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35 Cards in this Set
- Front
- Back
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what do non-selective bronchodilators act on?
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alpha, beta 1 & beta 2
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what are the actions of NS bronchodilators on alpha receptors?
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vasoconstriction, vasopressor effect (can provide decongestion in upper airway)
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what are the actions of NS bronchodilators on beta 1 receptors?
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stimulate HR and contractility and conductivity
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what are the actions of NS bronchodilators on the beta2 receptros?
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relax bronchial SM, inhibit inflammitory med release, stimulate clearance of mucous
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SEs of NS bronchodilators?
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increased HR, tremor
pt with CAD or HTN = risk of MI **do not play a role in routine asthma exacerbation |
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by what mechanism do beta2 agonists cause their effect?
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effect: smooth muscle relaxation
cause by: increase adenylate cyclase, which increases cAMP, which antagonizes contraction |
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what are some quick acting beta2 agonists? and what is their onset time and duration?
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albuterol, levalbuterol, pirbuterol (all end in -buterol)
3-5 min onset, 4-6 hour duration albuterol: tablets, syrup, nebulizer all others: nebulizer |
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adverse reactions of albuterol?
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tachycardia, tremor, hypokalemia
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what are some long acting beta2 agonist? onset and duration?
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albuterol (again, tablet form), salmeterol (partial agonist), formoterol (full agonist), arformotrol, indacaterol
onset and duration are variable: 5-45 min, 8-12-24 hours |
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what property of long acting beta2 agonists makes them long acting?
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lipophilic
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what does LTB4 do??
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neutrophil chemotaxis
mucus production |
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which are the short acting antimuscarinic?
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iprtropiums, 10-15 min onset, 4-8 hours coverage
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which are the long acting antimuscarinic?
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tiotropium, 30 min onset, 24 hours coverage
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what do anti muscarinics do?
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reduce muscarinic induced intrinsic vagal tone of airway
may cause drying of pulmonary secretions (also a SE: dry mouth, throat, dysphagia) |
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what do LTc4, LTD4, LTE4 do?
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allergy, broncoconstriction and mucus production
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which are the LT1 receptor antagonists?
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montelukast, zafirlukast
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which are the 5-LO inhibitor and what does 5-LO do?
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zileuton
5-LO catalyzes Arachodonic Acid --> leukotriene A4 (precursor for all leukotrienes) |
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which antileukotriene has no specific adverse effects? and what are the common adverse effects of the others?
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moteleukast (singular): but takes 3-4 hours, others take 30 min
others: reversible hepatitis |
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do you use anti-leuks for actue excerbations?
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no! they take a few days to work so are only for managing chronic cases
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what do corticosteroids do?
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inhibit neutrophil degranulation, inhibit inflammation, inhibit leukocyte recruitment, inhibit stability of some mRNA
induce lipocortin (which inhibits phospholipase2) induce anti-inflammitory genes |
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beclomethasone
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corticosteroid
SE: cough, dysphonia, oral thrush |
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budesonide
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corticosteroid
high doses have potential for adrenal suppression, osteoporosis, skin thinning |
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flunisolide
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corticosteroid
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fluticasone, mometasone
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corticosteroid, low-med doses can decrease growth velocity in children, may be transient
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triamcinolone
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cortisteroid
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prednisone, methylprednisolone, prednisone
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corticosteroid: short term can cause reversible abnormality in glucose metabolizm, increase in appetite, weight gain, mood alteration,, hypertension
long term: immune suppression, osteoperosis, hypertension, growth suppression |
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what three ways do methylxanthines work? and what are they?
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they are caffeine, theobromine, and theophylline
1. inhibit phosphodiesterase --> increase cAMP --> andtagonize constriction --> SM relaxation (just like beta2 agonists) 2. direct and indirect effect on inctracellular Ca++ (probably decrease) 3. mild anti-inflammitory |
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metabolizm of methylxanthines?
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CYP enzymes
CYP YOUR COFFEE |
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theophilline/aminophylline SE?
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dose related: tachycardia, nausea, vomiting, CNS stimulation, seizures, hyperglycemia, hypokalemia (think of caffeine)
usual dose: insomnia, GI upset, GERD, hyperactivity, difficulty urinating if BPH (again, think of caffeine) |
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what about the therapeutic index of theophylline?
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it's narrow! monitor closely
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mast cell stabilizers: MOA
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blocks release of inflammitory granules in mast cells
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what is cromolyn? SE?
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a mast cell stabilizer, with cough irritation and bad taste as a SE
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how do the immunomodulators work and what is one?
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the bind the Ab sites on mast cells and inhibit the binding of IgE and limits release of mediators
omalizumab |
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what does alpha-1 proteinase inhibitor do?
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it inihibits the enzyme responsible for the breakdown of alpha-1 antitrypsin
alpha1 AT allows for adequate anti-neutrophil elastase activity in the lungs of those with the alpha1 AT deficiency |
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what does roflumilast do?
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it and its active N-oxide metabolite inhibite phosphodiesterase-4 --> increases cAMP within inflammatory and structural cells important in the pathogenesis of COPD --> suppression of cytokines and inhibition of neutrophil infiltration and decreased pulmonary remodeling and mucociliary malfunction
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