Miscellaneous Quiz / anti-asthmatic agents

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Can you name the anti-asthmatic agents?

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HintAnswer
Metaproterenol class
Used systemically: very severe persistent asthma uncontrolled by ICS and LABA or for emergent severe asthma or exacerbation of symptoms
Plasma concentration of methylxanthine > 40 mg/ml
MOA 2: Inhibits function of immune cells - inhibit cell growth, prevent release of inflammatory mediators and cytokines, susceptible to receptor down regulation and desensitization
Most effective med for symptomatic relief of acute bronchospasm. Used in mild to moderate asthma alone or in combo for severe asthma.
Flunisolide class
Prednisone class
Used in adjunctive therapy only for patients > 12 yrs who have allergies and moderate to severe persistent asthma inadequately controlled with ICS. Given SC q 2-4 weeks
MOA: decreases vascular permeability and potentiates B-agonist effects on airway obstruction. Inhaled are more effective in the long term
Mometasone furoate class
Used as an inhaled agent. Most potent and effective. Mild persistent or exercise induced asthma, and moderate to severe asthma
Terbutaline class
MOA: LTD4 receptor antagonist (prevents leukotriene-induced bronchoconstriction)
Formoterol class
Caffiene class
MOA: 5-lipooxygenase inhibitor --> decreased leukotriene production
Beclomethasone class
SE: inhaled (low), tachycardia, cardiac arrhythmias, tremulousness, muscle cramps, metabolic disturbances
SE: well tolerated, occasional N/V, bitter taste, sore throat, HA, cough, rhinitis
Advantage = inexpensive and oral; Disadvantage = needs plasma monitoring, insomnia, serious toxicity of OD
Used in long-term prevention of symptoms, PROPHYLACTIC use only. Use if nonresponder to steroid, want to reduce steroid dose when used in combo or when inciting stimulus is known
Pirbuterol class
MOA: muscarinic receptor antagonist --> blocks parasympathetic bronchoconstriction and mucus release
HintAnswer
Used as 1st line therapy for COPD or in combo with b2/steroid for moderate asthma for relief of acute bronchospasm. Added to SABA or given if SABA not tolerated
MOA: increases release of norepinephrine used as a second-line asthma therapy
SE: occasional liver toxicity
Plasma concentration of methylxanthine 5-20 mg/ml
Montelukast class
Drug(s) which in older adults may be associated with dose-dependent reduction in bone mineral content. Needs to be given with Ca supplements and Vit D.
Possible contraindications or caution needed with sympathomimetics, SABAs, and LABAs for:
Nedocromil class
Salmetrol class
Always given in combo with anti-inflammatory. Used long-term mgmt of moderate and severe persistent asthma. Not for acute symptoms or exacerbation.
Theobromine class
Albuterol class
MOA: inhibits late phase of airway inflamm & hyperreactivity via inhibition of transcription of pro-inflamm mediators & enzymes. Inactivates phospholipase A2 preventing prod of pro
L-albuterol class
MOA: alters chloride channel function reducing mast cell degranulation and nerve conduction in lungs mediating cough
Used for long-term control in mild persistent asthma (secondary to corticoids) In combo ICS, allergic rhinitis. Improves lung function, reduces need for SABA, prevents exacerbation
Not appropriate for monotherapy
Methylprednisolone
Low risk for adverse SE at recommended dose. Reduce SE with spacer and rinsing mouth; use lowest dose; use in combo w/ LABA. Monitor growth in kids - poorly controlled asthma may d
SE: dose dependent tox (monitor plasma levels), low anorexia, N/V, abd discomfort, HA, anxiety. May cause nervousness and insomnia. High level of seizures and arrhythmias.
Omalizumab class
More than one canister/month suggests inadequate asthma control. Regularly scheduled use is not recommended.
Plasma concentration of methylxanthine > 20 mg/ml
HintAnswer
Zafirlukast class
Triamcinolone class
Budesonide class
SE: B1 effects: tachycardia, arrhythmia, angina pectoris
Clearance by liver, rate varies widely -- fastest in children, slowest in neonates and infants, dose corrected needed in liver dz.
Sympathomimetic drugs
MOA: lowers IgE to undetectable levels: inhibit the binding of IgE to mast cells. Inhibits early and late responses to antigen challenge
SE: comparable to placebo, rash, GI upset, bleeding, viral infections, may increase potential for malignant neoplasms
Ipratropium class
Limit to 5-10 days. Many SE: change in glucose metabolism, increased appetite, wt gain, fluid retention, mood changes, peptic ulcer, HTN, adrenal suppression (cushings), candiasis
Drug(s) which may cause older adults to experience confusion, agitation, and changes in glucose metabolism
Zileuton class
Tiotropium class
Used if beta-2-glucocorticoid combo is not effective. Not preferred, used as an alternative
Added to inhaled corticosteroid for increased symptomatic relief in moderate to severe asthma. >12 hrs
SE: increased mortality with monotherapy -- systemic effects are reduced by inhalation application
Theophylline class
Cromolyn class
MOA: b2 receptor agonist -> increased intracellular cAMP and smooth muscle relaxation -> relaxed airway smooth muscle -- somewhat resistant to receptor downregulation and desensiti
Most effective bronchodilator is theophylline. Given as different salts, good PO absorption.
MOA: phosphodiesterase inhibitor --> increased cAMP and cGMP AND adenosine receptor antagonist --> smooth muscle relaxation. Mild to moderate bronchodilator

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