Pharmacology Exam 4

Front 1

Definition of asthma

Back 1

Inflammation of the airway- bronchospasms, thickened mucous production, edema.
1- Intrinsic asthma: exercise, cold, psychological
2- Extrinsic asthma: specific allergens

-NOT the same as COPD

Front 2

Normal airway physiology

Back 2

- Particles activate tracheal sensors--> cough reflex & smooth muscle constriction
- Increased mucous production (amount and stickiness)
- Prolonged irritation --> activation of immune system (release of immunomodulators and immigration of immune cells)
- Other factors: dietary, aspirin, exercise, cold air, etc

Front 3

Status asthmaticus

Back 3

One asthma attack after another

Front 4

Cells of the asthmatic response

Back 4

Immune cell: IgE binding causes synthesis and secretion of histamine, leukotrienes, and cytokines; beta 2 binding increases cAMP which shuts off synthesis and secretion

Bronchial smooth muscle: Muscarinic receptors (ACh), beta 2 binding inc cAMP and causes relaxation, leukotrienes cause constriction

Front 5

Non-pharmacologic Tx of asthma

Back 5

Patient education, change the environment, stop using bronchospasmic drugs (beta blockers, cholingeric agonist, NSAIDS), diet (stay away from sulfites)

Front 6

DOC for short term asthma relief

Back 6

Bronchodilators, the beta 2 agonists

Front 7

Beta 2 agonists (2)

Back 7

1- Epinephrine: activates ALL adrenergic receptors; increases HR and BP w/ many other SE; used to Tx anaphylactic shock
2- Isoproterenol: More selective B2 agonist but still has some B1 effects

- Both have a short T.5

Front 8

Selective B2 agonists (5)

Back 8

1- Albuterol
2- Terbutaline
3- Pirbuterol
4- Bitolerol
5- Levalbuterol

- Longer T.5, more selective, inhaled

Front 9

Less selective B2 agonist (3)

Back 9

1- Ephedrine
2- Isotharine
3- Metaproterenol

Front 10

Longer acting B2 agonist (4)

Back 10

1- Formoterol
2- Arformoterol
3- Salmeterol
4- Indacaterol

- Used for prophylaxis

Front 11

Side effects for B2 agonists

Back 11

Long term use decreases B2 receptor sensitivity, tremors, tachycardia, palpatations

Front 12

Cholinergic Blockers (2)

Back 12

1- Ipratopium bromide
2- Tiotropium

- Inhaled, half as effective as B2 agonists, fewer SE but have muscarinic effects, mydriasis, loss of accommodation

Front 13

What is the primary use for cholinergic blockers?

Back 13

Tx of COPD

Front 14

Phosphodiesterase Inhibitor (1)

Back 14

1- Theopylline: given IV or orally; inhibits PDE --> inc cAMP

SE: CNS stimulation(tremors, insomnia, seizures), cardiovascular stimulation (arrhythmias), GI upset

Front 15

Mast cell inhibitors (2)

Back 15

1- Cromolyn
2- Nedocromil

- Fewer SE cause it's not absorbed systemically
- Inhibits the release of mediators from immune cells
- Used prophylactically in kids

Front 16

Glucocorticoids (9)

Back 16

DOC for prophylaxis
1- Beclomethasone
2- Budesonide
3- Flunisolide
4- Fluticasone
5- Mometasone
6- Triamcinolone
7- Ciclesonide
8- Prednisone
9- Dexamethasone

Front 17

Mech of action of glucocorticoids

Back 17

Immunosupressants; long term effects w/ systemic use

Front 18

Anti IgE antibody

Back 18

1- Omalizumab: Binds to IgE, given by injection, can induce an immune response, adjunctive to other drugs

Front 19

Leukotriene synthesis inhibitor

Back 19

1- Zileuton: inhibits the enzyme 5-lipoxygenase (which synthesizes leukotrienes)

SE: liver damage, metabolized by P450

Front 20

Leukotriene receptor blockers (2)

Back 20

1- Zafirlukast
2- Montelukast

Increase in liver enzymes