Pharmacology Test 3 - Bronchial Asthma

Front 1

Mild asthma suffer has about ____ attacks per week?

Back 1

2/week

Front 2

airway narrowing is treated by ?

Thickening mucus plug is treated by ?

Back 2

bronchodilator

anti-inflammatory drug

Front 3

TH1 or TH2?

usually a persons response to infection. Body has immune response to positively fight an infection

what we see in asthma. Usually release cytokines or inflammatory mediators.

Back 3

TH1

TH2

Front 4

cAMP is produced from the enzyme ___?___ and will cause bronchodilation

Back 4

adenylate cyclase

Front 5

___?___ breaks down cAMP

Back 5

phospodiesterases

Front 6

Muscarinic antagoist will block action of ACh and Theophylline will block adenosine in order to ___?___ bronchoconstriction

Back 6

stop

Front 7

When an inhaler is used, only ___?___ of drug reaches airways. The best particle size is ___?___ micrometers in diameter

Back 7

2-10%

2-5

Front 8

Typically .3-.5 mg ___?___ given IM used to treat anaphylactic shock. Don’t give it SubQ b/c the hypotension associated with shock will decrease blood flow to skin and it won’t get into the systemic circulation.

Back 8

epinephrine

Front 9

Longer duration than epi
Less potent than epi
Orally active (25 mg capsules)
Parenteral (50 mg/mL for injection)
Central side effects
Now not used in asthma

Crosses BBB and can cause HA

Back 9

ephedrine

Front 10

Preparations:
Inhalant 0.5, 1% for nebulization; 80, 131 mcg/puff aerosols
b1/b2 agonist:
Maximal bronchodilation within 5 min
60-90 min duration
Side effect: cardiac arrythmia

Back 10

Isoproterenol

Front 11

Short acting Beta 2 agonists

Back 11

Albuterol (Proventil, Ventolin)
Terbutaline (Brethine)
Metaproterenol (Alupent)
Pirbuterol (Maxair)

Front 12

SABA differ from epinephrine by having a ?

Back 12

large substitution on the -OH group

Front 13

Inhalant: 90 mcg/puff aerosol,
solution for nebulization
Oral: 2,4 mg tab; 2 mg/5mL syrup
Oral sustained release 4, 8 mg tab
R and S preparation

Most popular SABA

Back 13

albuterol

Front 14

Only one available for s.c. (0.25 mg)
Used similar to epi in emergency ttt of asthma when aerosolized therapy is not available or has become ineffective
Note that it has a long duration of action(cumulative effect)

Back 14

terbutaline

Front 15

Oral SABA include:

These have no advantages over inhalation and often cause side effects of:Skeletal muscle tremor
Tachycardia (note patients with CV diseases)
Nervousness, headache
HYPOkalemia (Na/K ATpase activation, gluconeogenesis, and insulin secretion)

Back 15

albuterol and terbutaline

Front 16

Most effective bronchodilators

First choice for severe acute asthma

Frequent administration (q20min)

Back 16

SABA (B2 agonists)

Front 17

Usually __?__ doses of 2.5 mg nebulized albuterol are needed for adults

Back 17

3

Front 18

Long acting Beta agonist include:

Back 18

salmeterol and formoterol

Front 19

Uses:
Combined with inhaled corticosteroids

Prophylactic against exercise-induced asthma

Nocturnal asthma (combine with corticosteroid, not more than twice a day)

Back 19

long acting beta 2 agonist (salmeterol and formoterol)

Front 20

When do you use oral beta 2 agonists?

Toxicities:
Decreased arterial oxygen tension (PaO2) …. Supplemental oxygen

Cardiac arrythmias

Tachyphylaxis / genetic polymorphism

Back 20

Children <5years old

Severe asthma exacerbations when aerosols may worsen cough or bronchospasm

Front 21

Methylxanthines include:

Not used much after Beta 2 agonist discovered. Main source is beverages

Back 21

Theophylline, aminophylline
Theobromine
Caffeine

Front 22

MOA:
PDE(4) inhibition:
Bronchodilation
Inhibition of cytokine release
Decreased immune cell
migration and activation

Adenosine receptors inhibition
Enhancement of histone acetylase

Back 22

Methylxanthines

Front 23

___?___ may restore corticosteriod responsiveness

Back 23

theophylline

Front 24

Uses: improves long term asthma control, alone or combined with corticosteroids .. Still not recommended by NIH for management of hospitalized asthma patients

Relieves acute asthma, controls chronic

has narrow therapeutic index and clearance is based on hepatic metabolism

Back 24

Methylxanthines (most effective is theophylline)

Front 25

Antimuscarinic agents include:

Back 25

ipratropium, tiotropium, and atropine

Front 26

delivered by inhalaltion, poorly absorbed into the circulation, and does not enter the CNS

Care when using a nebulizer (eye deposits)

Less effective bronchodilators than beta agonists, however, the addition of ___?___ enhances the bronchodilation action of nebulized albuterol in acute severe asthma

never use these as rescue inhalers

Back 26

ipratropium

muscarinic antagonists

Front 27

Effective in patients with COPD, using the long acting selective antimuscarinic agent ___?___.

It binds with equal affinity to M1, M2, and M3, but dissociates rapidly from M2, so it does not inhibit M2-mediated inhibition of the release of ACh (offers selectivity to M1 and M3)

Back 27

tiotropium

Front 28

common side effect of antimuscarinic agents are:

Back 28

dry mouth and bitter taste

Front 29

If you use a B2 agonist more than 2x/weekly you need to add __?__ to therapy

Back 29

inhaled corticosteriod

Front 30

MOA of what drug?

Inhibit production of inflammatory cytokines

Reduce bronchial reactivity

Reduce frequency of asthma exacerbations

Potentiate the effects of b2-agonists

Back 30

corticosteriods (antiinflammatory agents)

Front 31

Systemic corticosteriods include?

Urgent treatment:
30-60 mg prednisone /day or methylprednisone 1 mg/kg i.v. every 6 h, decrease daily dose after improvement

Usually discontinue systemic corticosteroids in 7-10 days

Back 31

prednisolone, methylprednisolone, and prednisone

Front 32

Systemic corticosteriods should be given __?__

Back 32

early in the morning

Front 33

To prevent nocturnal asthma, oral or inhaled corticosteroid is given ?

Back 33

late

Front 34

If corticosteriods are taken long term, adrenal suppression can occur and the body will stop producing __?__

you must ?

Back 34

cortisol

wean the pt off the corticosteriod so the body can catch back up

Front 35

inhaled corticosteriods include?

Back 35

Beclomethasone, Budesonide, ciclesonide, flunisolide, fluticasone, mometsone, triamcinolone

Front 36

if patient isn't responding to corticosteriods the dose can be __?__

Back 36

steadily increased

Front 37

prodrug that is an inhaled corticosteriod, bound to pp, no evidence of reduced side effects

Back 37

Ciclesonide

Front 38

Act on delayed Cl- channels in
membranes, inhibit cell activation
leading to:
Mast cell stabilizers (inhibit early response to Ag challenge
by inhibiting histamine release

Act on airways nerves, inhibit cough

Inhibit release of inflammatory mediators from eosinophils

Effect seems to be cell and organ specific

Back 38

Cromolyn and Nedocromil

Front 39

mast cell stabilizer administered MDI ?

Back 39

nedocromil

Front 40

Effective as aerosols in inhibiting Ag and exercise-induced asthma (EIA)

Chronic use slightly reduces bronchial hyper-Reactivity

No effect on bronchospasm, only used prophylactically

Back 40

Cromolyn and Nedocromil

Front 41

Prophylactic against exercise or allergen-induced asthma
2-4 puffs 2-4x / day, most effective in young patients with extrinsic asthma

Back 41

Cromolyn and Nedocromil

Front 42

adding __?__ to inhaled corticosteriods improves asthma control

Back 42

Nedocromil

Front 43

Side effects:
throat irritation, dry mouth, cough, rarely, wheezing, tight chest

Symptoms can be prevented by inhaling b2 agonist before the __?__

Back 43

Cromolyn or Nedocromil inhalation

Front 44

They improve asthma control and reduce frequency of exacerbations.
Advantage: taken orally, especially for children
Montelukast is approved for children as young as 6 years of age

Important in managing aspirin induced asthma

Back 44

leukotriene pathway inhibitors

Front 45

is the least prescribed because of occasional liver toxicity.

Back 45

Zileuton (5-LO inhibitor)

Front 46

Churg-Strauss syndrome (systemic vasculitis leading to worsening of asthma, pulmonary infiltrates, and eosinophilia) coincidental when prednisone dosage is reduced and adding

Back 46

zafirlukast or montelukast

Front 47

Anti IgE antibody that comes as a powder for sc injection, 202.5 mg

Used for severe asthma not controlled by other therapies

Helps reduce frequency and severity

Especially for patients with high corticosteroid requirement

Back 47

Omalizumab (Xolair)