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42 Cards in this Set

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  • Back
What are the 7 classes of long term medications used for the treatment of asthma?
1) Inhaled corticosteroids
2) Systemic corticosteroids
3) Inhaled Cromolyn sodium and Nedocromil
4) Inhaled long-acting beta2 agonists
5) Theophylline
6) Systemic Leukotriene modifiers
7) Omalizumab
What are the drugs of choice for asthma treatment long-term?
Inhaled corticosteroids
What are three important inhaled corticosteroids?
1) Budesonide
2) Fluticasone
3) Mometasone furoate
What is the mechanism of inhaled corticosteroids?
They are anti-inflammatory medications that reduce the markers of airway inflammation in the airway
Who should use inhaled corticosteroids?
Asthmatics who use beta2 agonists more than twice a week or twice a month during nighttime attacks
What are the clinical effects of inhaled corticosteroids?
1) reduction in symptom severity
2) improved peak expiratory flow
3) decreased airway hyperresponsiveness
Describe the localized adverse effects of inhaled corticosteroids
1) Oral Candidiasis
2) Dysphonia (hoarseness)
3) reflex cough and bronchospasm
Describe the systemic adverse effects of inhaled corticosteroids
They are similar to that of oral steroids but significantly less likely to occur
1) impaired growth in children
2) osteoporosis
3) disseminated varicella
4) hypothalamic-pituitary dysfunction
Describe the mechanism of action of cromolyn sodium
It stabilizes mast cells and decreases their degranulation
Of what is cromolyn sodium used as the major treatment?
Prophylactic treatment of exercise-induced asthma
Why are cromolyn sodium and nedocromil no longer used?
The clinical response is less predictable than inhaled corticosteroids and take 4-6 weeks to reach maximum benefit
What are the examples of long-acting beta2 agonists? (that we need to know)
1) salmeterol
2) formoterol
3) salmeterol/fluticasone combo
4) budesonide/formoterol combo
Until recently, what was the preferred agent for concomitant use with inhaled corticosteroids?
Long-acting beta 2 agonists
Should beta 2 agonists be used as monotherapy in the treatment of asthma?
No, they are contraindicated as monotherapy
Salmeterol and formoterol are also used to treat what disease?
COPD
Which is better, raising a steroid dose or adding a long-acting beta agonst?
It is better to add a long-acting beta 2 blocker
If a patient has an acute exacerbation of asthma, should they us a long acting beta2 agonist?
No, they have a black box warning against the use in acute exacerbation
Describe the proposed mechanism of action of theophylline
It can cause smooth muscle relaxation by inhibition of phosphodiesterase resulting in an increase in cAMP
Describe the clinical use of theophylline
It is a mild-to-moderate bronchodilator used as an adjuvant to inhaled corticosteroids for prevention of nocturnal symptoms
Describe the therapeutic range of theophylline
It is very narrow
What are the adverse side effects of theophylline?
anorexia, nausea and vomiting nervousness, insomnia, tremor, ulcer or reflux aggravation

above 40mcg/ml can cause seizures and arrhythmias

blood levels need to be monitored
What are the three leukotriene modifiers?
1) montelukast
2) zafirlukast
3) zileuton
What is the mechanism of action of montelukast?
It is a leukotriene receptor antagonist
What are the clinical uses of montelukast?
It is used in mild asthma or allergic rhinitis
What are the adverse side effects of montelukast?
Possible neuropsychiatric events
What is the mechanism of action of zileuton?
It is a leukotriene synthesis inhibitor that blocks 5-lipoxygenase
What are the clinical uses of zileuton?
Exercise induced asthma and aspirin induced asthma
What are the adverse side-effect associated with zafirlukast?
1) GI upset
2) Churg-Strauss
What are the clinical uses for leukotriene modifiers?
They can be used as monotherapy for mild asthma (but less effective than inhaled corticosteroids) or as an adjunct to steroids in moderate asthma; they are not used for acute attacks
What are some drug interactions associated with zafirlukast?
1) inhibits metabolism of warfarin
2) meals decrease bioavailability
What are the adverse reactions of zileuton?
liver toxicity; should be avoided in pregnancy
What is the mechanism of action of omalizumab?
It is an IgG antibody that binds to human IgE and functions to inhibit the binding of IgE to antibody, limiting the release of mediators from the mast cells

Decreases IgE receptor expression
Who can be treated with omalizumab?
Adults or adolescents older than 12 with severe persistent asthma with a positive skin test to an allergen with increased IgE levels and an FEV1 between 40-80% predicted
What is the black box warning associated with omalizumab?
anaphylaxis (can be delayed up to a 4 days)
What are the drugs used for quick relief of asthma ?
1) inhaled short-acting beta2 agonists
2) inhaled anticholinergics
3) systemic corticosteroids
What is most common inhaled short-acting beta2 agonist?
albuterol and levalbuterol
What are the clinical indications of short-acting beta 2 blockers?
1) acute asthma attack
2) exercise-induced bronchospasm
3) regularly scheduled use is NOT RECOMMENDED
What are the names of the inhaled anticholinergic?
tiotropium bromide
ipratropium bromide
Describe the mechanism of action of tiotropium
It is a competitive inhibitor of muscarinic cholinergic receptor inhibitor
Inhaled anticholinergics are used to treat what illnesses?
COPD and asthma
What systemic corticosteroids are used in the treatment of asthma and in what situation would they be used?
Prednisone and methylprednisone; they are used for asthma exacerbations unresponsive to bronchodilators
function of Endoplasmic Reticulum (ER)
stores
separates
cell's transport system

Rough ER has ribosomes, smooth does not