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32 Cards in this Set
- Front
- Back
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6 classes of drugs for asthma
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1. beta 2 agonists
2. muscarinic blockers 3. cromones (inhibit mast cell release) 4. antiphosphodiesterases 5. leukotriene receptor blockers 6. glucocorticoids |
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Epi for asthma? when to use?
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in emergency situation for a severe attack
would have lots of S/E |
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albuterol
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beta 2 selective agonist
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terbutaline
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beta 2 selective agonist
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salmeterol
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beta 2 selective agonist (long lasting)
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when would oral beta 2 agonists be used?
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coordination impaired people or people whose airways are irritated by aerosols
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what are side effects from too much albuterol?
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tachycardia
muscle tremor dizziness arrhythmias |
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mechanism of beta 2 agonist treatment of asthma
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beta 2 - adenylyl cyclase - cAMP - PKA -
MAJOR 1. bronchodilation (inhibit MLCK) MINOR 2. decrease mast cell release 3. increase ciliary function 4. vascular endothelium - maintain integrity (decrease permeability) |
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what is main innervation of bronchial smooth muscle?
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parasympathetic. no sympathetic innervation, just receptors
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ipatroprium
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anticholinergic
most effective in COPD and emphysema rather than asthma |
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combivent
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ipatropium + albuterol
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method of action of anticholinergics
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1. block muscarinic receptor induced vasoconstriction
2. decrease secretions 3. decrease vasodilation (decreases inflammation) most effective in COPD and emphysema rather than asthma |
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theophylline
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antiphosphodiesterase
increases cAMP |
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methylxanthines
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antiphosphodiesterases
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When are antimuscarinics for asthma a good idea?
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people with psychogenic exacerbation of asthma
people on beta blockers for hypertension, migraines, tachycardia, arrhythmia, etc |
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Mechanisms of antiphosphodiesterases?
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MAJOR:
1. inhibits phosphodiesterase minor: 1. blocks adenoside receptors 2. decreases fatigue of respiratory muscles and helps to strengthen accessory breathing muscles (makes it helpful for COPD) narrow therapeutic index |
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what drug is good for someone who has asthma in the early morning?
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salmeterol (long lasting wont run out on them)
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method of action of glucocorticoids on asthma treatment?
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change gene expression
decreases inflammation in airway decreases vascular permeability increases # of beta2 receptors! (gene expression) |
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beclomethasone
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glucocorticoid (inhaled)
front line controller therapy |
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fluticasone
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glucocorticoid (inhaled)
front line controller therapy |
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advair
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advair = fluticasone and salmeterol
great drug b/c it has quick reliever + inflammation controller |
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S/E of aerosol glucocorticoids
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1. adrenal suppression (- FB)
2. bone resorption 3. increase blood glucose (stress hormone) 4. cataracts 5. purpura 6. dysphonia 7. candidiasis - thrush in throat due to immune suppression 8. growth retardation in children |
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method of action of cromones
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MAJOR: inhibit mast cell release
2. decrease response to inhaled allergins 3. inhibits irritant receptors in airway 4. decreases plasma exudation in airway |
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cromolyn
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cromone
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nedocromil
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cromone
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how long do cromones take?
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6 weeks
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drug for exercised induced asthma?
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cromones: cromolyn or nedecromil
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what can be used for children with allergen induced asthma before going to glucocorticoids?
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cromones
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omalizumab
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monoclonal antibody against IgE
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xolair
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omalizumab
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how does NO cause vasodilation and bronchodilation?
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NO activates guanylyl cyclase, which produces cGMP, which inactivates MLCK, which decreasing smooth muscle contraction.
[NO inhibits MLCK] |
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NO effects?
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vasodilation
bronchodilation atherosclerosis - less NO, less antioxidant activity septic shock - mediates vasodilation inflammation - exacerbates inflammatory states may one day be used in lung transplant patients, resp edema, pulm embolism, pulm HTN, etc, etc b/c it causes bronchodilation |
