Pharm Bronchodilators & Other Drugs Used In Asthma

Front 1

Question: One effect that theophylline, nitroglycerin, isoproterenol, and histamine have in common is?

Back 1

Tachycardia

Note: nitroglycerin evokes a compensatory sympathetic reflex.

Front 2

Question: A 23 year old woman is using an albuterol inhaler for frequent acute episodes of asthma and complains of symptoms that she ascribes to the albuterol. What are possible side effects?

Back 2

At high dosage, induces beta1 cardiac effects as well as beta2-mediated smooth and skeletal muscle effects.

Front 3

Question: What drug is most likely to have adverse effects when used daily over long periods for severe asthma.

Back 3

Prednisone by mouth.

Front 4

Question: A 12 year old girl in asthma clinic has suboptimal response to her current therapy, and nedocromil is being considered for addition to the regimen. Nedocromil's major action is?

Back 4

Block of mediator release from mast cells.

Front 5

Question: What drug does NOT have a direct bronchodilator effect: Epinephrine, terbutaline, theophylline, ipratropium, nedocromil?

Back 5

Nedocromil

Front 6

Question: What are some established prophylactic strategy for asthma?

Back 6

Avoidance of antigen exposure; blockade of leukotriene receptors; inhibition of phospholipase A2; inhibition of mediators from mast cells and leukocytes.

Note: blockade of histamine receptors has not been est.

Front 7

Question: An ex-smoker with COPD has frequent bronchospasm. What drug is a bronchodilator useful in COPD and least likely to cause cardiac arrhythmia?

Back 7

Ipratropium--a muscarnic antagonist.

Front 8

Question: What is a nonselective but very potent and efficacious bronchodilator that is not active by the oral route?

Back 8

Epinephrine is the most potent and efficacious agent for asthma; however, is nonselective and can cause hypertension and arrhythmias.

Beta2 agonist are preferred.

Front 9

Question: What prophylactic agent stabilizes mast cells?

Back 9

Cromolyn and nedocromil.

Front 10

Question: PT is suffering seizures from overdosing . He took a drug orally and sometimes had insomnia after taking it. What drug is a direct bronchodilator used in asthma by the oral route and capable of causing insomnia?

Back 10

Theophylline.

Front 11

Question: What drug is used parenterally in life-saving situations for severe status asthmaticus and acts by inhibiting phospholipase As.

Back 11

Prednisone.

Front 12

Question: What has a slow onset but long duration of action and is always used in combination with a corticosteroid by inhalation?

Back 12

Salmeterol and formoterol.

Front 13

For acute asthma, what are the classes of "reliever drugs?"

Back 13

Beta2 agonists, muscarinic antagonists, and theophylline.

Front 14

Long-term preventive treatment for anti-inflammatory drugs used in treatment for chronic asthma are?

Back 14

Anti-inflammatory: corticosteroids

Mediators from mast cells and other inflammatory cells: cromolyn and nedocromil.

Leukotriene antagonists: can have an effect on both bronchoconstriction and inflammation for prophylaxis.

Front 15

Beta2 selective agonist:

Short-acting (for acute episodes) and long-acting (prophylaxis)?

Back 15

Short-acting: albuterol, terbutaline, metaproterenol (NOT a beta blocker!).

Long-acting: salmeterol and formoterol

Note: epinephrine and isoproterenol are used occasionally.

Front 16

How do beta2 agonist cause bronchodilation?

Back 16

Stimulation of Gs adenylyl cyclase that increases cAMP in smooth muscles.

Front 17

When long acting beta2 agonist are used alone, there is an increase risk of? How can you prevent this?

Back 17

Asthma mortality, which when used with corticosteroids, they improve control by improving the response to corticosteroids.

Front 18

Other than acute asthma episodes, short-acting beta2 agonist can also help with? However, at what cost?

Back 18

COPD PTs can benefit, although there is an increase risk of toxicity (arrhythmias since they often have concurrent cardiac disease).

Front 19

What are the SE of beta2 agonist?

Back 19

Skeletal muscle tremor.

At high dose, significant beta1 affects: tachycardia; arrhythmias.

Excess use can lead to loss of responsiveness (tolerance, tachyphylaxis)

COPD PTs: they often have concurrent cardiac disease and arrhythmias can occur at normal dosage.

Front 20

Methylxanthines are? What are three examples? Which one is only used for the treatment of asthma?

Back 20

Purine derivatives.

Caffeine (coffee), theophylline (tea), and theobromine (cocoa).

Theophylline can be used for asthma.

Front 21

What is the MOA of methylxanthines?

Back 21

They inhibit phosphodiesterase (PDE), an enzyme that degrades cAMP to AMP; therefore, methylxanthines increase cAMP.

Also block adenosine receptors in CNS.

Front 22

What are the clinical effects of theophylline?

Back 22

Bronchodilation, CNS stimulation, cardiac stimulation, vasodiltation, increase BP (via release of norepinephrine) and increase GI motility.

Front 23

What are the clinical usage of methylxanthines?

Aminophylline and pentoxifylline?

Back 23

Not as safe or effective as beta2 agonist (narrow therapeutic index: cardiotoxicity and neurotoxicity).

Slow release theophylline for control of nocturnal asthma.

Aminophylline: salt of theophylline sometimes prescribed.

Pentoxifylline: intermittent claudication (decreased viscosity of blood).

Front 24

What are the SE of methylxanthines?

Antidote for theophylline?

Back 24

GI distress, tremor, insomnia, hypotension, cardiac arrhythmias, and seizures.

Beta-blockers for reversing cardiovascular toxicity

Front 25

What are two antimuscarinic agent designed for aerosol use? MOA?

Back 25

Ipratropium and tiotropium (longer acting analog).

They prevent bronchoconstriction mediated by vagal discharge.

Front 26

Compare Ipratropium and tiotropium against beta2 agonist? Which one is more effective with COPD and why?

Back 26

The antimuscarinic are useful in 1/3 - 2/3 of asthma PTs whereas beta2 agonist are useful for nearly all.

Antimuscarinic antagonist are more useful with COPD since they do not cause arrhythmias.

Front 27

What two drugs prevent the release of leukotrienes and histamine from mast cells?

Back 27

Cromolyn and nedocromil.

Front 28

What clinical effect do cromolyn and nedocromil have? Clinical uses and SE?

Back 28

Do not have bronchodiltation actions; however, they prevent bronchoconstriction when faced with an allergic antigen.

Asthma, nasal and eye drops for hay fever, and to prevent food allergies.

Cough and irritation of airways.

Front 29

MOA of corticosteroids? Their effect?

Back 29

Reduce release of phospholipase A2, therefore, reducing arachidonic acid. Also, increases the responsiveness of beta2 receptors in the airways.

Prevent expression of inflammation and decrease leukotrienes that cause bronchoconstriction.

Front 30

Clinical uses and SE of corticosteroids?

Back 30

Early usage may prevent severe, progressive inflammatory changes characteristic of long-standing asthma.

In status asthmaticus, parenteral steroids are lifesaving.

Small degree of adrenal suppresion--rarely significant.

Regular use of inhaled steroids DOES cause growth retardation; but children eventually reach their predicted adult stature.

Front 31

If oral therapy of steroid is needed, then?

Back 31

Alternate day therapy: giving the drug a slightly higher dosage every other day than smaller doses every day.

Front 32

What are two leukotriene receptor blockers? What are they effective against?

Back 32

Zafirlukast and montelukast.

Preventing exercise-, antigen-, and aspirin-induced bronchospasm.

Front 33

What drug selectively inhibits 5-lipoxygnease? Its use and SE.

Back 33

Zileuton.

Prevents exercise-, antigen-, and aspirin-induced bronchospasm.

Elevated liver enzymes; therefore, less popular than leukotriene receptor blockers.

Front 34

How does aspirin produce bronchospasm?

Back 34

Divert all eicosanoid production to leukotrienes with COX pathway is blocked.

Front 35

What drug is a monoclonal AB that binds to IgE on sensitized mast cells to prevent release of inflammatory mediators?

Back 35

Omalizumab