Asthma

Question 1

How is asthma defined?

Answer 1

Wheezing, SOB, chest tightness, and cough

Question 2

What can induce an inflammatory cascade?

Answer 2

Cold air, exercise, Tobacco, or other air pollutants

Question 3

What populations is the prevalence of asthma in?

Answer 3

Pre puberty males and females post puberty

Question 4

What races is asthma more commonly associated with?

Answer 4

African Americans and native Americans

Question 5

What are the two major environmental factors affecting asthma development?

Answer 5

Airborne allergens and viral respiratory infections

Question 6

What are the inflammatory cells recruited during an asthma attack?

Answer 6

Eosinophils, lymphocytes, and phagocytes

Question 7

What are the structural changes that happen during remodeling leading to asthma?

Answer 7

Smooth muscle hyperplasia, epithelial damage/fibrosis, mucous production, and angiogenesis (proliferation of blood cells)

Question 8

What must happen in the cycle of inflammation that occurs in asthma?

Answer 8

1. Genetics or environmental stimuli initiated the cycle
2. Airway epithelium defends against allergens
3. Production of pro inflammatory cytokines like interleukin 2 and IL 25.
4. Inflammatory cells lead to chronic inflammation

Question 9

What are the signs and symptoms of asthma

Answer 9

Cough, SOB, tightness of chest, wheezing, sputum production

Question 10

What is the overall goal of asthma therapy?

Answer 10

To prevent Chronic effects like cough or SOB and maintain normal lung function to minimize future risk of asthma related mortality.

Question 11

What are common comorbidities of asthma?

Answer 11

Allergic rhinitis, eczema, obesity, obstructive sleep apnea, and rhino sinusitis

Question 12

What are the trends of patients with intermittent asthma?

Answer 12

Daytime symptoms less than 2 days a week
Nighttime symptoms less than 2 nights a month
Using B2 agonists less than 2 times a week
FEV and spirometer in normal range

Question 13

What classes are quick relief rescue asthma meds?

Answer 13

Anticholinergics, short acting B2 agonists, oral corticosteroids

Question 14

What are long term asthma med classes?

Answer 14

Inhaled corticosteroids
Long acting B2 agonists
Cromolyn sodium and nedocromil
Leukotriene modifiers
Immunomodulators
Methylxanthines

Question 15

What are impairment parameters for asthma?

Answer 15

Symptoms, nighttime awakenings, use of quick relief meds, impaired spirometer readings

Question 16

What are the risk parameters for asthma?

Answer 16

The # of asthma exacerbations requiring oral corticosteroids in a year

Question 17

What is the step wise approach to entreating asthma?

Answer 17

Increasing and decreasing meds based on symptoms

Question 18

What is the metabolism advantage of inhaled asthma therapy?

Answer 18

Bypasses first pass metabolism and smaller doses can be used for a therapeutic effect

Question 19

What are the disadvantages to inhaled asthma therapy?

Answer 19

Without a spacer only 10-40% of the drug leaving the device is deposited in the lungs

Question 20

What are the three types of inhaled asthma therapy?

Answer 20

Hydrifluroalkaline inhaler also metered dose inhaler, Dry powder inhalers, and nebulizers

Question 21

How does a spacer impact inhaled medications?

Answer 21

Improves the direction of the medications in the lungs, deposits drug deeper into lungs, reduces the amount of meds that sticks to the back of the throat

Question 22

T or F spacers help reduce thrush and voice hoarseness when using inhalers

Answer 22

T

Question 23

What is the most common error of the use of inhalers?

Answer 23

Not fully exhaling before using the device

Question 24

What are the short acting SABA

Answer 24

Albuterol and levalbuterol

Question 25

When should patients with an exercise trigger use their SABA?

Answer 25

10-20 min prior to exercise

Question 26

What is the black box warning of LABAs?

Answer 26

They increase the risk of asthma related death

Question 27

What enzyme catalyzes cyclic AMP from ATP

Answer 27

Adenyl Cyclase

Question 28

What is the difference in levalbuterol and albuterol

Answer 28

Levalbuterol has a slower peak effect

Question 29

What is the effect of beta 2 adrenergic agonists?

Answer 29

They stimulate intercellular adenyl cyclase

Question 30

What is the time of affect in SABA vs LABA

Answer 30

SABA 25 min in asthma LABA 2 hrs in COPD

Question 31

How is the excretion different in SABA vs LABA

Answer 31

SABA is excreted in urine and LABA is mostly feces

Question 32

What are the inhaled corticosteroids and when are the initiated?

Answer 32

Beclomethasone, fluticasone, budesonide, mometasome, flunisolide, ciclesonide They are initiated during step two of mild persistent asthma

Question 33

Which inhaled corticosteroid is safest in pregnancy?

Answer 33

Budesonide

Question 34

Where does the inhaled corticosteroid fluticasone act?

Answer 34

Locally in the lungs

Question 35

What are the LOCAL AEs of inhaled corticosteroids?

Answer 35

Dysphonia, topical candidiasis, contact hypersensitivity, and cough

Question 36

What are the SYSTEMIC AEs of inhaled corticosteroids

Answer 36

Adrenal suppression, lung infection, ocular effects (cataracts) skeletal effects (osteoporosis)

Question 37

When is a combo of inhaled corticosteroids and beta 2 agonists indicated?

Answer 37

Steps 3-6 of asthma. Do not add when asthma is controlled on a low or medium dose of ICS without LABA

Question 38

What are the LTRAs?

Answer 38

Zileuton, zafirlukast, and montelukast

Question 39

When are LTRAs more bioavailable?

Answer 39

When taken fasting

Question 40

T or F LTRAs are 100% protein bound

Answer 40

T

Question 41

What are the most common AEs of LTRAs?

Answer 41

Headache, GI upset, and liver injury (not montelukast)

Question 42

What drugs do zileuton and zafirlukast counteract with?

Answer 42

THEOPHYLLINE, warfarin, propranolol, and aspirin

Question 43

T or F montelukast has more drug interactions than other LTRAs

Answer 43

F

Question 44

What is the mast cell stabilizer drug name?

Answer 44

Cromolyn sodium

Question 45

T or F Cromolyn has a fast onset and can be used for Bronchospams

Answer 45

F

Question 46

How is Cromolyn sodium given?

Answer 46

Nebulizer QID

Question 47

What are the AEs of mast cell stabilizers

Answer 47

Nasal congestion, cough, sneezing, nausea

Question 48

What are the immunomodulators?

Answer 48

MABs, omalizumab, mepolizumab, reslizumab, benralizumab, dupliumab

Question 49

When are immunomodulators prescribed

Answer 49

>12 years old with moderate or severe persistent asthma with failure to ICS and a positive allergy skin test to perennial aero-allergen

Question 50

How are immunomodulators given?

Answer 50

SubQ or IV q 2-4 weeks

Question 51

What is the FDA warning when taking immunomodulators?

Answer 51

Potential cancer risk and cardiovascular events

Question 52

How do immunomodulators work?

Answer 52

They reduce IgE, IL-5, or IL4/13 antibodies

Question 53

When does bronchspams occur in people with asthma who take aspirin?

Answer 53

1-3 hours after dose

Question 54

When should you expect the asthma aspirin nasal polyp triad?

Answer 54

History of asthma after ASA or other COX -1, chronic nasal congestion, nasal polyps, CT shoes pacification of sinus cavities, and rapid onset of severe asthma with no apparent trigger

Question 55

What is the “not preferred” alternative med used in mild to moderate asthma?

Answer 55

Theophyline - but it is low cost

Question 56

Can theophyline be given safely to pregnant patients?

Answer 56

No it is category C

Question 57

What is the methylxanthine drug called?

Answer 57

Theophylline

Question 58

What substances released from mast cells, eosinophils, and basophils can cause airway smooth muscle contraction

Answer 58

Leukotrienes