Asthma/COPD (Exam #2)

Question 1

What is the typical treatment process for asthma (3)?

Answer 1

1. SABA
2. Add ICS
3. Add LABA (continue ICS ALWAYS and SABA PRN)

Question 2

Why do you always have to use an ICS in conjunction with a LABA?

Answer 2

Prevent beta receptor down regulation (prevent/reverse tolerance)

Question 3

Which group of meds are preferred for COPD, and why?

Answer 3

“-tropium” (Ipratropium, Tiotropium)

- Muscarinic antagonists → produce bronchodilation

Question 4

What three groups of drugs are used to reduce inflammation in asthma?

Answer 4

• Corticosteroids (ICS)
• Leukotriene inhibitors
• Monoclonal Abs

Question 5

What are the two SABA drugs?

Answer 5

• Albuterol

- Levalbuterol

Question 6

What are the three LABA drugs? What is often combined with these drugs (2)?

Answer 6

• Salmeterol
• Formoterol
• Vilanterol

+/- Fluticasone or Mometasone

Question 7

What is the difference between Ipratropium and Tiotropium, and what class of drugs do they come from? What are they used for?

Answer 7

Muscarinic antagonists for COPD

• Ipratropium: often combined with Albuterol used as a rescue inhaler or acute attack
• Tiotropium: longer DOA, only once daily administration

Question 8

Which LABA is administered orally, and what is an important PK of this drug?

Answer 8

Theophylline

- LOW therapeutic index (many AEs and drug interactions)

Question 9

What is the MOA of Theophylline (2)?

Answer 9

• Blocks adenosine receptors (prevents bronchoconstriction)

- Phosphodiesterase inhibitor = increase cAMP (increase bronchodilation)

Question 10

What four things INCREASE clearance of Theophylline? What DECREASES clearance of Theophylline?

Answer 10

• Increase: Phenytoin, Rifampin, smoking, oral contraceptives
• Decrease: Cimetidine

Question 11

Which administration route of corticosteroids is preferred, and why (2)? When would the lesser preferred route be used?

Answer 11

INHALED: improve sxs, decrease BA requirements

- Oral have more systemic sxs - should only be used short-term and/or severe cases

Question 12

What is the primary AE associated with ICS?

Answer 12

THRUSH (oropharyngeal Candidiasis)

Question 13

What are the three ICS drugs?

Answer 13

• Fluticasone
• Beclomethasone
• Flunisolide

Question 14

What asthmatic response is decreased with Leukotriene Inhibitors (2)? What do they decrease the need for?

Answer 14

Decrease asthmatic response to exercise, cold air

- Decrease need for ICS or oral steroids

Question 15

What is the main Leukotriene Inhibitor drug?

Answer 15

Montelukast (Singulair)

Question 16

What are the two main Monoclonal Ab drugs used for asthma, and what is the target of each?

Answer 16

• Omalizumab (Xolair): targets IgE

- Benralizumab: targets IL-5

Question 17

What three AEs may be seen with Leukotriene Inhibitors?

Answer 17

• Increase in URIs
• Sore throat
• Sleepiness

Question 18

What drug can be used to treat moderate/severe asthma not controlled with steroids?

Answer 18

Omalizumab (Xolair)

Question 19

What drug is used to treat severe asthma with eosinophilic phenotype?

Answer 19

Benralizumab

Question 20

What drug is used to treat asthma by inhibiting release of histamine from mast cells?

Answer 20

Cromolyn sodium

Question 21

What drug is often used prophylactically for asthma in peds?

Answer 21

Cromolyn sodium