Respiratory_Maloney_Asthma

Front 1

An exaggerated ____ response often predominates in asthma.

Back 1

TH2 (T Helper 2)

Front 2

What is the main effector function of TH2 cells?

Back 2

Stimulate differentiation of eosinophils

Activate B cells

Front 3

Chronic Asthma associated with allergies has 3 responses mediated by the immune system. What are they?

Back 3

Chronic inflammation

Bronchospasm

Airway hyperresponsiveness

Front 4

What are the most effective drugs for chronic tx of asthma?

Back 4

Anti-Inflammatory

Front 5

What is the best way to minimize systemic side effects from steroids when treating asthma?

Back 5

Inhalation

Less systemic effects since you're targeting the lungs. Also, with inhalation you are using lower dosages

Front 6

"-one/ -lide / -nide"

Back 6

Inhaled Corticosteroids

Front 7

Beclomethasone dipropionate

Fluticasone

Triamcinolone

Flunisolide

Budesonide

Ciclesonide

Back 7

Inhaled Corticosteroids

Front 8

Do inhaled corticosteroids cause bronchodilation?

Back 8

NO!

No direct effect on muscle tension

Front 9

Inhaled Corticosteroids MOA:

Back 9

Potentiate β adrenergic agents by:

↑cAMP and upregulating receptor level

Front 10

What is the most potent and consistently effective long termcontrol medication for asthma?

Back 10

Inhaled corticosteroids

Front 11

Advantage of using inhaled corticosteroids?

Back 11

Higher local drug concentration than an equivalent dose of systemic corticosteroids

**↓ SIDE EFFECTS**

Front 12

You have started a patient on a long term asthma drug and they complain of an unpleasant taste, oral thrush, difficulty speaking and lots of coughing with worsening asthma after use... what type of drug did you give them?

Back 12

Inhaled corticosteroid

Front 13

What are some ways we can prevent/reduce adverse effects with the use of inhaled corticosteroids?

Back 13

-Spacers or valved holding chambers

-Rinse and spit after inhalation

-Use short acting β2 activator before inhalation --> prevent bronchospasm

Front 14

"Predniso"

Back 14

Oral Systemic Corticosteroids

Front 15

Prednisone

Prednisolone

Methylprednisolone

Back 15

Oral Systemic Corticosteroids

Front 16

Why do you want to minimize the dose of oral steroids?

Back 16

Adverse Effects

Front 17

When would you use oral systemic corticosteroids for asthma?

Back 17

-Moderate to severe exacerbations of asthma (3-10 days to control severe cases)

-Used for long-term control ONLY in the MOST SEVERE, difficult to control cases (must minimize the dose)

Front 18

What can be used/done to block/inhibit the mediators of mast cells?

Back 18

Prevent Mast Cell Degranulation

Prevent IgE from binding to Mast Cell

Block Leukotrienes

Front 19

"Crom"

Back 19

Mast Cell Stabilizers

Front 20

Cromolyn

Nedocromil

Back 20

Mast Cell Stabilizers

Front 21

MOA of Cromolyn?

Mast Cell Stabilizer

Back 21

Prevents degranulation and the relase of mediators

*↓Histamine
*↓Leukotriene
*↓Cytokines

Front 22

Which Mast Cell Stabilizer affects a broader range of inflammatory cells?

Back 22

Nedocromil

Front 23

Would cromolyn reverse acute bronchospasm?

Back 23

NO!

Front 24

Side effects of Mast Cell Stabilizers?

Back 24

Irritate the throat
-Cough
-Transient bronchospasm

Nedocromil--> unpleasant taste

Front 25

How can you prevent/modify the action of leukotrienes?

Back 25

Affect conversion of Arachodonic Acid to Leukotriene

Inhibit LT1 receptors

Front 26

"-leu/luk"

Back 26

Leukotriene Modifiers

Front 27

"leu"

Back 27

Leukotriene Modifers

-Zyleutron

**Inhibit leukotriene production**

Front 28

"luk"

Back 28

Leukotriene Modifiers

-Montelukast
-Zafirlukast

**Block LT1 receptor**

Front 29

Which Leukotriene modifiers block the LT1 receptor?

Back 29

-Montelukast
-Zafirlukast

Front 30

Which leukotriene modifier inhibits leukotriene production?

Back 30

Zyleutron

Front 31

Anti-IgE therapy drug?

Back 31

Omalizumab

Front 32

What is omalizumab?

Back 32

Recombinant humanized monoclonal antibody to IgE

**Anti-IgE Therapy**

Front 33

When treating with omalizumab, is there allergen induced activation of mast cells?

Back 33

No

Front 34

What is an adverse side effect of omalizumab?

Back 34

Anaphylaxis

Front 35

Mast Cell stabilizers are ___ line for Asthma

Back 35

2nd line

Front 36

Leukotriene Modifiers are taken _____

Back 36

orally

Front 37

Are leukotriene modifiers good for acute asthma?

Back 37

No

Front 38

Which members of the population are more responsive to Leukotriene modifiers?

Back 38

Aspirin-Sensitive Asthmatics

Front 39

Why would montelukast reduce bronchoconstriction from aspirin induced asthma?

Back 39

Montelukast blocks LT1 receptors that bind to leukotrienes.

Front 40

When is omalizumab used to treat asthma?

Back 40

SubQ injection every 2-4 weeks

Adjunctive therapy in patients with severe persistent asthma that is INADEQUATELY controlled with the combination of high dose ICS and LABAs

Front 41

What are the three classes of bronchodilators?

Back 41

β2 agonists

M blockers

Methylxanthines

Front 42

Metaproterenol

Albuterol

Levalbuterol

Pirbuterol

Terbutaline

Back 42

Short Acting β2 Agonists

Front 43

Salmeterol

Formoterol

Arformoterol

Back 43

Long Acting β2 Agonists

Front 44

"-meterol/-moterol"

Back 44

LA β2 Agonists

Front 45

M Blocker

Back 45

Ipratropium Bromide

Front 46

What type of β and M receptors are in the lungs? what do they do?

Back 46

β2 --> bronchodilation

M3 --> bronchoconstriction

Front 47

Why is the use of β2 agonists considered functional/physiological antagonism?

Back 47

β2 agonists counteract (bronchodilate) M3 bronchoconstriction

Front 48

What drug would you use to block M3 receptors causing bronchoconstriction?

Back 48

Ipratropium bromide

Front 49

β2 agonists can cause palpitations, sinus tachycardia and ↑BP. Why?

Back 49

Higher doses of β2 agonists activate β1 receptors

Front 50

Adverse Effects

Tremor, HYPOkalemia, palpitations, sinus tachy, ↑BP

Back 50

β2 agonists

Front 51

What is the signaling pathway by which β2 agonists cause bronchodilation?

Back 51

↑cAMP

Front 52

What enzyme breaks down cAMP?

Back 52

PDE

Front 53

"-phylline"

Back 53

Methylxanthines

Front 54

Theophylline

Aminophylline

Back 54

Methylxanthines

Front 55

The chemical structure of Methylxanthine drugs closely imitates what?

Back 55

caffeine

Front 56

MOA: Methylxanthines

Back 56

Inhibits PDE (especially PDE-4)

Inhibits adenosine receptors

Front 57

MOA: Methylxanthines on smooth muscle cells

Back 57

↑cAMP ---> block adensoine receptors

** smooth m. RELAXATION**

Front 58

MOA: Methylxanthines on T cells, Eosinophils and Mast Cells

Back 58

↑cAMP --> block adenosine receptors

**Anti-inflammatory**

Front 59

Problems with methylxanthines

Back 59

Narrow TI

Erratic bioavailability

Front 60

Are problems with CNS stimulation from methylxanthine use more common in children or adults?

Back 60

Children

Front 61

Adverse Effects

-Irritate GI mucosa

-CNS Stimulation

-CV effects

Back 61

Methylxanthines

CV and CNS problems stem from Caffeine-like effects

Front 62

What is the drug of choice for treating ACUTE asthma symptoms and exacerbations?

Back 62

Short Acting β2 Agonists

Front 63

What is the drug of choice for preventing excercise-induced asthma?

Back 63

Short Acting β2 Agonists

Front 64

What drug is adminstered with SABAs in moderate to severe asthma cases in the ER?

Back 64

ipratropium bromide
(M blocker)

Front 65

Are LABAs recommended to treat acute asthma attacks?

Back 65

NO

Front 66

Longterm Asthma Therapy

-used adjunct to corticosteroids

-may be used before excercise

- not recommended as a monotherapy for long-term, persistent asthma

-not recommended for acute asthma attacks

Back 66

LABAs

Front 67

Which Methylxanthine drug can be used as an alternative, but not preferred, adjunctive therapy with inhaled corticosteroids for long-term control of moderate or persistent asthma?

Back 67

Theophylline

Front 68

What are the "quick relief" drugs for asthma?

Back 68

Inhaled SABAs, M blockers -->bronchodilate

Systemic corticosteroids --> anti-inflammatory

Front 69

What drugs can be used long-term for anti-inflammatory effects to treat asthma?

Back 69

-Inhaled Corticosteroids

-Leukotriene Modifiers

-Mast Cell Modifiers

-IgE-Antibodies

Front 70

What drugs can be used long-term for bronchodilation to treat asthma?

Back 70

LABAs

Methylxanthines

Front 71

Corticosteroids don't work well for COPD. Why?

Back 71

Corticosteroids don't really affect PMNs.

COPD is mostly a PMN-mediated problem

Front 72

Are anti-inflammatory agents useful for COPD?

Back 72

No, don't affect PMNs

Front 73

What drugs are useful for acute attacks of COPD?

Back 73

SABAs

**If prompt bronchodilation doesn't occur, ADD AN M BLOCKER**

Front 74

What drugs are useful for management of Stable COPD?

Back 74

β2 Agonists

M-blocker

Methylxanthine

**These are Bronchodilators**

Front 75

When should you use corticosteroids in treating COPD?

Back 75

Add inhaled glucocorticoid to bronchodilator tx for more severe symptomatic COPD (chronic therapy)

Systemic glucocorticoids for acute attacks of COPD