Asthma + COPD

Question 1

Systemic corticosteroids

Answer 1

Methylprednisolone

Question 2

Aerosol corticosteriods

Answer 2

Fluticason

Question 3

B2 adrenergic Ags

Answer 3

SABA = albuterol
LABA = Salmeterol

Question 4

Muscarinic blockers

Answer 4

• ipratropium bromide

* tiotropium

Question 5

Phosphodiesterase blocker

Answer 5

Theophylline

Question 6

Leukotriene pathway blocker

Answer 6

Montelukast

Question 7

IgE inhbitors

Answer 7

Omalizumab

Question 8

Asthma airway resistance

Answer 8

Reversible!

Question 9

Hallmark of asthma

Answer 9

Early rxn = mast cell + t lymp

Late rxn = Neutrophil/eosinophil release in late rxn,

Question 10

Maintenance therapy Rx

goal

Answer 10

• Prevent attack

* Affect airway responsiveness/reactivity

Question 11

Quick relief Meds

Goals

Answer 11

Relieve bronchospasm in attack

*affect airway resistance

Question 12

Topical delivery of aerosolized Rx

T.I. Effect?

Answer 12

UPs T.I.

Question 13

Methylxanthines target

Answer 13

Cholinergic

Question 14

ICS

Answer 14

• target + suppress inflammatory
• NOT cure
• anti-inflammatory (hours) –> maximal benefit (weeks)
• can add long acting B2 agonist

Question 15

Topical activity of ICS UPed by

Answer 15

17a sub

Question 16

Effect corticosteriods on Airway cells

Answer 16

*DOWN cytokines
No effect on mediater release
*UP B2 receptors

Question 17

ICS

S.E

Answer 17

• oropharyngeal candidiasis/dysphonia
• Hypothalamic pituitary axis (HIGH dose/systemic)
• COPD = only if FEV1 <50%

Question 18

B2 Ags

Effects

Answer 18

• relax airway

* inhibit release of mast cell mediators (less microvascular leakage)

Question 19

Rescue tx

Answer 19

SABA

Question 20

LABA used

Answer 20

Maintenance

ONLY w/ ICS

LABAs alnoe w/ COPD

Question 21

Most asthma controlled w/

Answer 21

ICS + b2 ag

Question 22

Albuterol

Time

Answer 22

• Short acting 3-5 min
• Peak 30-60 mins
• Duration 3-6 hours

Question 23

Salmeterol

Time

Answer 23

Long-acting

>12 hrs

Question 24

B2 ags

S.E.

Answer 24

*uncommon w/ short-acting b2

Tremor/tac/hypokalemia

Question 25

Muscarinic cholinergic antagonists Effects

Answer 25

Block Ach from vagus to M3 * down mucus * down secretion * NO anti-inflammatory * Limited unless B2 ag intolerant (Can do 2 together) *COPD effective in some

Question 26

Ipatroprium vs Tiotropium Time

Answer 26

Ipratropium = Short acting Tiotropium = long acting

Question 27

Antichol Why effective in COPD?

Answer 27

Vagal tone the only thing left to control

Question 28

Natural trippy atropine version

Answer 28

Datura stramonium

Question 29

Antichol Adverse effects

Answer 29

* Few systemic = poorly absorbed * NO prostatic hyperplasia * Dry mouth

Question 30

Methylxanthine Rx = Theophylline Effects

Answer 30

* Block cAMP phosphodiesterase = UP cAMP * oral * COPD = up diagragm muscle contractility, up ventilatory function

Question 31

Methylxanthine Rx = theophylline

Answer 31

* narrow T.I. = monitor plasma * cardio = tac, vasodilation, arrythmia * CNS = nervousness * GI = N/V

Question 32

Leukotriene pathway inhbitor

Answer 32

* GOOD in aspirin sensitive * inhibit bronchoconstriction * add-on * NO COPD

Question 33

Anti-IgE Mech

Answer 33

Binds Fc IgE, can't bind to mast cell No allergen induced activation of mast cells

Question 34

New drugs

Answer 34

IL=5 Mepolizumab Reslizumab

Question 35

COPD = LABAs superior to anticholinergics?

Answer 35

Don't know They help improve lung function and quality of life

Question 36

Deposition of inhaled Rx

Answer 36

80-90% swallowed Blood stream --> systemic effects + inactive metabolites

Question 37

Cortiocosteroids inhibit inflammation how?

Answer 37

* Stop gene transcription | * Stop acetylation of DNA so strand doesn't open

Question 38

Systemic glucocorticoid use

Answer 38

Asthma exacerbation SHORT TERM Methylprendisolone 3-10 days Withdraw over 2 weeks Status Asthmaticus? IV

Question 39

B2 agonists Mech

Answer 39

Through cAMP/PKA --> down Ca2+ influx into bronchial smooth muscle

Question 40

Montelukast blocks

Answer 40

Leukotriene receptor (CysLT1) = block: * plasma exudation * Mucus secretion * Bronchoconstriction * Eosinophil recruitment

Question 41

Omalizumab Mech

Answer 41

* anti-IgE antibody * binds Fc portion IgE, prevents Fc receptor binding to mast cells *use less steroid + prevent allergic reactions