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Asthma Flashcards

1
Q

what is the most common chronic dz in children?

A

asthma

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2
Q

is asthma reversible?

A

Yes

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3
Q

risk factors for asthma

A

Allergens
Respiratory infections
tobacco smoke, air pollution, occupation, diet

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4
Q

2 phases of asthma

A

immediate-phase response

late-phase response

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5
Q

what are the most effective drugs in the early phase of an asthmatic attack.

A

Bronchodilators

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6
Q

What occurs in the late-phase response of asthma?

A

bronchospasm, vasodilatation, edema and mucous secretion

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7
Q

what is needed for tx of late-phase response asthma?

A

Anti-inflammatory drug action

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8
Q

what are some environmental triggers of asthma?

A 
Dust mites
pet dancer
cockroaches
pollens
molds
viral URIs
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9
Q

What are some co-morbid conditions with asthma?

A

GERD
allergic rhinitis
sinusitis
depression

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10
Q

what drugs can induce asthma?

A

Cardioselective and non-selective Beta Blockers, Calcium antagonists
Dipyridamole
NSAID’s

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11
Q

Life-threatening acute deterioration of stable asthma

A

Acute asthma/ status asthmaticus

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12
Q

Acute or subacute onset of progressively worsening asthma symptoms

A

Asthma exacerbation

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13
Q

how much time does it take for an acute asthma exacerbation to occur

A

Sudden, less than 6 hours

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14
Q

Physical findings of asthma

A

Hyperexpansion of the thorax
Sounds of wheezing
Increased nasal secretion, mucosal swelling and nasal polyps
Atopic dermatitis/eczema

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15
Q

what do you use to establish reversibility of the airway?

A

spirometry

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16
Q

how often should short-acting inhaled beta-2 agonists be used?

A

<2 days / week

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17
Q

what meds are used for long term controll

A 
Corticosteroid : inhaled and systemic
Long-acting beta 2-agonist
Leukotriene modifiers
Methylxanthines
Cromolyn
Anti-IgE
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18
Q

What is used for quick relief of asthma

A

Short-acting beta 2 agonists (albuterol)
anticholinergics
systemic corticosteroids

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19
Q

Advantages of inhaled therapy

A

deliver drugs directly to the airways
deliver higher drug concentrations locally
minimize systemic side effects.

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20
Q

do you get a lot of systemic absorption with inhaled corticosteroid.

A

No

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21
Q

what makes it easier to use an inhaler?

A

Spacers

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22
Q

Convert a solution of drug into aerosol for inhalation
Used to deliver higher doses of drug to the lungs
more efficient than inhalers

A

Nebulizers

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23
Q

MOA of inhaled corticosteroids

A

Depress the inflammatory response and edema in the respiratory tract
Diminish bronchial hyper-responsiveness

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24
Q

What do inhaled corticosteroids decrease

A

Mucous production

Prostaglandins and leukotrienes

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25
what is the most effective long-term control for persistent asthma
corticosteroids
26
what do you often combine with inhaled corticosteroids?
beta 2 agonist or other asthma agents
27
when do symptoms of asthma respond to ICS?
1-2 weeks, max 4-8 weeks
28
when must inhaled corticosteroids be used?
Regularly in order to help | Will not help in an acute setting
29
Contraindications with ICS?
caution in growing children (wash mouth out after)
30
ADRs of ICS (local)
Reflex cough and bronchospasm | thrush
31
Systemic ADRs of ICS
hypothalamic-pituitary-adrenal suppression impaired growth in children dermal thinning-dose dependent
32
in adults what are some concerns with ICS?
bone mineral density | ocular effects- cataracts, glaucoma
33
How can you decrease systemic absorption with ICS?
use a holding chamber rinse and spit lowest dose possible used in combo w/ long-acting beta 2-agonists
34
Name the ICS
``` fluticasone Budesonide Beclomethasone Flunisolide Triamcinolone Mometasone ```
35
What are some ICS and LABA combos?
Fluticasone/ salmeterol (Advair) | Budesonid/ formoterol (symbicort)
36
List some long acting beta 2 agonists
Salmeterol | Formeterol
37
are LABAs a substitute for anti-inflammatory therapy? or for acute symptoms
No
38
can you develop tolerance with LABAs?
Yes- with chronic administration
39
what is the black box warning with long acting Beta 2 agonists?
Increase the chance of severe asthma episodes and death when those episodes occur
40
what can increase salmeterol plasma levels.
Concomitant use of CYP3A4
41
what drugs should be avoided with salmeterol
Ketoconazole, ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin
42
if a patient is controlled on a low dose ICS, should you start a LABA?
No
43
should LABA be used as monotherapy?
No
44
which LABA as a quick onset of action
Formoterol
45
what are three leukotriene receptor antagonists
montelukast (singulair) zafirlukast zileuton
46
MOA of leukotriene receptor antagonists
Competitively antagonize leukotriene receptors D4 and E4 in the bronchiolar muscle, antagonizing endogenous leukotrienes causing bronchodilation.
47
what leukotriene receptor antagonsits also inhibits 5-lipoxygenase?
Zileuton
48
how are luekotriene receptor antagonists administered?
Orally
49
Who is ziluton NOT indicated w/?
patients with active liver dz
50
who are luekotriene receptor antagonist contraindicated with?
pregnancy | elderly
51
ADRs with leukotriene receptor antagonists
GI disturbances | HA
52
What are 2 methylxanthines?
Theophylliline (oral) | Aminophylline (oral and iv form)
53
MOA of methylxanthines?
to increase cAMP levels in the bronchial smooth muscle cells by inhibiting phosphodiesterase, an enzyme which catalyses the hydrolysis of cAMP to AMP.
54
What does increased cAMP lead to?
relaxes smooth muscle, causing bronchodilation.
55
Indications for methylxanthines
refractory patients | monotherapy and combo with ICS
56
Contrindications of methylxanthines
Children <4 cardiac dz HTN hepatic impairment
57
Problems with methylxanthinesN
narrow therapeutic window | significant interactions
58
Name some mast cell stabilizers
``` cromolyn sodium (inhaled) nedocromil (inhaled) ```
59
MOA of mast cell stabilizers
stabilize mast cells preventing the release of inflammatory mediators
60
Indications for mast cell stabilizers
Patients <20 w/ allergic dz; pregnancy
61
which mast cell stabilizer is bitter?
Neocromil
62
How long must mast cell stabilizer be used for effects?
Several weeks
63
Reserved for moderate-to-severe persistent asthma in patients 12 years of age or older who are not controlled on other therapies (not first line therapy) SQ injection
Omalizumab (Xolair)
64
Black box warning for omalizumab
anaphylaxis
65
MOA os systemic corticosteroids
Decrease inflammation by suppression of migration of leukocytes and reversal of increased capillary permeability.
66
what route is preferred for systemic corticosteroids?
Oral over IV
67
when do you see effects of systemic corticosteroids?
after 4-6 hours
68
what are quick relief therapies for asthma?
Short acting beta2-adrenoceptor agonists
69
name some bronchodilators
Albuterol Pibuterol Metaproternol Levalbuterol
70
MOA of beta 2 adrenoceptor agnoist
: β2-adrenoceptors are located on the airway smooth muscles and respond to epinephrine.
71
indications of beta adrenoceptor agonist?
relieve bronchospasm during acute exacerbations | pretreatment exercise induced
72
ADRS of beta 2 adrenoceptor agonist
fine tremor tachycardia hypokalemia w/ high doses
73
____________ are the only inhaled agents indicated for acute asthma attacks therefore also used as rescue inhalers.
Short-acting beta agonist such as albuterol
74
list some anticholinergics used for relief of acute bronchospasm (not chosen over albuterol)
Ipratropium | Tiotropium
75
what anticholinergic may provide additive effects to B2-agonists, in acute setting
Ipratropium
76
Are anticholinergics good for maintenance?
No
77
Anticholinergics are an alternative for patients with what type intolerance?
B2-agnoist intolerance
78
2 contraindications with anticholinergics
Glaucoma | Pregnancy
79
what do systemic corticosteroids do?
prevent progression of asthma exacerbation | reduce morbidity of the illness
80
If systemic corticosteroids are used more than how many times in a year should you re-evaluate their asthma treatment.
3 courses a year
81
every patient diagnosed w/ asthma should get what?
SABA (rescue albuterol inhaler)
82
for mild intermittent asthma what should they be given?
No daily meds | quick relief only
83
If patient has mild persistent asthma what meds should they get?
Low dose inhaled steroids PRN SABA alternative tx- cromolyn or nedocromil, leukotriene modifier or theophylline
84
What meds do you give for moderate persistent asthma
Low dose ICS and LABA; PRN SABA | Alternative- med/high dose ICS or low dose ICS + leukotriene modifier or theophylline
85
Meds for severe persistent asthma
Medium or high dose ICS and LABA or if needed glucocorticosteroid
86
Is COPD reversible?
No
87
what do COPD patients get some relief from (not as well as asthmatics though)
Bronchodilators | Anti-inflammatory agents
88
what is a hugely important therapy in COPD patients
Oxygen
89
Associated with chronic or recurrent excess mucous secretion into the bronchial tree Cough that occurs on most days during a period of at least 3 months of the year for at least 2 consecutive years.
Chronic bronchitis
90
Abnormal, permanent enlargement of the airspaces distal to the terminal bronchioles Accompanied by destruction of their walls, without obvious fibrosis
Emphysema
91
how does oxygen work with COPD
It increases alveolar oxygen tension and decreases the work of breathing necessary to maintain arterial oxygen tension.
92
what COPD patients shouldn't receive oxygen?
patient who retain CO2, will depress their respiratory drive
93
what is the gold standard in COPD meds?
anticholinergics (can add beta 2 agonist, improves better combined)
94
Who should inhaled steroids be reserved for in COPD
Moderate to severe reduction in airflow that failed bronchodilator therapy
95
when are anitbiotics used with COPD?
When at least 2 of the following 3 are present increased dyspnea increased sputum volume increased sputum purulence

Pharm II (16 decks)

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