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