Bronchodilators

Question 1

prednisone

Answer 1

oral corticosteroid

Question 2

montelukast

Answer 2

leukotriene antagonist

Question 3

zafirlukast

Answer 3

leukotriene antagonist

Question 4

anti-IgE Ab

Answer 4

obalizumab

Question 5

bronchospasm

Answer 5

IgE on mast cells
-release histamine and other mediators

blocking single one - not very helpful

corticosteroids - block lots

Question 6

preformed mediators

Answer 6

histamine
TNF alpha
protease
heparin

immediate

vasodilation, edema

Question 7

lipid mediators

Answer 7

minutes
leukotrienes, prostaglandins

mucus secretion

Question 8

cytokines

Answer 8

interleukins, GM-CSF

hours

inflammatory cell proliferation

Question 9

IgE proliferation

Answer 9

IL-4, IL-5

Th2 cell

Question 10

aerosol delivery

Answer 10

lots swallowed
-bets drugs - poor GI absorption

spacer - larger particles deposited before inhales - allows only smaller -which go to small airways

1-5 micrometers - get to small airways

Question 11

DOC for rapid relief of bronchospasm

Answer 11

beta-adrenergic agonist

Question 12

beta agonist overuse

Answer 12

side effect intensify

seek help as soon as decline in efficacy of tx noticed

Question 13

asthma tx

Answer 13

control inflammatory component

bronchodialtor - sympomatic use PRN

Question 14

COPD tx

Answer 14

focus on reversible component

-bronchodilation

Question 15

no hand lung coordination

Answer 15

nebulizer

Question 16

SABA

Answer 16

albuterol

Question 17

LABA

Answer 17

formoterol

salmeterol

Question 18

emergency use

Answer 18

epinephrine - subQ

Question 19

beta agonist MOA

Answer 19

beta2 receptor

stimulate adenylyl cyclase and increase cAMP

relax bronchial smooth m, inhibit mediators of mast cells

Question 20

prevention of nighttime asthma attacks

Answer 20

salmeterol

prophylactic bronchodilation

slow onset - not for acute tx

Question 21

most effective long term treatment persistent asthma

Answer 21

inhaled corticosteroids

recommendations - long acting beta2 agonist in combination with inhaled corticosteroid

Question 22

beta agonist side effect

Answer 22

muscle tremor, cramps, tachyarrythmias, metabolic disturbanceq

Question 23

long term use of LABA

Answer 23

may down-regulate beta-2 receptors

lose protective effect

stop use once asthma control achieved and maintain use of an asthma-controller - inhaled corticosteroid

Question 24

anaphylactic rxn

Answer 24

epinephrine subQ

Question 25

quaternary muscarinic receptor antagonist

Answer 25

ipratropium bromide inhaled aerosol poor GI absorption** - swallowed little effect

Question 26

COPD tx

Answer 26

ipratropium

Question 27

long acting muscarinic antagonist

Answer 27

tiotropium

Question 28

theophylline

Answer 28

methylxanthine - adenosine receptor antagonist - PDE inhibitor - hyperpolarize cell membranes

Question 29

intranasal ipratropium

Answer 29

allergic rhinitis | postnasal drip syndrome

Question 30

methylxanthines

Answer 30

theophylline cause bronchodilation used to be first line for asthma - not less prominent role in therapy because benefits modest with narrow therapy index

Question 31

noctural asthma improvement

Answer 31

with slow release theophylline but corticosteroids and salmeterol are probably better option

Question 32

PDE4 inhibitor

Answer 32

roflumilast -for COPD increased cAMP levels and reduce inflammation reduced exacerbations side effects - nausea, diarrhea, psych, weight loss only pt not responding other therapy

Question 33

corticosteroid MOA

Answer 33

steroid receptor agonist -to nucleus and +/- regulate gene transcription - takes time inhibit lots of inflammatory mediators

Question 34

aerosol steroids

Answer 34

safer

Question 35

systemic corticosteroids

Answer 35

IV/oral - for severe asthma in hospital prednisone/methylprednisone - IV then oral tapered off dose

Question 36

corticosteroid side effects

Answer 36

``` HPA suppression bone resorption carb/lipids cataracts purpura dysphonia candidiasis ```

Question 37

combined products

Answer 37

fluticasone / salmeterol budesonide / formoterol mometasone / formoterol

Question 38

reversible component COPD

Answer 38

inflammation and bronchospasm this is drug therapy

Question 39

irreversible component COPD

Answer 39

alveolar destruction

Question 40

COPD tx

Answer 40

inhaled ipratropium / tiotropium with beta2 agonist monotherapy with inhaled corticosteroids - not approved for COPD

Question 41

growth retardation

Answer 41

concern with high dose corticosteroids in children

Question 42

triple therapy

Answer 42

for COPD -tiotropium, LABA, corticosteroid superior to 1 or 2 agents in relieving symptoms such as dyspnea and in improving lung function

Question 43

cromolyin

Answer 43

anti-inflammatory -inhibit antigen-induced bronchospasm inhibits release of histamine from mast cells not effective in tx of ongoing or acute bronchospasm - primarly used as prophylactic**

Question 44

LTD4 receptor antagonist

Answer 44

motelukast -oral prophylaxis for exercise induced asthma alt tx for mild persistant asthma