zafirlukast—Drug allergy has been reported
What is theophylline and how does it work
Theophylline is a methylxanthine derivative that increases levels of cAMP by inhibiting the enzyme phosphodiesterase, which results in bronchodilation. Theophylline also has some anti-inflammatory effects
Are there any drug interactions with theophylline
Cimetidine and erythromycin both increase theophylline plasma levels
Which drugs decrease plasma levels of theophylline
Phenytoin and quinolones
What are possible complications with theophylline overdose
The most common are tremor, insomnia, gastrointestinal distress, and nausea. The most dangerous are seizures and arrhythmias
What are cromolyn sodium and nedocromil, and how do they work
They are effective prophylactic agents that stabilize the membranes of mast cells and prevents mediator release, probably by blocking calcium gates
Can cromolyn sodium and nedocromil be used for treating acute attacks of asthma
No. They are effective prophylactic agents. Pretreatment with cromolyn or medocromil blocks allergen-induced and exercise-induced broncho-constriction
What are the potential toxicities of cromolyn and nedocromil
Cromolyn—infrequent laryngeal edema, cough, and wheezing
Nedocromil—unpleasant taste
What is status asthmaticus
A life-threatening attack of asthma
How do you treat status asthmaticus
IV corticosteroids and bronchodilators are first-line therapy, followed by theophylline
Which agent is the drug of choice for long-term care of asthma in the outpatient setting
Current recommendations state that patients with mild, persistent symptoms should be started on an inhaled steroid such as fluticasone propionate for routine use. Acute attacks are treated with β2-adrenergic agonists