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Pharm Block-3
Asthma
| Question | Answer |
|---|---|
| Metaproterenol (alupent) | beta2 agonist; low selectivity, very short duration, MDI, NEB, PO |
| Albuterol (ventolin, proventil, xopenex) | beta2 agonist; high selectivity, short duration, MDI, NEB, PO |
| Pirbuterol (maxair) | beta2 agonist, high selectivity, short duration, MDI only |
| Terbutaline (brethine) | beta2 agonist, high selectivity, short acting, PO, INJ |
| Salmeterol (serevent) | beta2 agonist, high selectivity, long acting, DPI (dry powder inhaler); NOT a "rescue" inhaler |
| Formoterol (foradil) | beta2 agonist, high selectivity, long duration, DPI; NOT a "rescue" inhaler |
| Zafirlukast (accolate) | leukotriene receptor modifiers; Tx for chronic ashtma 4qd; a sulfur; blocks inflam to antigens; PO only; min side effects (liver enzyme elev or Churg-Strauss syndrome); dec use of rescue inhalers, but inferior to inhaled CCsteroids |
| Monetlukast (singulair) | leukotriene receptor modifiers; Tx for chronic asthma 4qd; a sulfur; blocks inflam to antigens; min side effects (liver enzyme elev or Churg-Strauss syndrome); dec use of rescue inhaler, but inferior to inhaled CCsteroids; pediatric doses |
| Zileuton (zyflo) | leukotriene receptor modifiers; Tx for chronic asthma 4qd; dec synth by blocking 5-lipoxygenase (higher in pathway than other LRMs); min side effects (liver enzyme elev more common; SIGNIFICANT drug interactions); dec rescue inhaler, inferior to CCsteroid |
| Beclomethasone HFA (QVAR) | inhaled CCsteroid |
| Budesonide (pulmicort) | inhaled CCsteroid; significant first pass metabolism (only negligible amts are absorbed if given orally)==> a beneficial trait for inhaled CCsteroids |
| Flunisolide (aerobid) | inhaled CCsteroid |
| Fluticasone (flovent HFA) | inhaled CCsteroid |
| Mometasone (asmanex) | inhaled CCsteroid |
| Triamcinolone (azmacort) | inhaled CCsteroid |
| Prednisolone (orapred, pediapred, prelone) | systemic CCsteroid |
| Methylprednisolone (solu-medrol-IV; Medrol-PO) | systemic CCsteroid |
| Prednisone (deltasone, sterapred) | systemic CCsteroid |
| Dexamethasone (decadron, dexasone) | systemic CCsteroid |
| Hydrocortisone (solu-cortef, A-hydroCort, Cortef-PO) | systemic CCsteroid |
| Fluticasone and Salmeterol (advair) | combination CCsteroid |
| Omalizumab (xolair) | anti-IgE drug |
| Ipratropium bromide (atrovent) | anticholinergic muscarinic antagonist (local effects in respiratory mucosa only); not systemic; acute bronchoconstriction/broncospasm managment NO bronchodilatory or anti-inflam effects; inferior to b2-agonists (can be used in combo though) |
| Cromolyn sodium (intal) | mast cell stabilizer; anti-inflam NOT bronchodilator; nebulized/MDI; very safe; maintenance therapy as effective as theophylline, but inferior to inhaled CCsteroids |
| Medocromil (tilade) | mast cell stabilizer; anti-inflam NOT bronchodilator; MDI only; very safe; maintenance therapy as effective as theophylline, but inferior to inhaled CCsteroids |
| Theophylline (aminophylline) | phosphodiesterase inhibitor; bronchodilator (inhibits phosphodiesterase, inc cAMP in airway smooth m); dose: 5-15; [high serum] a/w toxicity 15-30: GERD, tachycardia, HA, vomiting, nervousness, insomnia, >35: seizures cardiac arrhythmias (PVCs, V-tach) |
| Asthma definition | intermittant lung inflam; wheezing (not bronchiolitis/bronchitis), night cough, dyspnea, tight chest; air flow obstruction on pulmonary fxn test; continuous or seasonal; may overlap w/COPD; allergen provokation, rhinitis, atopic dermatitis |
| Asthma risk factors | atopic disease, fam Hx of atopic disease; neonatal tobacco smoke exposure; viral airway infxns; male gender, low birth weight, 50-80% of kids <5yo w/asthma symptoms develop chronic asthma |
| Early Phase of Asthma (min - hours) | bronchoconstriction (prevent w/b2 agonists); Acute inflam (IgE activates mast cells/MQs; histamine, leukotrienes, cytokines inc vascular permeability, vasodilation, edema (pulm edema late); cytokines inc mucus (ptn/cell mix = obstructing plugs) |
| Late acute phase of asthma (6-9 hours) | severe bronchoconstriction not reversed w/b2 agonists; a/w inflam activity (eosinophils, Tcells, neutrophils, basophils, MQs; continual proinflam cytokine release, immune adhesion molec), bronchial hyperresponsiveness |
| Chronic Asthma | epithelial cell "immune barrier" loss (inc sensitivity, dec proteolytic enzymes, inc permeability), inc eosinophils/mast cells in airway; remodeling/narrowing of airway BM; hyperreactive bronchospasm to allergens; chronic mucus (hypertrophic goblet cells) |
| Asthma triggers | pollen, mold spores, roaches, dust mites, dander, smoke, pollutants, meds (sulfites in wine/food), b-blockers, ASA/NSAIDs, viruses, occupational exposures, humidity; exercise, cold air, stress, menses, GERD, rhinitis |
| Acute Asthma: Signs and Symptoms | wheeze, SOB/dyspnea, chest tight, tachycardia, tachypnea, cough, 2-3 words b/f breath, accessory mm, pulsus paradoxus (>10mmHG dec in sys bp w/inspiration), nasal flare, nml CXR (unless pneumonia), dec O2sat, resp alkalosis d/t hypervent (pCO2<50mmHg) |
| Chronic Asthma: Signs and Symptoms | inc bronchial sensitivity to "triggers;" dec pulmonary function tests, finger clubbing, dec A/P diameter (barrel chest) on CXR |
| Dx of Asthma | episodic airflow obstruction; symptoms reversed w/meds (usu inhaled b2-antagonists); no other problems to explain s/s; confirm w/spirometry; not all wheezes is asthma; often undiagnosed or hidden |
| Asthma subjective assessment | do sx affect daily activities, physical activity, sleep, school perfomance? any ER visits d/t asthma? how often are short-acting b-agonists needed? |
| Asthma physical assessment | lung hyperexpansion (A/P diameter), use of accessory mm, spirometry (FEV1/FVC) values below predicted; peak expiratory flow; severe disease or other pulmonary prob if cyanosis after kids eat or finger clubbing |
| Pulmonary function studies: Peak expiratory flow rate (PEFR) | measures max air flow velocity during expiration w/max effort; use hand-held peak flow meter at home or in office; normal values = 550-700L/min (<4yo, critically ill, or elderly/MR cannot do test) |
| Metered dose inhalers (MDI) | uniform aerosolized dose released from pressurized canister thru valve in mouthpiece |
| Dry powder inhalers | device that stores inhalation doses in form of powder and deposits dose into chamber to be released by forceful inhalation |
| Small volume nebulizer (SVN) | 3-6mL of liquid containing meds in a reservoir cup; cup is connected to hose w/O2 or air; when air and liquid is mixed in the baffle a fine mist of aerosol is created |
| Beta2-agonists: Pharmological effects | local (bronchodilation of airway smooth muscle); *Drug of choice in acute managment;* Systemic (Na/K ATPase activation produces hypokalemia, tachycardia, tremors of skeletal m); NOT anti-inflam; side effects relative to b2 selectivity of drug |
| beta2-agonist tolerance | bronchodilatory effects are minimally affected by down-regulation; BUT, bronchoprotective effects can be diminished with chronic use of b2-agonist (including long-acting products) |
| CCsteroids | BEST anti-inflam for chronic/acute management of asthma!! interact w/glucocorticoid receptor to inc expression of anti-inflam ptns/dec inflam ptns; inhibit inflam response; dec hyperresponsive airway, dec b2-receptors, mucous, remodeling; takes time |
| Short-term effects of CCsteroids | hypertension, pshyciatric changes, hyperglycemia/diabetes, inc appetite, fluid retention, peptic ulcer |
| Long-term effects of CCsteroids | HPA-axis suppression/Cushings, osteoporosis/dec growth, hypertension, immunosuppression, hyperglycemia/diabetes, peptic ulcer, dermal thinning |
| low to moderate doses of inhaled CCsteroids are not specifically harmful to children | inhaled CCsteroids are preferred in ALL children w/signs and symptoms of poorly controlled chronic asthma (mild-persistent - severe) b/c benefits outweigh potential effects on growth/HPA axis/BMD |
Created by:
bscaryp