LECOM Pharm Ch 46 integrated Asthma
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| Drug derived from atropine | ipratropium
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| MOA of ipratropium in asthma | M3 cholinergic receptor antagonist, bronchorelaxation and decreased mucus
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| SE of ipratropium | dry mouth, GI upset
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| Long acting Anticholinergic used for COPD | Tiotropium
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| MOA of epinephrine | α-, β1-, β2- adrenergic agonist
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| MOA of isoproterenol | β1-, β2- adrenergic agonist
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| Activation of beta-adrenergic receptors has what effect on cAMP? Ca++? K permeability? | increases cAMP; decreases intracellular Ca; increases K permeability
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| Stereoisomer of albuterol that has higher affinity for β2- adrenergic receptors? | Levalbuterol (R-)
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| SE caused by epinephrine but not isoproterenol? Why? | HTN; alpha adrenergic agonist
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| 5 “newer” agents that bind β2- adrenergic receptors 200-400x more than β1-? | levalbuterol, albuterol, terbutaline, bitolterol, pirbuterol
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| MOA of Salmeterol/Formoterol? Difference? | long acting β2- adrenergic agonist; Formoterol is fast acting, salmeterol is not
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| MOA of theophylline | nonselective phosphodiesterase inhibitor; prevents cAMP degredation and T-cell immunomodulator
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| Drug used in Tx of asthma that can cause ventricular arrhythmias and seizures | Theophylline
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| Pt w/ Hx of asthma. Dx with GERD and started on new drug. Pt presents to the ED with NVD, insomnia and then seizure. What are the 2 drugs he is being treated with? | Theophylline and Cimetidine
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| Glucocorticoids decrease what 2 factors that reduce the inflammatory response in asthma? | Il-4 and IL-5
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| 2 inhaled steroids that do not exhibit 1st pass metabolism | beclomethasone and triamcinolone
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| Oral infection by this bug can be a side effect of inhaled steroids. How can you mitigate? | Candida ; spacer and wash out mouth
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| MOA of cromolyn | “mast cell stabilizer” as well as preventing mediator release from other WBCs
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| This drug is used with success in younger patients as well as those with exercise induced asthma. | cromolyn
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| Downfall of cromolyn administration | QID treatments- inhaled
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| MOA of zileuton | 5-Lipoxegenase inhibitor
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| These levels are decreased with Zileuton treatment. | LTA, LTC, LTD, LTE
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| MOA of montelukast and zafirlukast | CysLT1 receptor blockers aka LTC4, LTD4, LTE4 blocker
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| What is different about Tx with Leukotriene pathway blockers than all the other drugs? | oral administration
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| What is seen in Pts with decreased pulmonary function with administration of leukotriene pathway inhibitors? | slight increase in pulmonary function
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| MC toxicity with Zileuton treatment | hepatotoxicity
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| An asthmatic Pt presents with granulomatous vasculitis iinvolving the small arteries of the heart, lungs, kidney and skin. What drug is causing this? | Leukotriene receptor blockers aka montelukast and zafirlukast
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| MOA of omalizumab | FcεRI antibody; blocks IgE from binding on mast cell and decreases circulating levels of IgE
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| Omalizumab also has this effect of IgE receptors | downregulation of receptor production
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| Tx with Omalizumab differs from all other asthma treatments because of what? | It is parenteralally administered; SubQ every 2-4 weeks
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| Treatment with theophylline and zifirlukast results in what? | decreased levels of zafirlukast
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