P'Col- AntiAsthmaticsssssss SUCK
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63 terms
Terms | Definitions |
|---|---|
 Pathogenesis of asthma involves activation of ______, ________ production & release, and ________ of bronchial mucosa. | eosinophils, IgE, remodeling |
| Remodeling involves what? | thickening of lamina reticularis, hyperlasia of smooth muscle cells and goblet cells |
| Drug treatment options for asthma | bronchodilators and anti-inflammatory agents |
| What is the most common bronchodilator class? | beta2 agonists |
| The beta2 agonists consist of what drugs? | Albuterol, terbutaline, formoterol, metaproterenol, salmeterol |
| What is the route of administration that is preferred? | inhaled |
| What are the non-selective beta2 agaonists? | Epinephrine and Isoproterenol |
| What is the problem with non-selective beta2 agonists? | they have bad CV side effects so they are rarely used |
| What are some of the effects beta2 agonists have on the airways? | relax airway smooth muscle inhibit release of leukotrienes and histamine Increase ciliary activity |
| Aerosol deposition depends on what 3 things? | particle size pattern of breathing geometry of airways |
| _____% of total dose is deposited in the mouth and pharnyx | 80-90 |
| What is the duration of most inhaled beta2 agonists? | 3-6 hours |
| Which two beta2 agonists have a duration >12 hours? | salmeterol and formoterol |
| What drug is currently in development with a duration of >24 hours? | Indacaterol |
| SQ injections of _______ are available for emergency situations. | Terbutaline |
| ADEs of beta2 agonists | tachycardia, palpitations, tremors, HYPOkalemia, possible tolerance, increased insulin, lactate, glucose, pyruvate, and free fatty acids |
| What are the 3 methylxanthines? | Theophylline Theobromine Caffeine |
| What are the general MOAs of methylxanthines? | Inhibit PDE enzymes, inhibit adenosine receptors, promote apoptosis of eosinophils and neutrophils, regulate inflammatory gene transcription |
| Which of the methylxanthines have toxicity issues? | Theophylline |
| Why do blood levels of Theophylline need to be monitored? | narrow therapeutic window, plasma clearance varies widely |
| ADEs of Theophylline | anorexia, nausea, vomitting, HA, Gi upset, anxiety, seizures |
| Clinical usage of Theophylline | severe asthma and COPD |
| Is Theophylline used alone or in combo? | alone or in combo with corticosteroids |
| What are the anti-muscarinic agents? | ipratropium bromide, tiotropium bromide, prototype atropin |
| What is the bronchodilator of choice for COPD? | Tiotropium bromide |
| Whats the problem with prototype atropin? | lots of side effects |
| Is Tiotropium bromide short or long acting? | long |
| What receptors does Tiotropium bromide bind? | M1, M2, and M3 receptors |
| Which receptor does Tiotropium bromide dissociate away from rapidly? | M2 |
| ADE of inhaled Ipratropium bromide | bitter taste |
| AE of nebulized ipratropium bromide | glaucoma |
| 3 corticosteroids | Prednisone, Triamcinolone, Ciclesonide |
| Which corticosteroid is taken orally? | prednisone |
| Which corticosteroid is an aerosol preparation? | Triamcinolone and Ciclesonide |
| What is Ciclesonide activated by? | esterases |
| Corticosteroid MOAs | anti-inflammatory: inhibit PLA2 DO NOT act as direct bronchodilator, but potentiate beta agonist effects |
| Regular corticosteroid therapy is maintained with which dosage form? | aerosol |
| Oral and parenteral corticosteroids are used for emergency in which patients? | when bronchodilator shows little improvement or worsening symptoms despite therapy |
| Two common ADEs of corticosteroids | hoarsness and oropharyngeal candidiasis |
| What can be done to help with the ADE of oral candidiasis? | gargle water after inhaled treatment |
| ADE of corticosteroid in kids | stunts growth |
| ADE of corticosteroids in adults | increased risk of osteoporosis and cataracts |
| 2 aerosols that are insoluble salts that are only used for PROPHYLAXIS | Cromolyn and Nedocromil |
| MOA of Cromolyn and Nedocromil | Alters function of delayed chlorine channels so inhibits cell activation |
| Which one inhibits cough? | Nedocromil |
| Special population for cromolyn and nedocromil | young patients |
| Cromolyn and nedocromil also reduce symptoms of what? | allergic rhinoconjunctivitis |
| two words that describe the ADEs of cromolyn and nedocromil | Mild and Rare |
| LTB4 is a what? | potent neutrophil chemoattractant |
| LTC4 and LTD4 contribute to asthma how? | bronchoconstriction, increased bronchial reactivity, mucosal edema, and mucus hypersecretion |
| two classes of leukotriene pathway inhibitors | 5'-lipoxygenase enzyme inhibitors LTD4 receptor antagonists |
| What is the one 5' lipoxygenase enzyme inhibitor? | zileuton |
| What are the LTD4 receptor antagonists? | montelukast, zafirlukast, pranlukast |
| Which of the LTD4 receptro antagonists is not available in the US? | pranlukast |
| Leukotriene pathway inhibitors are _______ effective than corticosteroids in asthma symptoms. | less |
| Route of administration of leukotriene pathway inhibitors | oral |
| Montelukast is approved for as young as what age? | 6 years old |
| Leukotriene pathway inhibitors play an important role in what type of asthma? | aspirin induced |
| Zileuton ADE | occasional liver toxicity |
| Which leukotriene pathway inhibitor is most commonly prescribed? | Montelukast |
| Montelukast and zafirlukast have _______ toxicity. | little |
| Omalizumab is a ________. | Anti-IgE Monoclonal antibody |
| What is the benefit of Omalizumab? | reduces exacerbations requiring hospitalization by 88%, enables a reduction in corticosteroid treatment |
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