2- Asthma

Question 1

What is first line tx for asthma?

Answer 1

Beta 2 agonists

Question 2

What is the MOA for beta 2 agonists in the tx of asthma?

Answer 2

Increase cAMP, relax airway smooth muscle, inhibit histamine release

Question 3

How is a beta 2 agonist delivered in an emergency situation?

Answer 3

Injected

Question 4

What drugs are SABAs? (5)

Answer 4

Albuterol

Levalbuterol

Pirbuterol

Terbutaline

Bitolterol

Question 5

What is the use of SABAs?

(Albuterol, Levalbuterol, Pirbuterol, Terbutaline, Bitolterol)

Answer 5

Asthma attack in progress (act immediately)

Question 6

Salmeterol drug class?

Answer 6

Long acting beta 2 agonist (LABA)

Question 7

What is the use of Salmeterol?

Answer 7

Asthma prevention and prophylaxis (act after 20-30 min)

Question 8

Salmeterol should always be used in conjunction with what?

Answer 8

Steroid (Advair)

(to avoid tolerance)

Question 9

What are the SEs of beta agonists?

Answer 9

Tachycardia, nervousness, dizziness, tremor (oral)

Question 10

Pt with asthma presents to your office in need of an inhaled medication to help with sxs. Hx reveals intolerance to beta 2 agonists. What should you prescribe them?

Answer 10

Ipratropium (Atrovent)

Question 11

What is the MOA for Ipratropium?

Answer 11

Muscarinic antagonist

Question 12

Pt presents with COPD and is in need of an inhaled medication to control sxs. What should you prescribe?

Answer 12

Ipratropium (Atrovent)

(if Combivent, give w/ albuterol)

Question 13

The following are the MOAs for what drug?

PDE inhibitor (increases cAMP), blocks adenosine receptor, relaxes smooth muscle

Answer 13

Theophylline

Question 14

What is the drug of choice for a pt whose asthma or COPD is NOT controlled by beta agonists or muscarinic antagonists?

Answer 14

Theophylline

Question 15

Pt with asthma/ COPD presents to your office in need of tx. Upon taking hx, pt states they currently take cimetidine for acid reflux. What drug should you NOT prescribe them?

Answer 15

Theophylline

(caution w drug interactions in general)

Question 16

What is the caution with Theophylline?

(asthma/ COPD 3rd line tx)

Answer 16

Low therapeutic index

Question 17

What are the SEs of Theophylline?

Answer 17

CNS, cardiac, muscle, diuretic

Question 18

Pt who has overdosed on Theophylline will display what sxs? (5)

Answer 18

Palpitations, HA, nausea, emesis, seizures

Question 19

What anti-inflammatory drugs are used in the tx of asthma?

Answer 19

Corticosteroids, Leukotriene inhibitors, Cromolyn sodium

Question 20

What drugs are used orally in severe asthma or asthma exacerbations and improve response to beta agonists?

Answer 20

Corticosteroids

(can also be inhaled)

Question 21

What are the SEs of inhaled corticosteroids?

Answer 21

Oral candidiasis (thrush), hoarseness

Question 22

What drugs are Leukotriene Inhibitors?

Answer 22

Zileuton (Zyflo CR)- 5-LO inhibitor

Zafirlukast (Accolate)- LT antagonist

Montelukast (Singulair)- LT antagonist

Question 23

What drug is used for pt with aspirin-sensitive asthma?

Answer 23

Zileuton

Question 24

What drugs have NO effect on asthma attack in progress (still need beta 2 agonist) but may allow for decreased steroid dose?

Answer 24

Leukotriene inhibitors

(Zileuton (Zyflo CR), Zafirlukast (Accolate), Montelukast (Singulair))

Question 25

What are the SEs for leukotriene inhibitors?

Answer 25

URIs, sore throat, HA, abd pain, sleepiness

Question 26

What asthma drug is a monoclonal antibody and prevents binding of IgE to cells a/w allergic response?

Answer 26

Omalizumab (Xolair)

Question 27

What drug is used in the tx of moderate to severe allergic asthma?

Answer 27

Omalizumab (Xolair)

Question 28

What are the SEs for Omalizumab (Xolair)? (used in mod to severe allergic asthma)

Answer 28

Rash, injection site reactions, small decrease in platelets

Question 29

What asthma drugs inhibit release of histamine from mast cells?

Answer 29

Cromolyn sodium, Nedcromil (NOT bronchodilators)

Question 30

What asthma drug is used for a pediatric patient or for prevention and is taken 4x daily (takes time to be effective)?

Answer 30

Cromolyn sodium, Nedcromil

Question 31

What asthma drug can also be used for conjunctivitis? (eye drops)

Answer 31

Cromolyn

Question 32

What is the asthma step therapy? (5 steps)

Answer 32

1. SABA 2. SABA + low dose ICS 3. SABA + low dose ICS + LABA 4. SABA + med dose ICS + LABA 5. SABA + high dose ICS + LABA 6. SABA + high dose ICS + LABA + oral steroid