anti- inflammatory drugs

Question 1

Leukotrienne antagonist

Answer 1

Montelukast (singulair)
categorized as a leukotrienne receptor antagonist
does not alter leukotrienne production
binds to a leukotrienne receptors and inhibits effect on bronchial smooth muscle
(called CystLT receptors)
PO- Pill form
once daily, when for routine maintenance.

Question 2

clinical use for leukotrienne antagonist

Answer 2

part of maintenance therapy for asthma 
add on therapy after on ICS 
an alter option during therapy escalation 
can lower use of B2 agents 
allow lower steroid levels 
Also effective for EIA

Question 3

montelukast negatives

Answer 3

only inhibits one pathway of inflammation
must be use as part of a drug regimen
doesn’t stop leukotrienne production

Question 4

side effect of montelukast

—– Leukotrienne antagonist——-

Answer 4

headache
neuro-psychiatic
eosinophilia
churg- strauss vasculitis (inflammation of the vessels)

Question 5

Roflumilast (Daxas)

—- Phosphodiesterase 4 inhibitor ——–

Answer 5

Decreases inflammation by decreasing the ability of inflammatory cells to produce mediators
elevated cAMP inside immune
inhibition or prevents fibrotic changes
inhibition of airway infiltration of WBCs
use on mod to severe COPD
maintenance therapy

Question 6

Daxas (phisphodiestarase 4 inhinitor) dosing

Answer 6

Once daily
Oral (PO)
Pill form
may take up 4-8 months before effects are seen

Question 7

Roflumilast side effects

Answer 7

significant incidence of neuro- Psychiatric changes 
Diarrhea (about 12% of patients ) 
weight loss (avg 10lbs)

Question 8

monoclonal antibody drugs

Answer 8

Monoclonal Antibodies are lab created antibodies targeting specific human mediators
A significant area of Pharmacology for the treatment of:
Cancers
Autoimmune disorders (transplant rejection)
Inflammatory conditions (Crohn’s, Asthma)
COVID

Question 9

Omalizumab (xoliar)

monoclonal antibody for asthma

Answer 9

produced by genetically modified chinese hamster ovary cells
binds to IgE and prevents it from binding to mast cells

Question 10

Omazumab (xolair) dosing

Answer 10

given by SI
usually every 4 weeks (bur as frequent as 2 weeks)
circulatinf IgE starts to decrease within 1 hr after administration
cause 96% of IgE decrease

Question 11

Omaxumab (xolair ) usage

Answer 11

use for the management of chronic asthma
After ICS, LABA and alternate therapies are inadequate
use less ICS
have less exacerbations

Question 12

Omalizumab side effects

Answer 12

pain, redness around injection site

very infrequent incidence of anaphylaxis

Question 13

Methylxanthines

Answer 13

older class of drug
found in coffer, tea and cocoa
added on later for the Tx of COPD and asthma

Question 14

What are the two drugs in methulxanthines ?

Answer 14

– theophylline—
Used in COPD pts
Caffeine
— used in preterm infants with :apnea of prematurity ___

Question 15

Theophylline

Answer 15

minimal bronchodilating properties
improves diaphragm strength from increase muscle contractility
mild cardiac improvement
CNS stimulation increase ventilatory drive
Mils diuresis

Question 16

dosing of theophylline

Answer 16

PO
sustaines release tablet, serum
metabolized by the liver at different rates person to person
may use loading dose to reach serum level then adjust based on lab work

Question 17

theophyllines (negs)

Answer 17

changes from person to person
high serum variation with hepatic or renal dysfunction
wide range of drug interaction with a wide array of drugs

Question 18

theophylline side effects

Answer 18

CNS- headaches, anxiety, insomnia, seizures
CVS– dysrhythmias, palpitations
GI– nausea, vomiting, anorexia, diarrhea, GER

Question 19

Caffeine (methylxanthines )

Answer 19

used in neonates to streghtne drive to breath
apnea of prematurity
diffuses easier into CSF than theophylline
has potent CNS and respiratory stimulants effects

Question 20

Caffeine use and dosing

Answer 20

given orally or by IV
has a wide therapeutic range
dosing is based of weight

Question 21

Magnesium sulfate

Answer 21

used in sever asthma exacerbations when respiratory failure is impending

Question 22

use of MgSO4

Answer 22

Inhibits Calcium uptake into bronchial smooth muscle
Potentiating the effects of Beta2 Agonists
Inhibiting Histamine release from Mast cells
Blocking AcH release in cholinergic nerve endings

only use when other options have been tried

Question 23

administration of MgSO4

Answer 23

given via IV over 20 mins
dosage is weight based
usually just one dose is given

Question 24

Torsades de pointes (MgSO4)

Answer 24

a lethal heart rhythm—-may help in converting to stable rhythm

Question 25

preeclampsia

Answer 25

a syndrome characterized by hypertension in pregnant mothers. preemclampsia decreases BP and seizure risk, used to prolong pregnancy by 1-2 days

Question 26

Asthma severity

Answer 26

based on two criteria symptom control risk of exacerbation severity is establish after 1-2 months after drug regimen initiated

Question 27

assessment of asthma severity

Answer 27

``` frequency of symptoms recue medication use frequency of exacerbations airflow restriction airflow restriction on pulmonary function resting existing co- morbidities ```

Question 28

Reliever therapy

Answer 28

Low dose ICS-LABA | or SABA

Question 29

maintenance therapy

Answer 29

an increasing escalation of therapy involving multiple drugs

Question 30

MIld asthma

Answer 30

``` symptoms less than 2 times a month low ICS-LABA PRN (50-100mg) no routine medication is required Fluticason and salmeterol budenoside/ formoterol mometasone/ formtorerol fluticasone/ vilanterol ```

Question 31

Mod Asthma

Answer 31

``` for symptoms more frequent than twice a month, but not daily maintenance option- low dose ICS, with SABA relieve ( beclomethasone + salbutamol) or PRN ICS LABA combo futher add on daily LTRA (Montelukast reliever therapy PRN low dose ICS- LABA budesonide/ formoterol ```

Question 32

Severe Asthma

Answer 32

``` symptoms most days or symptoms frequently causing night time waking preferred maintenance option Medium dose ICS-LABA combo ( 200-400mg) further maintenance option high dose ICS (500-600) add on : LAMA or LTRA reliever therapy ICS-LABA combo fluticasone/ salmeterol ```

Question 33

uncontrolled asthma

Answer 33

severe asthma with the inability to control symptoms High dose ICS-LABA momentasone/ formoterol (zenhale) 500-600 mg add on LAMA or Omalizumab Xolair reliever therapy ICS-LABA combo drug

Question 34

Gold guidelines

Answer 34

A.) minimal symptoms, low exacerbation risk (SAMA pm or SABA prn ) b. ) moderate symptoms, Low exacerbation risk (LAMA or LABA) c. ) minimal symptoms, high exacerbation risk (ICS+LABA) or LAMA d. ) frequent symptoms, high exacerbation risk ICS +LABA and or LAMA