Dr. Williams MCP II Test 1

Asthma

Chronic condition in which the airways are predisposed, or susceptible to inflammation and narrowing resulting in diffiiculty breathing.

True or False.

1. Chronic asthma causes remodeling of the airways

True

Asthma is characterized by what?

1. Wheezing

2. Chest tightness

3. SOB

4. Coughing

How do Histamine, PGD2, LTC4, LTD4, and PAC contribute to swelling on the smooth muscle of the bronchial?

They attract other factors to the site that contributes to the swelling and inflammation.

What is epinephrine used for in asthma and why is it not the first choice for asthma? Any side effects?

1. Can be used to treat asthma and manage it, in emergency management.

2. It is not the first choice for asthma because it is non-selective and will bind to different receptors causing an unwanted response.

3. Has added risks such as tachycardia, angina, and arrhythmias, but no added benefits.

What is ephedrine used for in asthma and why is it not the first choice for asthma? Any side effects?

1. It Can also be used to treat asthma, but not great for managing asthma.

2. Less selective than epi.

3. More CNS effects

What is isoproterenol used for in asthma and why is it not the first choice for asthma? Any side effects?

1. Bronchial smooth muscle relaxtion

2. Only beta selective, which means it can select for B1 (Heart receptor) and also B2 ( LUng receptor )

3. Increase lethal arrythmias

Albuterol

Levalbuterol

Terbutaline

Metaproterenol

Pirbuterol

Are all considered what?

Short Acting Beta Agonist

Salmeterol

Formeterol

Arfomoterol

Are all considered what?

Long Acting Beta Agonist

Indacaterol

Olodaterol

Are considered what?

Very Long Acting Agonist

What is the difference between salmeterol and formoterol?

Formoterol has a more rapid onset of action, while sormeterol does not.

What is difference between arformoterol and formoterol?

Arformoterol is more potent and is the enantiomer of formoterol.

What are Short Acting beta agonists used for?

Typically used as "rescue" medications to provide quick relieve of asthma symptoms.

- Asthma Attacks

What are long acting beta agonists used for?

Used to manage chronic asthma.

In Asthma, what are sympathomimetics used for?

1. Bronchial Smooth Muscle Relaxation

What is the main route of administration for Beta 2 Agonists? Alternative Routes?

1. Metered Dose Inhalers

2. Nebulizer

3. Dry Powder Inhaler

ALternative Routes

1.Oral Albuterol

2. Oral & Subcutaneous terbutaline

How do the physiological effects of Systemic vs Aerosol Differ?

1. Aerosol is more direct and has less side effects compared to Systemic.

For management of acute asthma exacerbations ( 1st Line )

SABA's

For long term management of asthma ( In conjunction with glucocorticoids )

LABA's

Name the drug interactions for Beta Agonist.

1. Beta Blockers

2. Other sympathomimetics

Name Toxicities primarily observed with systemic treatment.

1. Cardiovascular

- tachycardia

- hyper or hypo tension

2. CNS

3. GI

4. Genitourinary

5. Tachyphylaxis

- rapidly diminishing response to successive doses of a drug,

Methylxanthine is indicated in asthma as a

1. Airway smooth muscle relaxor

2. Anti-inflammatory

Name a methylxanthines and name the MOA.

1. Theophylline ( Theo-24 )

Moa

- PDE Inhibition

- Adenosine Recepter Antagonist

- Histone Deacetylase Activation ( HDAC )

Why does methylxanthines have limited use? Explain.

1. Limited Due to Toxicity

- CNS

Excittation, convulsions, nervousness, tremors

- Cardiovascular

Positive inotropic, chronotropic effects, arrhythmias

- GI

Upset, Vomiting

Describe the Methylxanthine MOA: PDE inhibition

1. Methylxanthine inhibits phosphodiesterase ( which blocks CAMP ) which causes an increase in camp, which results in increases relaxtion of the bronchial smooth muscle

Name the Antimuscarinics, and what they target.

1. Ipratropium

2. Tiotropium

3. They target the bronchial smooth muscle and relax it.

Why is ipratropium/ tiotropium is preferred over atropine?

Adverse Effects for Antimuscarinics.

1. Dry Mouth

2. Pharyngeal Irritation

Where is cortisol produced and what effect does it have on the body?

1. It is produced in teh adrenal cortex

2. Has a wide range of effects

- growth

- immunity

- stress

If there is too much costisol being produced in the body, what does the adrenal cortex do?

1. It sends signals to the anterior pituitary and hypothalamus to halt the process of making cortisol.

Describe the anti-inflammatory effects of glucocorticoids.

1. Annexin A1

- Repressed Eicosanoids

2. Suppress lympocyte, mast cells, eosinophil Infiltration.

3. Restore sensitivity to beta agonists.

Describe the function of Anti-inflammatory genes.

1. Helps restore, tissue and prevent leaking.

2. Interact with receptor and turn off pro-inflammatory genes..

Why do we pair LABA's with glucocorticoids?