Asthma

Question 1

What is known about the etiology of asthma?

Answer 1

Not a ton exactly. The etiology is far from completely understood. It does related to genes, environmental and biological triggers.

Question 2

What are the characteristics of asthma?

Answer 2

Airway inflammation
Airway obstruciton-REVERSIBLE
Hyperresponsiveness

Question 3

Define IAR and LAR

Answer 3

Immediate asthmatic response-Occurs over minutes

Late asthmatic response- Occurs over hours

Question 4

What is the key cell involved in immediate asthmatic response?

Answer 4

Mast cells. They release histamines, also leukotrienes and other inflammatory responses

Question 5

What triggers mast cell activation?

Answer 5

Antigen

Question 6

What is getting activated in lat asthmatic responses?

Answer 6

Activation of other inflammatory mediators like eosinophils that is activated by mast cells and lymphocytes

Question 7

How many levels are there of asthma classification?

Answer 7

Four

Question 8

What is the definition of FEV1

Answer 8

Forced expiratory volume in 1 second

Question 9

What is the definition of PEF

Answer 9

Peak expiratory flow, the speed of the air moving out of your lungs at the beginning of the expiration

Question 10

What is COPD mediated by?

Answer 10

Neutrophils

Question 11

What are the four components of treating and managing asthma?

Answer 11

1- Measures of asthma assessment and monitoring
2- Education
3- Control of environmental factors and other triggers
4- Meds

Question 12

What is the main thing needed for component 2?

Answer 12

A written asthma action plan for daily management and how to recognize/handle worsening asthma symptoms

Question 13

What is the key points of component 3?

Answer 13

Avoid non selective beta blockers
Reducing allergens
Avoid triggers

Question 14

What are the SABAs? Short acting beta 2 agonists

Answer 14

Albuterol and levolbuterol

Question 15

What changed in the mid 2020s for management of asthma?

Answer 15

Use inhaled corticosteroids instead of SABA for patients over 12

Question 16

What are the LABAs for asthma? Long acting beta agonists

Answer 16

Salmeterol and formoterol

Question 17

What are the LABAs for COPD?

Answer 17

Aformoterol, indacaterol, vilanterol (Can be used for asthma I guess), olodaterol,

Question 18

Which LABA is highly selective for B2 over B1?

Answer 18

Olodaterol

Question 19

What is the mnemonic for short acting beta agonists?

Answer 19

Effective, BUT short acting
alBUTerol
levalBUTerol

Question 20

What is the pneumonic for LABAs for COPD?

Answer 20

Airway-Arformoterol
Is- Indacaterol
Very- Vilanterol (can be used for asthma)
Obstructed- Olodaterol

Question 21

What is the MOA of Beta 2 agonists?

Answer 21

Stimulation of adenylyl cyclase, increasing cAMP and increasing bronchial dilation

Question 22

What are the potential problems with inhaled beta 2 agonists?

Answer 22

Regular use is associated with diminished control of asthma

Question 23

What medication should never be used with asthma without concurrent ICS use?

Answer 23

LABAs

Question 24

What is the MOA of antimuscarinic compounds?

Answer 24

Inhibit the action of ach at muscarinic receptors

-Basically prevents bronchoconstriction

Question 25

What is the pneumonic for long acting muscarinic antagonists?

Answer 25

``` Is- Ipatropium- Only for asthma That- Tiotropium- COPD for the rest All- Aclindinium Understood- Umeclidinium Go- Glycopyrrolate Roos- Revefenacin ```

Question 26

What serious side effects can aclidinium cause?

Answer 26

Diabetes, cardiac effects

Question 27

What is the MOA of theophylline?

Answer 27

Blocks adenosine, preventing bronchoconstriction. Also inhibits PDE, causing more cAMP to cause bronchodilation

Question 28

What are the inhaled corticosteroids?

Answer 28

Fluticasone, budesonide, beclomethasone, ciclesonide, and mometasone

Question 29

How large of a dose of theophyliline will cause vomiting, arrhythmias, or intractable seizures?

Answer 29

Greater than 20mcg/ml

Question 30

What is inhaled corticosteroids MOA?

Answer 30

Inhibit multiple cell types involved in process of inflammation.

Question 31

What is the age cut off for use of inhaled corticosteroids?

Answer 31

12 years and older CAN use it

Question 32

What is a situation to be cautious with when it comes to giving ICS?

Answer 32

When a patient has an infection like HIV

Question 33

What class of drug is cromolyn?

Answer 33

Mast cell stabalizer

Question 34

What is cromolyns MOA?

Answer 34

Prevents release of inflammatory chemicals, histamine from mast cells, but may do more

Question 35

What is cromolyn not good for?

Answer 35

Acute attacks

Question 36

What has cromolyn been replaced by predominately?

Answer 36

LTRA

Question 37

What is an LTRA?

Answer 37

Leukotriene receptor antagonist

Question 38

What are the LTRAs?

Answer 38

Motelukast and zafirlukast

Question 39

What is the MOA of LTRAs?

Answer 39

Block binding of leukotrienes to CysLT1 receptors

Question 40

What class is Zileuton?

Answer 40

Lipoxygenase inhibitor

Question 41

What drug class is Omalizumab?

Answer 41

Immunomodulator | Anti-Ige

Question 42

What scenario is Omalizumab ideal for?

Answer 42

Asthma of allergic etiology

Question 43

What are some other immunomodulators? The pneumonic?

Answer 43

``` Mepolizumab Reslizumab Benralizumab Dupilumab MRBD- For eosinophillic ``` Only Omalizumab for allergic asthma

Question 44

What infection is contraindicated for use of biologics that treat eosinophillic asthma?

Answer 44

Helminth infection

Question 45

What are the treatment options for COPD?

Answer 45

SABA, LABA, ICS, theophylline Phosphodiaterase 4 inhibitor- Roflumilast Antibiotics- Azithromycin Antimuscarinics- Tiotropium, aclidinium