Mechanism of Action
This second messenger increases after β2 receptor activation and causes bronchodilation.
What is cAMP?
This class has onset <5 minutes and duration 4–6 hours.
What is SABA?
Most inhaled corticosteroids are metabolized by this CYP enzyme.
What is CYP3A4?
Excessive SABA use (>200 doses/month) increases risk of this.
What is asthma-related death?
Clarithromycin increases systemic steroid exposure by inhibiting this enzyme.
What is CYP3A4?
This receptor subtype is blocked by ipratropium and tiotropium.
What is the M3 muscarinic receptor?
This LABA has rapid onset similar to albuterol.
What is formoterol?
Smoking induces this enzyme, increasing theophylline clearance.
What is CYP1A2?
LABA monotherapy is contraindicated in asthma due to risk of this outcome.
What are severe exacerbations and asthma-related death?
Protease inhibitors plus fluticasone may lead to this syndrome.
What is Cushing’s syndrome?
This enzyme is inhibited by theophylline to enhance bronchodilation.
What is phosphodiesterase (PDE)?
This LAMA provides bronchodilation for ~24 hours due to slow dissociation.
What is tiotropium?
Neonates have increased total body water, increasing this pharmacokinetic parameter.
What is volume of distribution?
This common ICS adverse effect results from local immunosuppression.
What is oral candidiasis (thrush)?
Stopping smoking increases levels of this narrow therapeutic index drug.
What is theophylline?
This cellular process explains why corticosteroids have delayed onset.
What is genomic modulation of inflammatory gene transcription?
Maximum therapeutic benefit of ICS may take this long.
What is 4–6 weeks (or up to 3–4 months for full effect)?
This corticosteroid requires hepatic activation to become active.
What is prednisone?
Chronic OCS use suppresses this physiologic axis.
What is the hypothalamic-pituitary-adrenal (HPA) axis?
Montelukast plus OCS may increase risk of this fluid-related adverse effect.
What is peripheral edema?
Corticosteroids enhance LABA effectiveness by increasing this receptor’s expression.
What is the β2 receptor?
Tolerance to β2 agonists can occur within approximately this time frame.
What is about one week?
This pharmacokinetic property of ICS reduces systemic toxicity.
What is extensive first-pass hepatic metabolism?
Explain why LABA monotherapy in asthma increases risk of asthma-related death despite improving lung function.
What is maintenance bronchodilation masking uncontrolled airway inflammation, leading to continued inflammatory progression and increased risk of severe exacerbations?
A patient taking inhaled fluticasone is started on ketoconazole. Within several weeks, she develops weight gain, facial rounding, and easy bruising. Identify the pharmacologic mechanism responsible for this adverse effect.
What is CYP3A4 inhibition leading to increased systemic corticosteroid exposure and adrenal suppression (iatrogenic Cushing’s syndrome)?