1. Acute mediators of bronchospasm
    • LTC4, LTD4
    • from mast cells after binding IgE antigen complex
  2. Chemotactant released by mast cells
  3. drug class for chronic inflammation
    • corticosteroids
    • drugs that block release of mediators from cells; cromolyn and nedocromil
  4. Short acting B2 agonist
    • atenolol
    • terbutaline
    • metaproternol
    • first line of defense in acute asthma
  5. Long acting B2 agonist
    • salmeterol
    • formoterol
    • slow onset of action
    • 12 hours or more
    • used as prophylaxis
  6. Beta agonist MOA
    • Bind Gs coupled receptor and stimulate cAMP production
    • cAMP activates protein kinase A thick phosphorilates myosin light chain kinase inactivating it
  7. toxicity of B agonists
    • skeletal muscle tremors, not totally B2 specific
    • tachycardia
    • tolerance
    • anxiety
  8. Methylxanthines
    • caffeine
    • theophylline, only one effective in treating asthma
    • theobromine
    • p450 cleared by liver
  9. MOA for methyxanthines
    • inhibit PDE4 and antagonizes adenosine receptor
    • increases cAMP
    • must used as a slow release control for nocturnal asthma
    • small therapeutic index, since adenosine slows heart rhythm blocking its receptors can cause arrhythmia
  10. Toxicity of methyxanthines
    • GI distress
    • tremor
    • insomnia
    • large overdoses can cause arrhythmia
  11. Muscurinic antagonists
    • atropine, not used for asthma anymore because of systemic effects
    • ipratropium
    • tiotropium- longer lasting
    • stops phospholipase C
    • used more in COPD then in acute asthma. Less toxic then B agonist in COPD, less risk of cardiovascular toxicity
  12. Cromolyn and nedocromil
    • decrease the release of mediators; leukotrienes and histamine
    • only have local effects, no absorption
    • used in asthma and hey fever, can be a nasal and eye drops
  13. Corticosteroids
    • safe if used as an inhaler, no systemic effects
    • beclomethasone, flunisolide used most
    • budesonide, dexamethasone, fluticasone, mometasone
  14. status asmaticus
    • acute asthma attack that does not respond to normal treatment
    • IV prednisolone
  15. MOA of corticosteroids
    • reduce synthesis of arachidonic acid
    • inhibits phospholipase A2
  16. clinical use of corticosteroids
    used in most cases of asthma that do not respond well to B agonists
  17. Toxicity of corticosteroids
    • aerosol may occasionally lead to slight adrenal suppression
    • if given orally alternate dose to stop adrenal suppression
    • more severe reactions when used for severe refractory asthma for more then two weeks
    • can cause mild growth retardation , but they will recover
  18. leukotriene receptor blockers
    • zafirlukast and montelukast
    • antagonize the LTD4 and LTE4 receptor
    • orally taken and prevent exercise, antigen, and aspirin induced bronchospasms
    • increase infections
  19. lipoxygenase inhibitor
    • zileuton
    • inhibits 5 lipoxygenase, key enzyme in leukotriene synthesis
    • increase infections
  20. indirect sympathomimetics
    • ephedrine
    • release epi and norepi form stores
    • produce alpha and beta reactions
    • taken orally so produce systemic and cns effects
  21. Anti IgE antibody
  22. Patient is on Beta blockers for heart condition and is an asthmatic
    use muscurinic blockers, beta agonists would knock beta blocker off receptor and reduce its effects
  23. effect of cotisol on chatacholomines
    • helps them bind to there receptors and stops desensitization
    • give low dose with B2 agonist
Card Set
Bronco dilators