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PCol I - Final Exam

Asthma drugs - 2

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
Created by: Krafty