Question | Answer |
name 4 effects of LTs in asthma | 1) potent bronchoconstrictors, 2) increase mucosal edema, 3) increase bronchial reactivity, 4) mucous hypersecretion |
LTs effects compared to histamine | LTD4 is 100x more potent at bronchoconstriction than histamine |
Zileuton MOA | 5-lipoxygenase inhibitor |
Zafirlukast, Montelucast MOA | LT-D4 receptor antagonists |
what # of asthmatics are sensitive to aspirin | 5-10%; LT-inhibitors (Zileuton, Zafirlukast, Montelucast) effective in treating aspirin-induced asthma, and mild asthma in general |
what is the most effective preventative medication we have for asthma? | inhaled steroids (glucocorticoids) |
when should inhaled steriods be used? (British guidelines) | 1) ptns w/exacerbation inn last 2 years; 2) ptns using rescue meds (b2 agonists) 3x a week or more; 3) ptns who are symptomatic 3x a week or more; 4) waking one night a week or more |
presistent asthma (US guidelines) | SX > 2x a week during day or > 2x a month at night |
glucocorticoids - MOA | inhibit degranulation of inflammatory cells; decrease capillary permeability; decrease accumulation in lung of basophils, eosinophils, etc; decrease LT production & release; increase B-adrenorecptor synthesis (making B2 agonists more effective) |
name 3 ILs that glucocorticoids block | IL-4, 5, 13 |
usual length of treatment when using glucocorticoids systemically for acute asthma | orally administered for 5-10 days; can withdraw abruptly and any adrenal function suppression dissipates w/in 1-2 weeks |
adjustments when longer term treatment using inhaled glucocorticoids for chronic asthma is used | dose must be tapered to avoid return of asthma symptoms & suppressing pituitary/adrenal function |
order of admin when using both B2 agonists and glucocorticoids | admin B2 first to open up bronchioles so more of the GC reaches the lungs and gets further down into the lungs |
inhaled/long-term glucocorticoids (6) | beclomethasone, budesonide, fluticasone, flunisolide, triamcinolone, mometasone |
systemic/short-term glucocorticoids (3) | methylprednisone, prednisolone, prednisone |
SEs of inhaled glucocorticoids | oral candidiasis, dysphonia |
SEs of oral glucocorticoids | adrenal suppression |
transient SEs of glucocorticoids | facial flushing, acne, headache, mood changes, gi irritation, appetite stimulation |
mometasone advantage over other glucocorticoids | once daily dosing |
oral (systemic) recent dosage guideline change (prednisone example) | 1/3 of old standards; prenisone 40-80 mg/day until peak expiratory flow rate reaches 70% |
symbicort - 2 products, onset of action | budesonide (GC), formoterol (B2 agonist) - onset in < 15 min |
advair- 2 products, onset of action | fluticasone (GC), salmeterol (B2 agonist) - onset in 30 to 60 min |
four ways to reduce potential AEs in inhaled corticosteroids | 1) using spacer and rinsing mouth; 2) using lowest dose possible; 3) using in combination w/long-acting b2 agonists (salmeterol in advair, formoterol in symbicort); 4) monitoring growth in children |
five benefits of inhaled corticosteriods (daily use) | 1) fewer SXs; 2) fewer severe exacerbation; 3) reduced use of rescue meds; 4) improved lung function; 5) reduced airway inflammation |
Omalizumab (Xolair) - MOA | binds IgE, preventing it from bindng mast cell to degranulation |
what is the black box warning for Omalizumab (IgE binder) - when do most rxn occur | reports of serious & life-threatening hypersensitivity reactions; occurs after 1st dose or more than 1 yr later --> most reactions occur w/in 2 hours |
what must be done before presribing Omalizumab | allergy-induced asthma must be established by a skin or blood test |
who is Omalizumab restricted to? | ptns w/severe asthma, not controlled well by other drugs, shown to have clear allergic component |